Voided and washed urine cytology in diagnosis of bladder cancer. Dose it make differences

Objectives: To evaluate the diagnostic value of voided and washed urine cytology in diagnosis of bladder cancer. Methodology: This is a prospective, cross-sectional, descriptive hospital- based study conducted at Gezira Hospital for Renal Diseases and Surgery (GHRDS). Random voided urine samples from 86 patients with suspected bladder cancer were collected before cystoscopy and bladder washing at the time of transurethral resection of bladder tumor (TURBT). Each urine and bladder washing were examined microscopically, and the test is considered positive if cells are malignant or suspicious. Results: The study patients age ranged between 25- 95 years and 62 (72.1%) of the patients were male with a ratio of 2.5:1. According to the histological finding: 90.3% of study cases were having transitional cell carcinoma (TCC); 64.5% were having high grade urothelial cancers (2 or 3), and Khartoum Medical Journal (2017) Vol. 10, No. 03, pp. 1411 - 1418 1412 Introduction: Urine cytology was popularized by George Papanicolaou in the 1940s as a way to detect and follow-up patients with bladder cancer (BC) (1). The current standard of care for the primary detection and follow-up of nonmuscle- invasive bladder cancer (NMIBC) consists of urethro-cystoscopy (UCS), which is invasive and uncomfortable. Cytopathological examination of urine is a routine, non-invasive, diagnostic procedure to detect cancers of the urinary tract. Many urine-based tests have been developed, and in general, these tests have a higher sensitivity than cytology, but a lower specificity. Furthermore, urine cytology enables direct microscopic examination of individual urothelial cells and it has shown clinical cost-efficacy when compared with novel tests such as: bladder tumor antigen (BTA), nuclear matrix protein 22 (NMP22) and fluorescence in-situ hybridization (FISH) (2). The accuracy of urine cytology depends on several factors that are mainly related to: histologic grade of the tumor, the pre-treatment or post-treatment status, the nature of specimen and sampling (3). There are six types of urinary specimens for cytologic analysis, the most common is voided urine. Bladder washing samples are also very frequent samples sent for cyto-pathological examination. A most common sample from the urinary tract is spontaneous-voided urine. In collecting true voided urine, one should avoid the first morning 41.9 were diagnosed as having bladder tumor grade 3. The sensitivity of both voided and washed urine cytology in the study was 93.5%; specificity 100%; and positive predictive value was 100%. More than79% of bladder wash-out specimens had an excellent quality with more cellularity and preservation of cells observed in cytological smears, while only 30.2% of voided urine had an excellent quality. Conclusion: We have demonstrated the superiority of bladder washing over voided urine cytology in terms of excellent quality with more cellularity and preservation of cells in the cytological smears, and recommend its routine use in spite of patient discomfort and the additional cost.