Korean J Urol.  2009 Feb;50(2):125-129.

The Significance of Persistent Abnormal Urine Cytology

• Park SW
• Chang IH
• Han JH
• Kawk KW
• Ahn SH

Abstract

PURPOSE
We investigated the factors that predicted later transitional cell carcinoma (TCC) in a subgroup of patients with abnormal cytology and negative initial evaluations.
MATERIALS AND METHODS
From January 2002 to June 2007, we retrospectively identified 58 patients. Cases were considered discordant if a work-up of urine cytology was abnormal although initial cystoscopy, upper tract evaluation, and biopsies resulted in a negative or benign diagnosis. Patients who could complete a urine cytology test after 6 to 8 weeks and who were followed up for at least 1 year were included in this study. According to later TCC demonstration, we compared risk factors for TCC between the later TCC group and the benign group and evaluated the independent factors that predicted later TCC by use of a Cox proportional hazards regression model.
RESULTS
Of the 58 patients, the mean follow-up was 12.7+/-17.3 months (range: 2-83 months), and 14 patients (23.7%) had a prior history of TCC. During follow-up, 9 patients (15.3%) had TCC and 1 patient had prostate cancer. In the later TCC group, the incidence of a prior history of TCC (p=0.03) and persistent abnormal cytology (p<0.001) were higher than in the benign group in univariate analysis. In the Cox proportional hazards regression model, persistent abnormal cytology (p=0.033, relative risk (RR): 17.380 [95% CI: 1.265-238.783]) was the only independent factor to predict later TCC. The mean follow-up duration of later TCC demonstration was 8.55 months (range: 2-32 months).
CONCLUSIONS
Our results suggest that in the setting of persistent abnormal urine cytology with a negative initial evaluation, 53.3% of patients will later develop TCC. Patients with persistent abnormal cytology need intensive follow-up within 1 year.

Keyword

Urine; Cytology; Bladder; Carcinoma, transitional cell

MeSH Terms

Biopsy
Carcinoma, Transitional Cell
Cystoscopy
Follow-Up Studies
Humans
Incidence
Prostatic Neoplasms
Retrospective Studies
Risk Factors
Urinary Bladder

Figure

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  Fig. 1 Flow diagram of the study design and results of abnormal urinary cytology-later transitional cell carcinoma demonstration for 205 patients. There were 58 patients with abnormal urinary cytology and a negative initial evaluation for malignancy, and transitional cell carcinoma was diagnosed in 9 of these patients on further investigation as a result of persistent abnormal cytology or abnormal cytology at the time of the second investigation. TCC: transitional cell carcinoma.

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  Fig. 2 Kaplan-Meier curves for disease-free survival according to the absence or presence of persistent abnormal urine cytology. The patients with persistent abnormal urine cytology (n=15) had lower disease-free survival than did the patients with normal urine cytology at follow-up (n=43, p<0.001).

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