Journal Article Page
European UrologyVolume 62, issue 5, pages e83-e94, November 2012
Letters to the Editor published online
Re: Anobel Y. Odisho, Anna B. Berry, Ardalan E. Ahmad, Matthew R. Cooperberg, Peter R. Carroll, Badrinath R. Konety. Reflex ImmunoCyt Testing for the Diagnosis of Bladder Cancer in Patients with Atypical Urine Cytology. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.04.019
Accepted 30 July 2012, Published online 10 August 2012, page e87
Refers to article:
Reflex ImmunoCyt Testing for the Diagnosis of Bladder Cancer in Patients with Atypical Urine Cytology
Accepted 3 April 2012
May 2013 (Vol. 63, Issue 5, pages 936 - 940)
We read this article  with special interest. The authors have very convincingly clarified the issues related to atypical urine cytology samples, for which the dilemma persists as how to follow up such cases. The authors concluded that when used as a reflex test to arbitrate atypical urine cytology, a negative ImmunoCyt result can be used to avoid cystoscopy in patients with a history of low-grade cancer or without a history of urothelial cancer.
Urinary cytology has low sensitivity (5%) for detecting low-grade tumors, so the chances of a false-negative result are very high in such tumors with cytology alone, whereas immunocytology has high sensitivity and specificity for both low- and high-grade tumors . The authors  have applied immunocytology in patients with atypical cytology samples only. We are of opinion that immunocytology may be used as a second-level reflex test in negative cases of cytology as well to avoid the high false-negative results associated with it; otherwise, such cases will remain unevaluated.
The authors  have not discussed the limitations of the ImmunoCyt test. A positive test means the presence of one confirmed red or green positive cell. If fewer than five positive cells are counted, the manufacturer of the ImmunoCyt kit  (used in this article) recommends evaluating a second sample. This issue has not been discussed by the authors .
A study by Vriesema and colleagues  of the diagnostic efficiency and reproducibility of the positive ImmunoCyt/uCyt test found high interobserver variability, so it is important to repeat the test as recommended by the manufacturer before declaring a test to be positive. Vriesema and co-authors concluded that the validity of ImmunoCyt was insufficient to justify the omission of cystoscopy in patients for follow-up for superficial urothelial cancer. This issue needs to be clarified further before using immunocytology as a second-level reflex test.
Conflicts of interest
The authors have nothing to disclose.
-  Odisho AY, Berry AB, Ahmad AE, Cooperberg MR, Carroll PR, Konety BR. Reflex ImmunoCyt testing for the diagnosis of bladder cancer in patients with atypical urine cytology. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.04.019.
-  M. Lodde, C. Mian, G. Negri, et al. Role of uCyt in the detection and surveillance of urothelial carcinoma. Urology. 2003;61:243-247 Crossref.
-  Summary of procedure [ImmunoCyt/μCyt+]. Denville, NJ: Scimedx Corporation. http://www.scimedx.com/products/bladder_cancer/summary_procedure.php. Accessed June 30, 2012.
-  J.L. Vriesema, F. Atsma, L.A. Kiemeney, et al. Diagnostic efficacy of the ImmunoCyt test to detect superficial bladder cancer recurrence. Urology. 2001;58:367-371 Crossref.
Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
© 2012 European Association of Urology, Published by Elsevier B.V.
Recommend this article
Currently this article has a rating of 0. Please log in to recommend it.