Positive urine cytology but negative white‐light cystoscopy: an indication for fluorescence cystoscopy?

• Published in: BJU international Vol. 103; no. 4; pp. 484 - 487
• Main Authors: Karl, Alexander, Tritschler, Stefan, Stanislaus, Peter, Gratzke, Christian, Tilki, Derya, Strittmatter, Frank, Knüchel, Ruth, Stief, Christian G., Zaak, Dirk
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-02-2009; Wiley-Blackwell
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; bladder cancer; Carcinoma in Situ - diagnosis; Carcinoma in Situ - pathology; Cystoscopy - methods; Cystoscopy - standards; cytology; detection; Female; fluorescence cystoscopy; Humans; Male; Medical sciences; Microscopy, Fluorescence - methods; Middle Aged; Nephrology. Urinary tract diseases; Sensitivity and Specificity; Tumors of the urinary system; Urinary Bladder Neoplasms - diagnosis; Urinary Bladder Neoplasms - pathology; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urine - cytology; Young Adult; Urine; fluorescence cystoscopy; Nephrology; detection; Urinary system disease; White light; Indication; Cytology; Cystoscopy; Fluorescence; Urinary tract disease; Malignant tumor; Bladder cancer; Urology; Bladder disease; Diagnosis; Cancer
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2008.08032.x

OBJECTIVE
To evaluate the possible benefit of fluorescence cystoscopy (FC) in detecting cytologically ‘confirmed’ lesions when assessing urothelial carcinoma of the bladder, as negative white‐light cystoscopy in cases of a positive cytological finding represents a diagnostic dilemma.
PATIENTS AND METHODS
From January 1996 to December 2006, 348 patients, who had cystoscopy for surveillance or due to suspicion of urothelial carcinoma, presented with an entirely negative white‐light cystoscopy at our hospital. However, 77 of the 348 patients (22.2%) were diagnosed with a positive cytological finding. All patients had white‐light cystoscopy first and a bladder‐wash cytological specimen was obtained, then FC, followed by cold‐cup biopsies and/or transurethral resection of the bladder tumour.
RESULTS
In the 77 patients with a positive cytological specimen FC enabled the detection of the precise site of malignancy within the bladder in 63 (82%). As malignant or premalignant lesions, there were 18 moderate dysplasias, 27 carcinoma in situ (CIS), and 18 pTa‐1/G1‐3 tumours. Moreover using FC, malignant or premalignant lesions were detected in 43 of 271 patients (15.9%) who had a negative cytological specimen (15 moderate dysplasias, six CIS, 22 pTa‐1/G1‐3).
CONCLUSION
This study shows that FC is beneficial in the detection of malignant and premalignant lesions, if there is negative white‐light cystoscopy but positive urine cytology. The immediate identification of the exact site of a malignant lesion during FC enables the physician to diagnose and treat these patients more accurately and with no delay.