DefinePK

Research Objective

To compare the sensitivity of conventional smear cytology with the cell block technique for diagnosing malignant cells in urine and to assess the efficacy of p53 immuno-marker in the diagnosis and prognosis of urinary bladder cancer.

Methodology

A cross-sectional study was conducted in the department of Histopathology, Pakistan Institute of Medical Sciences (PIMS), Islamabad. Cell blocks and cytology smears were prepared from urine samples of 80 patients diagnosed with urothelial carcinoma. p53 stain was applied. Data was analyzed using SPSS version 21. Sensitivity of conventional smear and cell block techniques were calculated for both low and high-grade urothelial carcinomas.

Methodology Flowchart

                        graph TD;
    A["Sample Collection Urine"] --> B["Preparation"];
    B --> C["Conventional Smear Cytology"];
    B --> D["Cell Block Preparation"];
    D --> E["p53 Immunostaining"];
    C --> F["Data Analysis SPSS v21"];
    E --> F;
    F --> G["Sensitivity Calculation"];
    G --> H["Comparison of Techniques"];
    H --> I["Conclusion"];                    

Discussion

The cell block method is superior to conventional smears for diagnosing atypical urothelial cells in urine, particularly for high-grade lesions. It is a cost-effective, simple, and non-invasive technique that can serve as an adjunct to biopsy. The study also highlights the potential of p53 immunostaining as a prognostic marker, with higher positivity observed in high-grade tumors.

Key Findings

The sensitivity of detecting atypical cells using conventional smear was 31% for low grade and 70.6% for high grade urothelial tumors. The sensitivity increased to 41.4% for low grade and 84.3% for high grade urothelial carcinomas with the cell block technique. Positive p53 stain was seen in 13.8% of low grade tumors and 66.7% of high grade tumors.

Conclusion

The sensitivity of urine cell blocks is higher than the conventional smear method for detecting high-grade urothelial lesions. Cell blocks are an efficient non-invasive technique and can be used as an adjunct tool for determining disease relapse and overall survival in patients.

Fact Check

1. The study included 80 patients diagnosed with urothelial carcinoma.
2. The sensitivity of the conventional smear for high-grade urothelial tumors was 70.6%.
3. The sensitivity of the cell block technique for high-grade urothelial tumors was 84.3%.

Mind Map