Bladder cancer diagnosis: A comparative study of cystoscopy and urine cytology in a Nigerian cohort

Bladder urothelial cancer is the first most common cancer of the urinary system, the 10th most common in men and the 17th in women, with its incidence being 3-4 times higher in men than in women. In addition, Tobacco smoking increases the risk of bladder cancer incidence and recurrence. Urine cytology, cystoscopy and biopsy are the three most common techniques employed in diagnosing bladder cancer. Cystoscopy and biopsy are mostly inconvenient and invasive, in addition to being expensive, especially in resource-limited settings. Therefore, there is a need to evaluate the possibility of adopting urine cytology as a screening method for bladder cancer diagnosis, while understanding the association between smoking and risk of bladder cancer. We studied the morphological features of exfoliated cells in the urine of suspected bladder cancer patients and that of apparently healthy subjects to determine its efficacy as a standard diagnostic procedure. The urine samples were aseptically collected from 40 adult patients suspected of having bladder cancer, and 10 healthy adults from Abubakar Imam Urology Center, Kano, Nigeria . Samples were analyzed by Papanicolaou and Diff Quick staining techniques. Biopsy and cystoscopic samples were collected only from the test subjects. With 26% of the subjects showing an unsatisfactory cytological finding, 36% were negative for high-grade urothelial cancer (NHGUC), 18% were suspicious for high-grade urothelial cancer (SHGUC), and 20% had high-grade urothelial cancer (HGUC). Cystoscopy reveals that 57.5% showed signs of malignancy, while bladder biopsy revealed that 50% of subjects showed no evidence of primary tumor (T0), 25% had noninvasive carcinoma (Ta), 5% had carcinoma in situ (TIS), and 20% had invasive carcinoma (T2). The majority (36%) of the subjects were found to be negative for bladder cancer. Also, the majority of those diagnosed with HGUC were found to be moderate to severe smokers between the ages of 67-75 years, and none among those aged 45-55 were found to have HGUC. Urine cytology remains a useful tool in evaluating suspected urothelial malignancies and can serve as an adjunct to cystoscopy and biopsy, especially in resource-limited settings. Smoking and old age were found to be among the predisposing factors to the development of bladder urothelial cancer.