Cytopathologic Diagnosis of Bladder Cancer in Urine and Bladder Washings
The cytopathologic examination of urine and bladder washings is a simple method for the detection of primary bladder cancer in symptomatic patients or in patients with hematuria. This method is very useful for follow-up of patients after treatment in order to detect recurrence of bladder cancer, which occurs in a significant percentage of patients. Cytopathologic examination is very reliable for the diagnosis of high grade urothelial carcinoma, but it is less useful for the detection of low grade urothelial neoplasms. Cells with obvious morphological signs of malignancy can be reliably recognised as such also in the case of intraepithelial urothelial carcinoma. However, as isolated malignant cells are involved, they cannot be reliably assessed concerning their invasive potential. The proper handling and transport of urine or bladder washings, as well as standardised procedures in the cytopathology laboratory, are very important to achieve the best possible results of cytopathologic examination. In the last decade, several new methods have also emerged in attempt to improve the cytopathologic examination of bladder cancer in doubtful cases. Among these, the UroVysion test is the most promising one. By using the method of fluorescent in situ hybridisation, this test can detect several cytogenetic changes characteristic of bladder cancer of various grades.