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Journal Article

The cytologic diagnosis of transitional cell tumors of the urinary bladder and its histologic basis. A study of 567 cases of urinary-tract disorder including 170 untreated and 182 irradiated bladder tumors.

01 Mar 1970-Acta Cytologica (Acta Cytol)-Vol. 14, Iss: 3, pp 145-155
About: This article is published in Acta Cytologica.The article was published on 1970-03-01 and is currently open access. It has received 94 citations till now. The article focuses on the topics: Urinary tract disorder & Urinary bladder.
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Journal ArticleDOI
25 Jun 1999-Cancer
TL;DR: The authors examined the clinical and pathologic records in three hospital pathology practice settings—academic, community, and cancer referral settings—to determine the diagnostic yield of urinary cytology under daily clinical conditions.
Abstract: BACKGROUND Most studies of urinary cytology have been research analyses designed to test the method itself, and many claim that the high diagnostic yields in these studies cannot be achieved in daily practice. The authors examined the clinical and pathologic records in three hospital pathology practice settings—academic, community, and cancer referral settings—to determine the diagnostic yield of urinary cytology under daily clinical conditions. METHODS Records of consecutive urinary cytology specimens from 1672 patients reported from the years 1990–1994 were reviewed and correlated with histologic and clinical information. Initial analyses were based on the records themselves, without review of pathologic specimens. Subsequently, a subset of specimens was reviewed to determine reasons for noncorrelations. RESULTS Results confirmed that the diagnostic sensitivity and specificity of urinary cytology for high grade transitional cell neoplasms, as reported in the daily practice of pathology, are very high (79% and >95%, respectively). Disaggregated cells from low grade transitional cell neoplasms usually lack recognizable features of neoplasia, and attempts to classify such lesions cytologically result in low diagnostic yield, with an overall sensitivity of 26%. Of these 1672 patients, 707 had insufficient clinical information for analysis, despite diligent and persistent efforts to acquire it. CONCLUSIONS The diagnostic yield of consultations based on urinary cytology in the daily practice of pathology is high, regardless of whether the practice setting is referral-based or community-based. The available information indicates that in approximately 79% of patients with high grade transitional cell neoplasms, the neoplasms can be detected using urinary cytology. Conversely, a negative result is predictive of no cancer in more than 90% of cases. Sensitivity for detecting low grade urothelial lesions is low; however, most of these are easily detected cystoscopically. The authors' inability to acquire sufficient information to determine diagnostic yield in a large percentage of their cases was disturbing to them. Not only did this deficiency render their analyses incomplete, but lack of easily accessible follow-up and the apparent low priority for quality assurance activities among pathologists in all types of practice settings is likely to significantly reduce the feedback required for pathologists to acquire and maintain expertise in this very difficult area. Cancer (Cancer Cytopathol) 1999;87:118–28. © 1999 American Cancer Society.

