title: Cytologic persistence of malignant cells after transurethral resection of bladder tumors: Implications for concomitant manipulation of the urinary tract at the time of endoscopic resection.
abstract: BACKGROUND
  The current study was conducted to determine the feasibility of cytologically clearing the bladder of tumor cells after transurethral resection of bladder tumor (TURBT) and aggressive serial bladder washing.
  
  
  METHODS
  A prospective pilot sample of 20 patients with known bladder masses was enrolled before undergoing TURBT. Preoperative cytology and 4 postoperative cytology specimens were assessed for malignant cells between serial bladder washes. Surgeons assessed tumor grade visually at the time of TURBT.
  
  
  RESULTS
  Surgeons were able to differentiate high-grade disease with limited accuracy (75% sensitivity, 92% specificity, 85% negative predictive value, and 86% positive predictive value). For patients with low-grade disease (12 patients), cytology was atypical in 25% of patients immediately before TURBT and was negative after serial washings in all patients. In patients with high-grade disease (8 patients), approximately 75% had cytology consistent with high-grade urothelial carcinoma immediately before TURBT and only 1 patient was cleared cytologically after serial bladder washings.
  
  
  CONCLUSIONS
  In patients with high-grade disease, serial bladder washing after TURBT does not appear to clear malignant cells as detected by cytology. This theoretical oncologic risk should be weighed when considering concomitant upper tract procedures such as retrograde pyelography. Future work is needed to quantify risk. Cancer Cytopathol 2017;125:114-119. © 2016 American Cancer Society.
authors: Section of Urology, Virginia Mason Medical Center, Seattle, Washington.|Department of Urology, University of Washington School of Medicine, Seattle, Washington.
authors: Liam C
authors: http://orcid.org/0000-0003-1163-6621
authors: LC
authors: Macleod
authors: Section of Urology, Virginia Mason Medical Center, Seattle, Washington.
authors: Khanh N
authors: KN
authors: Pham
authors: Section of Urology, Virginia Mason Medical Center, Seattle, Washington.
authors: S Nicholas
authors: SN
authors: Agoff
authors: Section of Urology, Virginia Mason Medical Center, Seattle, Washington.
authors: Kathryn L
authors: KL
authors: Dahl
authors: Section of Urology, Virginia Mason Medical Center, Seattle, Washington.
authors: Thomas R
authors: TR
authors: Pritchett
authors: Section of Urology, Virginia Mason Medical Center, Seattle, Washington.
authors: John M
authors: JM
authors: Corman
mesh_terms: D000368:Aged; D003581:Cytodiagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014551:Urinary Tract / Q000473:pathology / Q000601:surgery*; D014567:Urography
keywords: bladder cancer; cytology; transurethral resection of bladder tumor (TURBT); urothelial cancer