Objectives: Urothelial carcinoma (UC) requires lifelong surveillance due to its variable clinical behavior. Urine cytology is a non-invasive diagnostic tool, enhanced by ancillary tests such as the bladder tumor antigen (BTA) stat test and cytokeratin-20 immunohistochemistry (CK20 IHC) in cases of atypical urothelial cells (AUCs). The Paris System (TPS) standardizes cytology reporting, emphasizing high-grade UC (HGUC). This study evaluates the correlation between BTA, urine cytology, and histopathology. Materials and Methods: An observational cross-sectional study included 230 voided urine cytology samples with concurrent BTA results and 153 transurethral resection of bladder tumors specimens were collected over 14 months at a tertiary care center. Urine cytology was reported per TPS, with CK20 IHC performed on AUC cases. Clinical history, risk factors, imaging, and cystoscopic findings were recorded. Statistical analysis: Sensitivity, specificity, positive predictive value, and negative predictive value for urine cytology and BTA were calculated using the Statistical Package for the Social Sciences version 28. Results: BTA showed a sensitivity of 58.53% and specificity of 96.67%, improving to 98.21% for HGUC. Urine cytology demonstrated 68.29% sensitivity and 66.67% specificity, increasing to 89.29% for HGUC. CK20 IHC showed a significant correlation with histopathology ( P < 0.001). Conclusions: TPS improves urine cytology accuracy, particularly for HGUC. While BTA offers higher sensitivity, urine cytology remains a cost-effective screening tool. CK20 IHC serves as a valuable ancillary test in diagnosing carcinoma within the AUC category.
Pandey et al. (Thu,) studied this question.