The Role of Cytologic Analysis in Follow-Up of Non-Muscle Invasive Urothelial Cell Carcinoma in Relation to Cystoscopic Biopsy

Background: Bladder urothelial carcinoma has high recurrence rate so patients with bladder urothelial carcinoma have to be monitored thoroughly for disease recurrence, this makes bladder cancer one of the most expensive cancer types for the health care system. Voided urine cytology is the most commonly used noninvasive follow-up diagnostic tool. The purpose of this study was to assess the role of voided urine cytology for the follow-up of patients with non-muscle invasive urothelial carcinoma (NMIUC). Materials and methods: In total, 200 patients were enrolled in this study. Both urine cytology and cystoscopy were done for each patient every three months and end-point of the surveillance was at 9 months after the first collection of urine and first cystoscopy done. In each time we correlate the findings of urine cytology and cystoscopy. Results: The sensitivity of voided urine cytology was low while the specificity of voided urine cytology was high after their estimation every three months for nine months. The positive predictive value of voided urine cytology was 0.867, while the negative predictive value was 0.919 at the end point of surveillance. None of the 180 patients with negative results of both cytology and cystoscopy developed recurrence for 6 months after initial diagnosis. Conclusion: Cytology has higher specificity than sensitivity especially for high grade urothelial carcinoma and high predictive value but it still was not sufficiently good to be a substitute for cystoscopy. However, follow-up cystoscopy may be temporarily postponed for a period of 6 month if urine cytology is negative.