DNA flow cytometry and bladder irrigation cytology in detection of bladder carcinoma

In this study we assessed the role of DNA flow cytometry (FCM) as an adjunct to bladder irrigation cytology to detect carcinoma of the bladder. We selected only those cases who had urinary symptoms and cystoscopic examination or histology-proven cases of bladder cancer who underwent cystoscopy for a follow-up study. Cystoscopy, cytologic examination, and DNA FCM were performed in every case. There were 9 fresh cases and 21 follow-up cases of proven transitional-cell carcinoma (TCC) of the bladder. Cystoscopy revealed growth in all 9 fresh cases as well as in 11 follow-up cases. Cytology was positive in 16 cases, out of which there were 8 each of fresh and recurrent cases. None of the cases showed positive cytology with negative cystoscopy findings. DNA FCM was positive in 13 cases. Aneuploidy was detected in 5 cases, out of which there were 3 hyperdiploid and 2 hypodiploid cases. Nine cases had high (equal or more than 10%) S and G2-M phase cells, ranging from 10-19.36%. One case showed aneuploidy along with high S-G2M phase. Both cytology and DNA FCM were positive in 9 cases. In 2 cases, DNA FCM showed aneuploidy, but cytology and cystoscopy were negative. The sensitivity and specificity of the bladder wash cytology were 80% and 100%, and those for DNA FCM were 55% and 83.3%, respectively. We conclude that both bladder wash cytology and DNA FCM techniques should be done in all the cases of suspected TCC to detect more number of positive cases.