1983 Volume 74 Issue 1 Pages 81-99
A total of 90 dyestuff, workers who were engaged in the production of aromatic amine during the post-war period after the 2nd world war have been examined since 1967 by exfoliative cytologic examiniation. Those identified as class-3 or over by this first screening test were then submitted to a second sereening which consisted of periodic cystscopic examinations and 1 or 2 intravenous pyelographies per year. This system of mass screening has been used for the past 15 years, and we have discovered 13 cases of bladder tumor and 1 case of asynchronous bilateral ureteral tumor.
Out of the 11 cases, bladder tumors were discovered in 5 cases within 3 months after a positive exfoliative cytology result, and in 4 cases within 1 year. The presence of a tumor was confirmed in 81% of those patients within 1 year and in all of them in about 3 years.
Periodic examinations have identified all the tumors when they were about 5mm in size and in stage O through A, demonstrating the usefulenss of systematic examination.
Treatment included intravesical instillation of anticancer agents, mostly mitomycin C, for 7 cases, TUR for 5 cases and partial cystectomy was performed in one case. The patient with an asynchronous bilateral ureteral tumor, who was treated first by right total nephro-ureterectomy with cuff resection of bladder and later by ureter excision and nephrostomy, has been in good health for 7 years.
Recurrence was observed in 3 out of the 7 cases treated with intravesical anticancer agents, and in 4 out of the 5 cases treated by TUR, including two who had more than 2 heterotopic recurrences in 1 year.
Survival of 5, 10 and 15 years was 84%, 55% and 44% respectively. One patient died of post operative peritonitis after a bile duct cancer operation in the first year: the other of cerebral hemorrhage in the 4th year; the third of primary lung cancer in the 7th year; the fourth of primary liver cancer in the 8th year and two more patients died of ileus in the 7th and 11th year.
From the results obtained during the past 15 years by urinary cytology examination routinely applied to 90 ex-workers of a dye factory, we conclude that exfoliative cytology is superior to cystoscopy or histology for early detection of bladder tumors.