244 citations

Journal ArticleDOI
C. O'Toole1, Peter Perlmann1, B. Unsgaard1, G. Moberger1, F. Edsmyr1 
TL;DR: Maintenance of lymphocyte cytotoxicity, as measured in this system, appears to require the presence of either viable tumour or tumour‐derived material, which is inhibited however by large viable tumours and also metastases.
Abstract: As tested in vitro in a microcytotoxicity assay, purified peripheral blood lymphocytes from patients with carcinoma of the urinary bladder have a specific destructive effect on primary cultures of autologous and allogeneic tumour target cells, as well as on bladder carcinoma cell lines. No specific effect is observed on cells derived from normal tissues or tumour cells of other histogenic origin. Serial tests made on individual patients have shown that the incidence of lymphocyte cytotoxicity varies with the clinical staging of the disease. While 88% of patients with localized tumours, stage T1-T2, have a response before treatment, the corresponding figure for those with T3-T4 stage tumours is 41%. Local radiotherapy in tumour doses of 3,500–8,400 R either destroyed or diminished existing cytotoxicity. The response remained depressed as long as irradiation was continuous. After therapy all patients with T2 stage tumour redeveloped a response, usually within 7 days. While 80% of T3 patients had cytotoxicity at this time, the incidence in T4 cases was 50%. In some T3 and T4 patients no response redeveloped after radiotherapy or conversely a response was induced by the treatment. Patients lacking cytotoxicity after therapy invariably had distant metastases and/or large residual tumours detected within 3 months. Weak post-therapy cytotoxicity was usually accompanied by development of recurrent tumour or distant metastases during a 9-month observation period; this was not seen in patients whose post-irradiation cytotoxicity was strong during this time. In the absence of viable tumour the post-irradiation response seems to wane with time. Evidence for this comes from patients tested 1-10 years after radiotherapy. Here the presence of cytotoxic lymphocytes was usually associated with viable tumour. The majority of patients clinically tumour free had no response. Maintenance of lymphocyte cytotoxicity, as measured in this system, therefore appears to require the presence of either viable tumour or tumour-derived material. This cytotoxicity is inhibited however by large viable tumours and also metastases. Immunite cellulaire envers L'epithelioma vesical humain. I. correlation avec le stade clinique et la radiotherapie Un test de microcytotoxicite in vitro a montre que les lymphocytes purifies du sang peripherique de malades atteints d'epithelioma vesical ont un effet destructeur specifique sur les cultures primitives de cellules-cibles de tumeurs autologues et allogeneiques, ainsi que sur les lignees cellulaires d'epithelioma vesical. Aucun effet specifique n'a ete observe sur des cellules provenant de tissus normaux ou de tumeurs d'autre origine histogene. Une serie de tests effectues sur chaque malade a montre que l'incidence de la cytotoxicite lymphocytaire varie selon le stade clinique de la maladie. Alors que 88% des malades porteurs de tumeurs localisees aux stades T1-T2 reagissent avant le traitement, le pourcentage correspondant pour les malades atteints de tumeurs aux stades T3-T4 est de 41%. La radiotherapie locale en doses de 3,500 a 8,400 rad a detruit ou attenue la cytotoxicite existante. La reponse est restee faible tant que la radiotherapie a ete continue. Apres le traitement, tous les malades porteurs de tumeurs au stade T2 ont developpe une nouvelle reponse, en general dans les 7 jours qui ont suivi. Alors qu'a ce moment on observait une cytotoxicite chez 80% des malades au stade T3, l'incidence etait de 50% au stade T4. Dans quelques cas T3 ou T4, aucune reponse n'est reapparue apres la radiotherapie ou bien, au contraire, le traitement a provoque une reponse. Les malades ne presentant aucune cytotoxicite apres le traitement avaient invariablement des metastases distantes et/ou de grosses tumeurs residuelles dans les 3 mois qui suivaient. Une faible cytotoxicite post-therapie s'est generalement accompagnee du developpement de tumeurs recurrentes ou de metastases distantes au cours d'une periode d'observation de 9 mois, contrairement a ce que l'on a constate chez les malades presentant une forte cytotoxicite post-irradiation pendant cette periode. En l'absence de tumeur viable, la reponse post-irradiation semble disparaǐtre avec le temps. La preuve en est apportee par les malades examines 2 a 10 ans apres la radiotherapie. Dans ces cas, la presence de lymphocytes cytotoxiques etait generalement associee a une tumeur viable. La majorite des malades qui, d'apres l'examen clinique, n'avaient plus de tumeurs, ne reagissaient pas. D'apres ces observations, la persistance de la cytotoxicite lymphocytaire semble donc exiger la presence d'une tumeur viable ou d'elements d'origine tumorale. Cette cytotoxicite est cependant inhibee par de grosses tumeurs viables ainsi que par des metastases.

223 citations

Journal ArticleDOI
TL;DR: Both patients with cancer had positive cytology findings and hematuria, suggesting that routine bladder biopsy in the asymptomatic patient may not be warranted and the high risk of malignancy in these patients is yet another compelling reason to minimize the use of long-term indwelling catheters.

192 citations

Journal ArticleDOI
TL;DR: This study supports the contention that transitional cell carcinoma of the bladder is a less aggressive disease in patients who are in the first 2 decades of life than in older patients.

117 citations

Journal ArticleDOI
TL;DR: The extrinsic and intrinsic factors which influence the interpretation of cytologic findings are explained and attempts are being made to improve the efficacy of urine cytology in the detection of neoplasms of the urinary tract.

116 citations