Urinary cytology and quantitative BTA and UBC tests in surveillance of patients with pTapT1 bladder urothelial carcinoma.

OBJECTIVES: To compare results of urinary cytology, quantitative detection of human complement factor H-related protein (BTA TRAK), and urinary fragments of cytokeratins 8 and 18 (UBC IRMA) with the recurrence status in patients with pTapT1 bladder cancer and to define the possible role of these methods in a surveillance protocol. METHODS: We collected urine from 88 consecutive patients with primary pTapT1 tumors before the first transurethral resection (TURB) and before each follow-up cystoscopy. In all samples urinary cytology and quantitative BTA and UBC tests were performed. We compared results with recurrence status and with tumor characteristics in the case of recurrence. We constructed receiver operator characteristic (ROC) curves for quantitative methods. In addition, we evaluated individual cutoffs based on pretreatment levels. RESULTS: During the mean follow-up of 16.96 months, we performed 313 cystoscopies, 93 of which were positive in 51 patients. The sensitivity and specificity of cytology, BTA, and UBC were 19.8% and 99%, 53.8% and 83.9%, and 12.1% and 97.2%, respectively. The sensitivity of pTis detection was 66.6%, 0%, and 100%, respectively. With cutoffs set to a sensitivity of 90%, the specificity of BTA and UBC dropped to 24.8% and 20.4%, respectively. Individually calculated cutoffs did not provide a significant benefit. CONCLUSIONS: Because of high specificity and sensitivity in pTis detection, urinary cytology fulfills requirements for an adjunctive method to cystoscopy. Quantitative BTA and UBC tests have a low sensitivity in the detection of bladder cancer recurrence and cannot be used routinely to reduce the number of cystoscopies during follow-up.

Qualitative and quantitative detection of urinary human complement factor H-related protein (BTA stat and BTA TRAK) and fragments of cytokeratins 8, 18 (UBC rapid and UBC IRMA) as markers for transitional cell carcinoma of the bladder.

OBJECTIVE: To evaluate the role of BTA stat, BTA TRAK, UBC Rapid, UBC IRMA and voided urinary cytology in the detection of bladder transitional cell carcinoma (TCC). METHODS: The study included 78 patients with TCC of the bladder (group A), 62 patients with a history of bladder TCC without tumor recurrence at the time of examination (B, control group), 20 patients with other malignancy of the urinary tract (C), 38 patients with non-malignant urinary tract diseases (D), 10 patients with urinary tract infection (E) and 10 healthy volunteers (F). Except in group F, voided urine was collected before cystoscopy or cystectomy. RESULTS: The specificity and sensitivity in bladder cancer detection were 87.1 and 74.4%, respectively with BTA stat, 79.3 and 48.7%, respectively with UBC Rapid, 100 and 33.3%, respectively with cytology, 72.6 and 75.6%, respectively with BTA TRAK, 64.5 and 70.5%, respectively with UBC IRMA. CONCLUSIONS: The BTA stat and BTATRAK tests are superior to UBC Rapid, UBC IRMA and urinary cytology in detection of bladder TCC. In daily practice however cytology remains the best adjunct to cystoscopy because of its high sensitivity in Tis and 100% specificity. Cystoscopy cannot be replaced by any of evaluated methods.

Postoperative cytology in relation to recurrences of superficial bladder tumours.

TNM classification allows only a partial estimation of future tumour behaviour after surgery. More knowledge on malignant potential is needed. Spreading of viable tumour cells during transurethral resection (TUR) and their possible subsequent implantation in the bladder mucosa should be an important factor influencing duration of the tumour-free interval (TFI). A total of 1384 fresh urine samples sequentially taken after surgery from 356 patients were examined in a cytological laboratory. Data analysis confirmed significant differences in TFI between the groups with negative, suspicious and positive cytology. The higher the cytological abnormalities the shorter was TFI, regardless of which histopathological tumour grade has been verified.

Blood group antigens in epithelial tumours of the urinary bladder.

The occurrence of blood isoantigens, demonstrated using an immunofluorescence technique in urothelial tumours of 40 blood group A, B, or AB patients who had been treated and followed up during the years 1977-1983, has been compared with their histological grading and clinical course. In both of the 2 papillomas and 35 grade I papillocarcinomas, a positive expression of the relevant isoantigens could be demonstrated, while all of the 19 grade III papillocarcinomas just as the 22 anaplastic carcinomas always proved negative. In a group of 34 grade II papillocarcinomas, 21 of the tumours proved positive and 13 negative; with all tumours showing signs of invasiveness being always negative. Correlation of these results with the clinical courses of the disease did not exhibit such unequivocal results, even though, in a group of 7 patients who had died of a generalized urothelial carcinoma verified by post-mortem, all of the 19 examinations that have been performed proved, with the exception of one, to be negative. These results confirm the fact that identification of blood isoantigens may help to reach a more accurate prediction of the biological behaviour and prognosis of urothelial carcinomas, especially, among grade II papillocarcinomas since loss of the antigen expression appears to be related to the tumour's capacity of invading the mucous stroma.