Cyto-Histological Study of Urinary Bladder Neoplasms.

Urinary cytology has an increasingly prominent role in the multidisciplinary diagnostic approach to bladder cancer. It is used as a valuable adjunct to cystoscopy and biopsy for diagnosis and follow up of patients with bladder cancer. Bladder cancer accounts for 7% of all cancers in male and 2% of all cancers in female. In the year 2002, in Chennai Bladder cancer accounted for 2.28 % of all cancers in male and 0.78 % of all cancers in female29. Cytological examination of voided urine is a non-invasive screening test for bladder tumors, which can be carried out in remote areas of the country. By cytology one can even classify type and grade malignancy. In 1945 Papaniculoau and Marshall recommended cytological examination of urinary sediment for diagnosis and follow up of patients with urological malignancies. The prognostic value of conventional cytology to monitor patients with superficial bladder carcinoma is well established. While cystoscopy and biopsy are optimum for diagnosis of visible disease, the entire bladder mucosa can be sampled by cytology, enabling detection of occult urothelial abnormalities. Traditionally cytological examinations have been used to detect in situ and early invasive bladder cancer in high-risk population and in conjunction with cystoscopy and biopsy to diagnose new or recurrent bladder tumor. Cytology also has been used to identify persistent tumor after transurethral resection. Cystoscopy remains the standard for the diagnosis and surveillance of bladder tumors, allowing the lesions to be mapped and sampled. However, cystoscopy cannot explore the whole bladder urothelium, and cannot diagnose all carcinoma in situ cases or lesions of upper urinary tract. Thus, it must be combined with urinary cytology, particularly in search for tumor cells from high-grade lesions, wherever their location in the urinary tract. Urine cytology can detect bladder tumor before it can be detected cystoscopically. Urine cytology is still indispensable in the management of patients with transitional cell carcinoma. It remains as a gold standard for bladder cancer screening.