Clinical utility of squamous and transitional nuclear structure alterations induced by Schistosoma haematobium in chronically infected adults with bladder damage verified by ultrasound in Ghana

OBJECTIVE: To evaluate the clinical utility of quantitative nuclear morphometry-i.e., alteration in nuclear size/shape, DNA content and chromatin structure-of intact cells obtained from the sediment of urine specimens collected from people living in an area highly endemic for Schistosoma haematobium in Ghana. STUDY DESIGN: Digital images of Feulgen-DNA-stained squamous cell (SC) and transitional cell (TC) urothelial nuclei were captured using the AutoCyte imaging system, and nuclear morphometric descriptors (NMDs) were calculated. A total of 3,495 and 4,523 SC and TC nuclei from normal bladder ultrasound subjects (n=21) and 3,465 and 3,064 SC and TC nuclei from severely abnormal bladder ultrasound subjects (n = 20) were captured. RESULTS: Univariate logistic regression analyses of pooled SC and TC nuclei training sets showed that 27/40 NMDs and 24/40 NMDs were univariately significant for differentiating between SCs and TCs of subjects with normal and severely abnormal bladder ultrasound. Multivariate models constructed using NMDs with 50% inclusion frequency yielded AUC-ROCs of 75.23% and 74.42% in the SC training and validation, and 69.90% and 66.70% for TC training and validation. Further, a squamous cell patient-specific model predicted severe bladder damage with an AUC-ROC of 86.90%, yielding the sensitivity, specificity and accuracy of 85.00%, 76.19% and 80.49%, respectively. CONCLUSION: Quantitative nuclear structure alterations can be used to make a noninvasive assessment of cytologic changes observed in both SC and TC bladder epithelia due to S haematobium infection.