Enhanced detection of bladder cancer in urine cytology with Lewis X, M344 and 19A211 antigens

Lewis X, M344 and 19A211, all glycoprotein antigens associated with bladder tumors, were evaluated in urine cytologic specimens from 52 patients with transitional cell bladder neoplasms and from 12 controls. Forty-three of 52 patients had a tumor on a concurrent bladder biopsy, while 9 of 52 patients had a negative biopsy. Of the 43, 27 (62.8%) had positive or suspicious cytology, 35 (81.4%) had positive immunocytochemical reactions with at least one antibody, and 36 (83.7%) had either cytologic or immunocytochemical abnormalities. Of the 15 patients with a low grade tumor (papilloma or grade 1 transitional cell carcinoma), 14 (93.3%) had positive immunohistochemical findings, while 6 (40%) had recognizable abnormal cells on routine cytology. Of 28 patients with a high grade tumor, 21 (75%) had positive immunohistochemical findings, while 21 (75%) had abnormal cytology. Staining of rare epithelial cells was seen in 2 of 12 control cases (specificity, 83.3%). Immunocytochemistry with antibodies to tumor-associated antigens can enhance the cytologic detection of exfoliated low grade bladder epithelial tumor cells.