Diagnostic accuracy of preoperative urinary smear test in patients with bladder urothelial carcinoma in a high-volume center.

OBJECTIVES: To determine diagnostic accuracy of urinary cytology (smear test) in patients with preoperative diagnosis of urothelial bladder carcinoma. METHODS: Clinical records of the patients with urotelial bladder carcinoma at the Instituto Nacional de Cancerología (Bogotá D.C.,Colombia) from January 2006 to November 2010 were reviewed. Demographic data, pathological reports of preoperative cytology and definitive surgery, tumor classification and time between sample taking for cytology and final pathology were extracted. Descriptive statistics and graphs for continuous and categorical variables were performed. RESULTS: We included 52 patients, 20 underwent cystectomy and 32 transurethral resection of the bladder tumor (TURB). 41 were male. Mean age was 66.6 ± 10.7 years. 151 smears were obtained before surgery, with a median of 3 smears performed per patient at 2.5 ± 1.8 months before definitive surgery. 107 were negative, 14 low grade positive and 30 high grade positive. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 30.7%, 90.9%, 97.7%, 9.34%, 3.37 and 0.76 respectively. When the high-grade cytology was compared with the high-grade definitive report some characteristics increased (Sensitivity 47.4%, Specificity: 97.8%, Positive Likelihood Ratio: 21.8) and also when compared with muscle invasion (Sensitivity: 73.9, Positive Likelihood Ratio: 7.27 ). CONCLUSION: Preoperative cytology has sensitivity and specificity similar to those described in other clinical settings. Also noteworthy is that one high-grade preoperative cytology has a high positive likelihood ratio for high-grade tumor and invasive tumor (≥T2).

Validez diagnóstica de la citología urinaria preoperatoria en pacientes con carcinoma urotelial de vejiga en el Instituto Nacional de Cancerología, Colombia / Diagnostic validity of preoperative urine cytology in patients with bladder urothelial carcinoma in the "Instituto Nacional de Cancerologia" Colombia

OBJETIVO: Determinar la validez diagnóstica de la citología urinaria preoperatoria en los pacientes con diagnóstico de carcinoma urotelial de vejiga. MÉTODOS: Se revisaron los registros de los pacientes con diagnóstico de carcinoma urotelial de vejiga en la base de datos del Instituto Nacional de Cancerología (Bogotá D.C., Colombia) desde enero de 2006 hasta noviembre de 2010. Se extrajeron datos demográficos, reportes histopatológicos de las citologías preoperatorias y de la pieza quirúrgica definitiva, clasificación del tumor y tiempo transcurrido entre la toma de la muestra para la citología y la patología definitiva. Se utilizó estadística descriptiva y gráficos acordes para las variables continuas y categóricas. RESULTADOS: Se incluyeron 52 pacientes, 20 llevados a cistectomía y 32 a resección transuretral (RTU). 41 fueron masculinos. El promedio de edad fue 66,6 ± 10,7 años. Se obtuvieron 151 citologías preoperatorias, con una mediana de 3 citologías por paciente realizadas 2,5 ± 1,8 meses antes de la cirugía definitiva. 107 fueron negativas, 14 positivas de bajo grado y 30 positivas de alto grado. La sensibilidad, especificidad, valor predictivo positivo y negativo, razón de probabilidad positiva y negativa (LR + y LR -, de su descripción en inglés) generales fueron respectivamente: 30,7%, 90,9%, 97,7%, 9,34%, 3,37 y 0,76. Cuando se comparó la citología de alto grado con el reporte definitivo de alto grado algunas características aumentaron (sensibilidad: 47,4%; especificidad: 97,8%; LR+: 21,8) así como cuando se comparó la citología de alto grado con el reporte definitivo con invasión muscular (sensibilidad: 73,9; LR+: 7,27). CONCLUSIÓN: La citología urinaria preoperatoria presenta sensibilidad y especificidad similares a las descritas en otros contextos clínicos. Además se destaca que una citología urinaria preoperatoria positiva de alto grado tiene una razón de probabilidad muy elevada para diagnóstico de tumor invasivo (>=T2) o de alto grado

OBJECTIVES: To determine diagnostic accuracy of urinary cytology (smear test) in patients with preoperative diagnosis of urothelial bladder carcinoma. METHODS: Clinical records of the patients with urotelial bladder carcinoma at the Instituto Nacional de Cancerología (Bogotá D.C., Colombia) from January 2006 to November 2010 were reviewed. Demographic data, pathological reports of preoperative cytology and definitive surgery, tumor classification and time between sample taking for cytology and final pathology were extracted. Descriptive statistics and graphs for continuous and categorical variables were performed. RESULTS: We included 52 patients, 20 underwent cystectomy and 32 transurethral resection of the bladder tumor (TURB). 41 were male. Mean age was 66.6 ± 10.7 years. 151 smears were obtained before surgery, with a median of 3 smears performed per patient at 2.5 ± 1.8 months before definitive surgery. 107 were negative, 14 low grade positive and 30 high grade positive. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 30.7%, 90.9%, 97.7%, 9.34%, 3.37 and 0.76 respectively. When the high-grade cytology was compared with the high-grade definitive report some characteristics increased (Sensitivity 47.4%, Specificity: 97.8%, Positive Likelihood Ratio: 21.8) and also when compared with muscle invasion (Sensitivity: 73.9, Positive Likelihood Ratio: 7.27). CONCLUSION: Preoperative cytology has sensitivity and specificity similar to those described in other clinical settings. Also noteworthy is that one high-grade preoperative cytology has a high positive likelihood ratio for high-grade tumor and invasive tumor (≥T2)