Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 3
Bladder washing cytology: Usability during follow-up after intravesical mitomycin-C for noninvasive urothelial cancer
- Pages
- 335–341
- DOI
- —
Abstract
Introduction: Cytoscopic evaluation alone is inadequate in detecting residual tumor after intravesical therapy. Intravesical experimental evidence indicates that mitomycin C cause denudation and flattening of the noninvasive ürothelial tumors, often leaving tumor which may not be visible on endoscopic examination. Cytology has limited value for low grade tumors because of the toxic and metabolic effects of the intravesical chemotherapatic agents on the urothelial epithelium. Aim of this study is to review our experience regarding the value of urine cytology on follow up after intravesical mitomycin C therapy for noninvasive urothelial cancer in addition to observe any potential therapy induced-influence of mitomycin C. Materials and Methods: Study group consisted of 31 patients, after exclusion of 3 patients, 28 patients were given courses of intravesical mitomycin C for recurrent or newly diagnosed noninvasive urothelial carcinoma of the bladder. All of the 28 patients were underwent cytoscopy, bladder washings and TUR before and 4 weeks after therapy. Cytospin slides were stained with May Grünwald Giemsa. Four cyto-diagnostic categories were applied: nondiagnostic, benign, suspicous and malignant. Besides, cellular parameters such as background, cellularity, nuclear& cytoplasmic features were evaluated. In histopathologic evaluation, cases were graded according to 2004 WHO classification. Results: Of the 28 patients treated, 13 had complete responses while 10 had partial responses and 5 were nonresponders. Distribution of diagnosis in study population was as follows: 13 cases benign; 9 cases malignant; 6 cases suspicious. Although in majority of cases, cytological features depending on -obviously- metabolic and toxic effects of MMC were observed; six cases were diagnosed as suspicious since nuclear hyperchromasia and nucleomegaly were conspicious. In complete response group; sensitivity, specificity and accuracy rates for urothelial carcinomas were 66.6%, 55.5%, 58,3%, respectively; in low grade tumors and 100%, 100%, 100% for high grade tumors respectively. Among the tumors with partial response, low grade tumors displayed 100%, 83.3%, 85.7% and high grade ones had 100%, 100%, 100% sensitivity, specificity and accuracy rates, respectively. Conclusion: Our data suggest that cytologic evaluation was an accurate predictor of residual tumor or new tumor occurrence for patients with initial high grade ürothelial tumors. However, it reflects a reduced sensitivity of urinary cytology in low grade category due to the overlapping of cytopathic and/or real malignant cellular changes. In other words for low grade category, positive urine cytologic data, in the absence of endoscopically detectable tumor, can be assumed to represent either residual cancer or cytopathic effects of the Mitomycin-C therapy. Team cooperation between the urologist and (cyto) pathologist is crucial for follow up after treatment of urothelial carcinomas.
Özet
Mesane içi tedavi sonrası rezidüel tümörü saptamada sistoskopi yanı sıra mesane yıkama sitolojisi uygulanmaktadır; ancak kemoterapinin ürotelyumdaki etkilerine bağlı morfolojik değişikliklerle düşük-derecelitümörlerin hücresel değişikliklerinin ayırımındaki güçlük, sitolojinin kullanımını kısıtlamaktadır. Çalışmada, mitomisin C'nin sitopatik etkilerini ve invaziv olmayan-ürotelyal kanserlerin tedavi sonrası izleminde mesane yıkama sitolojisinin kullanılabilirliğini araştırdık. Mitomisin C tedavisi 28 olguya uygulandı. Tedavi öncesi ve tedaviden 4 hafta sonra sistoskopi, mesane yıkama sitolojisi, TUR yapıldı. Olgular, kontrol sistoskopilerindeki tümör boyutu ve mesane yıkama sitolojisi verilerine göre 'tam, kısmi ve yetersiz cevap gösterenler' olarak gruplandırıldı. Sitomorfolojik tanı kategorileri: nondiyagnostik, benin, kuşkulu, malin olarak belirlendi. Kemoterapinin etkileri yönünden hücresellikle nükleer ve sitoplazmik özellikler incelendi. TUR materyalleri DSÖ'ye göre derecelendirildi. Tedavi sonrası 13 olguda tam, 10'unda kısmi, 5'inde yetersiz cevap alındı. Mesane yıkama sitolojisinin duyarlılık, özgüllük, tanı doğruluğu oranları; tam cevap alınan düşük dereceli tümörlerde %66.6, %55.5, %58.3; yüksek derecelilerde %100, %100, %100'dür. Bu oranlar, kısmi cevap alınan düşük derecelilerde %100, %83.3, %85.7; yüksek derecelilerde %100, %100, %100'dür. Yüksek dereceli-invaziv olmayan ürotelyal kanserlerde mesane içi kemoterapi sonrası rezidü tümörün veya nüks gelişiminin saptanmasında sitoloji güvenle kullanılabilir. Düşük-dereceli-tümörlerde ise sistoskopi normalken saptanan pozitif idrar sitolojisi, rezidüel kansere veya mitomisin C'nin sitopatik etkisine bağlı olabilir. Mesane içi tedavi uygulanmış ürotelyal kanserlerin izleminde ürolog ile (sito) patolog arasında ekip çalışmasına gereksinim vardır.