Does voided urine cytology have biological significance?

To (i) define any correlation between the result of voided urine cytology (VUC) at presentation and the biological behaviour of Ta/T1 transitional cell carcinoma (TCC) of the bladder; and (ii) observe the natural history of Ta/T1 bladder cancer in relation to new prognostic groupings.

The study comprised 109 patients with newly diagnosed Ta/T1 TCC of the bladder, all of whom had VUC assessed at presentation. Information on the number of tumours at presentation and the subsequent tumour recurrence rate during clinical follow-up was compared with the outcome of VUC.

Of the 109 patients, 67 (61%) had Ta and 42 (39%) had T1 tumours. At presentation, there were 75 (69%) solitary (Ta=50, T1=25) and 34 (31%) multifocal (Ta=17, T1=17) tumours. At presentation, VUC was negative in 71 (65%), suspicious in 22 (20%) and positive for urothelial carcinoma in 16 (15%) patients. During follow-up, 58% of patients with Ta tumours and 83% of patients with T1 tumours developed recurrences (median follow-up 43.5 months, P=0.01), although there was no significant difference in the recurrence rate between these groups (P=0.096). In addition, for those patients with Ta tumours that were multifocal at presentation, there was a significantly higher recurrence rate (P=0.003). Although there was no correlation between the result of VUC and the number of tumours at presentation, there was a significantly higher tumour recurrence rate for those patients with suspicious/positive VUC than for those whose VUC was negative (P<0.05).

This study shows the impact of tumour multifocality at presentation on subsequent tumour recurrence rate. In addition, the VUC result at presentation correlated with tumour recurrence in patients with Ta/T1 TCC of the bladder.