Urinary cytodiagnosis: can it have a different prognostic implication than a diagnostic test?

In order to assess the clinical implications of the cytology of voided urine we analyzed 65 patients among 147 cases of transitional cell carcinoma (TCC) in relation to the cytohistologic correlation and prognostic significance. Urinary cytology detected 42.6% of bladder tumors, 59% of renal pelvic tumors, and 35.3% of ureteral carcinomas. None of the 3 cases of grade-1 upper urinary tract tumors was detected by preoperative urinary cytology. Tumors with positive cytology were associated with epidermal growth factor receptor expression (p = 0.0009) and a higher fraction of tumor proliferation as defined by Ki-67 immunohistochemistry (p = 0.0038). Anaplastic tumor cells in urine correlated fairly well with muscular invasion (p = 0.018) and the DNA aneuploidy of the tumor (p = 0.0038). Tumors with muscular invasion were more likely to be detected by cytologic examination (p = 0.013). In urinary bladder carcinoma (n = 107), patients with positive cytology had a higher incidence of tumor recurrence (p = 0.004), and had an unfavorable prognosis (p = 0.0001) with a median follow-up of 46 months. In Ta-T1 tumors (n = 87), urinary cytology had prognostic value in terms of risk of recurrence (p = 0.0001), and poor patient outcome (p = 0.0001). Our data suggest that urinary cytology can offer important biological information on TCC and may be used as a simple and effective short-term prognostic indicator.