PROGNOSTIC VALUE OF CYTOLOGICAL INVESTIGATIONS OF URINE SEDIMENT IN PATIENTS WITH BLADDER CANCER

THE AIM of the investigation was to study the prognostic value of a cytological investigation of urine sediment in patients with superficial cancer of the bladder. PATIENTS AND METHODS. Materials of 76 patients were analyzed after transurethral resection for cancer of the bladder. The ratio of men and women was 4:1, mean (±SD) age was 65±10 years. A histological investigation of the tumor tissue has shown that the depth of invasion of cancer Tis, Ta, T1, T2 and T4 was found in 2 (3%), 11 (16%), 37 (53%),19 (27%) and 1 (2%) patients respectively, the degree of differentiation G1, G2, and G3 – in 35 (50%), 19 (27%) and 16 (23%) patients respectively. A single cytological investigation of the sediment of the diurnal portion of spontaneous urination was carried onafter centrifugation at 1000 r during 4 min. The preparations were dried in the air and stained with azure[1]eosin by the method of Leischman. The cellular composition and cytological signs of malignization were assessed in the light binocular microscope with magnification 100×and 1000×according to cytological criteria of L.G. Koss classification. The cancer stage was determined in a histological investigation of the ablated tumor tissue according to TNM classification, the degree of differentiation of the tumor cells being estimated according to recommendations of F. Mostofi et al. RESULTS. The cytological investigation of the urine sediment has confirmed the clinical diagnosis of bladder cancer in 61 (80%) patients, 54 (89%) patients were found to have transitional cell carcinoma. The sensitivity of the cytological investigation in detection of bladder cancer of degrees G1, G2 and G3 was 74%, 93% and 94% respectively, with depth of invasion Tis, Ta,T1, T2 and T4 proved to be equal to 50%, 71%, 83%, 92% and 100% respectively. Differences of determination of category G in the tumor tissue and urine sediment were noted in 19 (58%) patients. Survival of patients with bladder cancer in the postoperative period of follow[1]up, recurrences of cancer and durationof periods without recurrences were closely connected with the degree of differentiation of the tumor cells (t=2.55; p=0.013, t=2.00; p=0.028 and r= 0.38; p=0.039 respectively). CONCLUSION. The cytological investigations in most cases gave information of histological characteristics and degree of anaplasia of carcinoma and made it possible to determine as early as at the preoperative period the belonging of patients to a group of high risk of recurrence and progression of cancer.

1. Аль-Шукри СХ, Ткачук ВН. Опухоли мочеполовых органов. Питер, СПб, 2000; 103-104

2. Петрова АС. Цитологическая диагностика опухолей и предопухолевых процессов. Медицина, М., 1985; 119-126

3. Roy JY, Staerkel GA, Ayala AG. Cytologic and histologic features of superficial bladder cancer. Urol Clin North Am 1992; 19: 435-453

4. Koss LG. Diagnostic Cytology of the Urinary Tract with histopathologic and clinical correlations. Philadelphia, New York., 1996; 3-385

5. Mostofi FK, Sobin LH, Torloni H. Histological typing of urinary bladder tumours. World Health Organisation., Geneva, 1973; 3-118

6. Матвеев БП.Клиническая онкоурология. Вердана, M., 2003; 219-226

7. Saad A, Hanbury DC, McNicholas A et al. The early detection and diagnosis of bladder cancer: a critical review of the options. Urol 2001; 39: 600-633

8. Brown FM. Urine cytology. Is it still the gold standard for screening? Urol Clin North Am 2000; 27: 25-37