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Cytology and Histopathology of Bladder Cancer Cases in a Prospective Longitudinal Study¹

The National Bladder Cancer Collaborative Group A (NBCCGA) has been established to carry out prospective longitudinal studies of patients with bladder cancer. This paper discusses the methods applied to the study of histological and cytological material in the Central Pathology Laboratory of the NBCCGA and provides some preliminary results.

Since the prognosis of the patient depends primarily on the nature and extent of changes in the urothelium remaining after the removal of visible lesions, the value of cytological study of bladder washings and cystoscopic urine samples and the value of selected site mucosal biopsies for detecting these epithelial changes are being assessed. The sites of visible lesions and the sites of biopsy are documented on bladder "maps." The extent of any "field change" in the bladder epithelium associated with bladder tumors is determined by this means in vivo.

Preliminary results indicate a greater than expected number of positive cytological diagnoses in Grade I transitional cell carcinomas, chiefly in bladder washings rather than urine samples obtained at cystoscopy. This may be due to the presence in the cytological preparations of cytologically malignant epithelial cells from some nonvisualized site other than that of the recognizable Grade I tumor. The value of bladder washing specimens in detecting bladder tumors appears to be somewhat higher than that of cystoscopic urine specimens in Grade II and III transitional cell carcinomas as well, but thus far both types of cellular samples appear to play a role in tumor detection and should continue under study.

¹ This investigation was supported by the following USPHS grants from the National Cancer Institute through the National Bladder Cancer Project: CA 15490, CA 15491, CA 15492, CA 15497, CA 15933, CA 15934, CA 15937, CA 15944, CA 16886, CA 16899, and CA 17446. This paper represents two presentations at the Conference, by Clair E. Cox and Gilbert H. Friedell.

² Principal Investigators and Member Institutions of the NBCCGA: G. R. Prout, Jr., NBCCGA Chairman, Massachusetts General Hospital, Boston, Mass. 02114; C. E. Cox, University of Tennessee, Memphis, Tenn. 38163; K. B. Cummings, Virginia Mason Research Center, Seattle, Wash. 98101; M. J. Flanagan, Rush Presbyterian-St. Luke's Medical Center, Chicago, III. 60612; G. H. Friedell, St. Vincent Hospital, Worcester, Mass. 01610; C. V. Hodges, University of Oregon, Portland, Oreg. 97201; W. W. Koontz, Jr., Medical College of Virginia, Richmond, Va. 23219; C. E. A. Merrin, Roswell Park Memorial Institute, Buffalo, N. Y. 14263; J. D. Schmidt, University of Iowa, Iowa City, Iowa 52242; R. J. Veenema, Columbia University, New York, N. Y. 10032; J. H. Warram, Harvard School of Public Health, Boston, Mass. 02115. Requests for reprints should be addressed to: Dr. George R. Prout, Jr., Massachusetts General Hospital, 32 Fruit Street, Boston, Mass. 02114.