World Journal of Urology

, Volume 10, Issue 1, pp 63–67 | Cite as

Flow cytometric evaluation of bladder cancer: recommendations of the NCI flow cytometry network for bladder cancer

  • R. L. Aamodt
  • J. S. Coon
  • A. Deitch
  • R. W. deVere White
  • L. G. Koss
  • M. R. Melamed
  • R. S. Weinstein
  • L. L. Wheeless
Free Paper


The National Cancer Institute-supported Flow Cytometry Network for Bladder Cancer concluded that when properly used, DNA flow cytometry of bladder irrigation specimens can be a clinically useful laboratory procedure to monitor patients with bladder cancer. It recommended the use of this technique in managing patients with low-stage disease, particularly flat carcinoma in situ. The method has limited value in managing patients with high-stage (i.e., muscle-invasive) carcinoma; it is not recommended for screening subjects in the absence of a clinical suspicion of or a history of bladder tumors. DNA histograms alone are not sufficient for diagnosis or clinical action but require correlation with other clinical information. Bladder irrigation specimens collected during cystoscopy or by vigorous barbotage via a number 18 Foley catheter may be processed for flow cytometric analyses. Criteria for sampling adequacy have been established and are presented in this report. Optimal results are obtained with fresh specimens that are stained and examined promptly after collection. Preservation procedures are described for cases in which fresh specimens cannot be evaluated. Used with appropriate quality-control measures, commercially available flow cytometers can provide clinically useful information. Staining protocols using propidium iodide are recommended by the Network. Staining protocols are described for isolated nuclei and whole cells (see Appendix). The presence of bladder cancer is signaled by the identification of cell populations with clearly aneuploid DNA content. Quality-control measures and issues of inter- and intralaboratory differences in histogram configuration and analysis must be considered in the interpretation of results. Although the Network participants recognize the potential value of additional markers, these were not evaluated.


Bladder Cancer Propidium Iodide Flow Cytometric Analysis Bladder Tumor Laboratory Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Badalament RA, Kimmel M, Gay H, Cibas ES, Whitmore WF Jr, Herr HW, Fair WR, Melamed MR (1987) The sensitivity of flow cytometry compared with conventional cytology in the detection of superficial bladder cancer. Cancer 59:2078–2085Google Scholar
  2. 2.
    Badalament RA, Hermanson DK, Kimmel M, Gay H, Herr HW, Fair WR, Whitmore WF Jr, Melamed MR (1987) The sensitivity of bladder wash flow cytometry, bladder wash cytology and voided cytology in the detection of bladder cancer. Cancer 60:1423–1427Google Scholar
  3. 3.
    Badalament RA, Fair WR, Whitmore WF, Melamed MR (1988) The relative value of cytometry and cytology in the management of bladder cancer: the Memorial Sloan-Kettering Cancer Center experience. Semin Urol 6:22–30Google Scholar
  4. 4.
    Coon JS, Landay AL, Weinstein RS (1987) Biology of disease: advances in flow cytometry for diagnostic pathology. Lab Invest 57:453–479Google Scholar
  5. 5.
    Coon JS, Deitch AD, deVere White RW, Koss LG, Melamed MR, Reeder JE, Weinstein RS, Wersto RP, Wheeless LL (1988) Interinstitutional variability in DNA flow cytometric analysis of tumors: the National Cancer Institute's Flow Cytometry Network experience. Cancer 61:126–130Google Scholar
  6. 6.
    Coon JS, Deitch AD, deVere White RW, Koss LG, Melamed MR, Reeder JE, Weinstein RS, Wersto RP, Wheeless LL (1989) Check samples for laboratory self-assessment in DNA flow cytometry: the National Cancer Institute's Flow Cytometry Network experience. Cancer 63:1592–1599Google Scholar
  7. 7.
    Deitch AD, Law H, deVere White R (1982) A stable propidium iodide staining procedure for flow cytometry. J Histochem Cytochem 30:967–972Google Scholar
  8. 8.
    Hermanson DK, Melamed MR, Coon JS, Weinstein RS, deVere White R, Deitch AD, Wheeless LL, Reeder JE, Wersto R, Koss LG (1989) Ethanol fixation of bladder irrigation specimens for flow cytometric analysis: A multi-institutional study from the Bladder Cancer Flow Cytometry Network. Cancer 63:1780–1783Google Scholar
  9. 9.
    Shapiro HM (1989) Flow cytometry of DNA content and other indicators of proliferative activity. Arch Pathol Med 113:591–597Google Scholar
  10. 10.
    Vindelov LL, Christensen IJ, Nissen NI (1983) A detergent trypsin method for the preparation of nuclei for flow cytometric DNA analysis. Cytometry 3:323–327Google Scholar
  11. 11.
    Wheeless LL, Coon JS, Deitch AD, deVere White RW, Koss LG, Melamed MR, Reeder JE, Robinson RD, Weinstein RS, Wersto RP (1988) Comparison of automated and manual techniques for analysis of DNA frequency distributions in bladder washings. Cytometry 9:600–604Google Scholar
  12. 12.
    Wheeless LL, Coon JS, Cox C, Deitch AD, deVere White RW, Koss LG, Melamed MR, O'Connell MJ, Reeder JE, Weinstein RS, Wersto RP (1989) Measurement variability in DNA flow cytometry of replicate specimens. Cytometry 10:731–738Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • R. L. Aamodt
    • 1
  • J. S. Coon
    • 2
  • A. Deitch
    • 3
  • R. W. deVere White
    • 3
  • L. G. Koss
    • 4
  • M. R. Melamed
    • 5
  • R. S. Weinstein
    • 6
  • L. L. Wheeless
    • 7
  1. 1.Cancer Diagnosis Branch, Division of Cancer Biology, Diagnosis and CentersNational Cancer InstitueRockvilleUSA
  2. 2.Department of PathologyRush-Presbyterian-St. Luke's Medical CenterChicagoUSA
  3. 3.Department of UrologyUniversity of California, DavisSacramentoUSA
  4. 4.Department of PathologyMontefiore Medical CenterNew YorkUSA
  5. 5.Department of PathologyMemorial Sloan-Ketterin Cancer CenterNew YorkUSA
  6. 6.Department of PathologyUniversity of ArizonaTucsonUSA
  7. 7.Department of Pathology and Laboratory MedicineUniversity of RochesterRochesterUSA

Personalised recommendations