Usefulness of urine cytology as a routine work-up in the detection of recurrence in patients with prior non-muscle-invasive bladder cancer: Practicality and cost-effectiveness
- Usefulness of urine cytology as a routine work-up in the detection of recurrence in patients with prior non-muscle-invasive bladder cancer: Practicality and cost-effectiveness
- 송필현; 옥봉기; 지윤섭; 고영휘
- aged; Article; bladder biopsy; bladder surgery; computer assisted tomography; controlled study; cost effectiveness analysis; cystoscopy; diagnostic value; feasibility study; female; follow up; human; human tissue; major clinical study; male; non muscle invasive bladder cancer; predictive value; retrospective study; sensitivity and specificity; tumor recurrence; urinalysis; urine cytology; cancer staging; cost benefit analysis; cytodiagnosis; cytology; economics; evaluation study; health care cost; middle aged; Neoplasm Recurrence, Local; pathology; procedures; South Korea; statistics and numerical data; Urinary Bladder Neoplasms; urine; very elderly; Aged; Aged, 80 and over; Cost-Benefit Analysis; Cystoscopy; Cytodiagnosis; Female; Health Care Costs; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Republic of Korea; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Urinalysis; Urinary Bladder Neoplasms; Urine
- Issue Date
- Korean Journal of Urology, v.55, no.10, pp.650 - 655
- Purpose: To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness.Materials and Methods: We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected.Results: Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041).Conclusions: Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient. ? 2014 The Korean Urological Association.
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