Korean J Urol.  2014 Oct;55(10):650-655. 10.4111/kju.2014.55.10.650.

Usefulness of Urine Cytology as a Routine Work-up in the Detection of Recurrence in Patients With Prior Non-Muscle-Invasive Bladder Cancer: Practicality and Cost-Effectiveness

• Ok BG
• Ji YS
• Ko YH
• Song PH

• KMID: 2069787
• DOI: http://doi.org/10.4111/kju.2014.55.10.650

Abstract

PURPOSE
To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness.
MATERIALS AND METHODS
We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected.
RESULTS
Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041).
CONCLUSIONS
Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.

Keyword

Cytology; Urinary bladder neoplasms; Urine

MeSH Terms

Aged
Aged, 80 and over
Cost-Benefit Analysis
Cystoscopy/economics
Cytodiagnosis/economics/methods
Female
Health Care Costs/*statistics & numerical data
Humans
Male
Middle Aged
Neoplasm Recurrence, Local/*diagnosis/economics/pathology
Neoplasm Staging
Republic of Korea
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed/economics
Urinalysis/economics/methods
Urinary Bladder Neoplasms/*diagnosis/economics/pathology/surgery
Urine/*cytology

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