Background: We evaluated the diagnostic accuracy of urinary cytology (UCy) for detecting recurrence in the remnant urothelium (RRU) after radical cystectomy (RC) for urothelial cancer.
Patients and methods: We conducted a 10-year retrospective analysis of a prospectively collected, single-center RC database comprising 177 patients who had undergone follow-up examinations at our department with ≥ 1 available postoperative UCy specimen. UCy specimens were classified using the Papanicolaou scheme.
Results: In total, 957 cytology specimens were collected. Negative UCy results were noted in 927 (96.8%), atypical urothelial cells in 19 (2.0%), and suspicious/positive for malignancy in 11 (1.2%) cases. RRU was diagnosed in 16 patients (9.1%) during a mean follow-up period of 37 months (range, 1-118 months). The mean interval from RC to RRU was 34.7 months. Only 2 of 11 positive UCy specimens (18.2%) were falsely positive, for an overall sensitivity and specificity of 56.3% and 98.8% for predicting RRU, respectively. Urethral recurrence was diagnosed by UCy alone before the patients had developed symptoms in 8 of 12 cases (66.7%). Patients with clinical symptoms at the diagnosis of RRU had poorer cancer-specific survival rates than those of asymptomatic patients, although this trend was not statistically significant (P = .496). Moreover, positive UCy findings were associated with significantly lower overall survival (P < .001) and cancer-specific survival (P = .04) compared with negative UCy findings.
Conclusion: Our results underline the predictive value of UCy in the surveillance of the remnant urothelium, with early detection of urethral recurrence before the development of clinical symptoms.
Keywords: Bladder cancer; Cytology; Follow-up; Upper urinary tract; Urethral recurrence.
Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.