CLINICAL DIAGNOSIS OF BLADDER CANCER BY MICROSCOPIC CHROMOCYSTOSCOPY

Abstract

The present investigations were performed to know whether microscopic chromocystoscopy (MCC) could predict the histology of bladder urothelium. The study included 57 patients with bladder tumors. Staining of urothelial surface cells was accomplished with intravesical instillations of 0.1 per cent methylene blue solution. MCC observations were undertaken using a contact-microcolpohysteroscope with 1-150 magnifications. The microscopic findings of the stained areas were classified into 5 groups (group X, 0, 1, 2 and 3), depending on configuration, size and distribution of the cell nuclei: Group X; the nucleus could not be recognized because of amorphous diffuse staining, group 0; almost normal nuclear features, group 1; relatively minimal abnormalities, group 3; a large number of abnormal features, group 2; intermediate changes of group 1 and 3.
In tumorous carcinomas which could be detected by conventional cystoscopy, 78 of 92 tumors were stained; the staining rates were higher in grade 2 and 3 carcinomas compared to grade 1 tumors.
Comparison of MCC with histological grading in 233 areas of flat epithelium were as follows. Of 125 areas which were stained, 53 were estimated to be in groups 1-3. Histologically, forty-seven of these 53 were diagnosed as either carcinomas (41) or dysplasia (6).
Out of 66 in group 0, only 6 areas were carcinoma in situ or dysplasia. In 108 areas where no staining was seen, 9 carcinomas and 8 dysplasia were found. These data show that the observations with MCC are roughly parallel with the histological examinations.
The results indicate that MCC examination is useful not only in estimating the grade of visible tumors, but also in detecting the abnormal vesical epithelia which can not be recognized by a conventional cystoscopic examination.