Quant1cyt: Karyometric Analysis of Bladder Washing for Patients with Superficial Bladder Cancer

Objectives. Quantitative cytology by image-analysis techniques enables objective interpretation of nuclear features in light microscopic images. QUANTICVT, a quantitative karyometric cytology system, was used in the follow-up of patients with superficial bladder cancer. Methods. From 1992 to 1995, 41 37 samples from 1412 patients were obtained. At 1 -year follow-up after the initial bladder washing, a tumor recurrence rate of 21% was found. In this period, tumor progression to invasive disease occurred in 1.6% of patients. Scoring of tumor by the QUANTICYT system was based on two nuclear features: the 2c deviation index and the mean of a nuclear shape feature: MPASS. Results. The method was found to be reproducible and superior to visual cytologic interpretation. QUAN­ TICYT analysis of the bladder washings resulted in a score of low, intermediate, and high risk. In a multivariate analysis, highest grade of earlier tumor and QUANTICYT risk score were the best predictors of tumor recur­ rence and progression. For the easy application of QUANTICYT analysis in daily routine, a report form that included patient history and DNA histogram was developed. Conclusions. QUANTICYT karyometric analysis of bladder-wash material proved a useful, clinically applicable grading tool in the follow-up of patients with superficial bladder cancer, with sufficient power to be used in decision-making in the individual patient. UROLOGY 48: 357-364, 1996. I n approximately 66% to 80% of patients with bladder cancer, the disease starts as a super­ ficial (tha t is, noninvasive) lesion in the blad­ der m ucosa.1,2 These so-called Ta and T1 tu­ mors show a tendency to recur in 30% to 60% of patients during follow-up after treatment of the primary tumor.2“4 Moreover, 15% of pa­ tients finally suffer invasive, often lethal, forms of bladder cancer.5 In recent years, clinical markers for the pre­ diction of prognosis have been studied.2,3 Mul­ tiple and early recurrent cancers showed a high tendency to progress to invasive disease.3 Kurth et a l 3 presented a table for relative progressionFrom the Department o f Urology, University Hospital, Nijme­ gen, The Netherlands; and Leiden Cytology and Pathology Lab­ oratory , Leiden, The Netherlands Reprint requests: J.A. Schalken, M.D., Department o f Urology, P.O. Box 9101, 6500 HB Nijmegen , The Netherlands Submitted: April 17,1996, accepted (with revisions): May 14,