Routine Urine Cytology has No Role in Hematuria Investigations

Mishriki, Said Fadel; Aboumarzouk, Omar; Vint, Ross; Grimsley, Samuel J.S.; Lam, Thomas; Somani, Bhaskar K.

doi:10.1016/j.juro.2012.10.022

Cited by 24 publications

(26 citation statements)

References 19 publications

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“…There were 47 cancers in the present series, which was low. A larger series may suggest a small benefit for urinary cytology in patients with a normal cystoscopy and imaging, as previously reported by others . We acknowledge that urinary cytology may test positive because of a cancer anticipatory effect .…”

Section: Discussionsupporting

confidence: 73%

Does urinary cytology have a role in haematuria investigations?

et al. 2018

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Urine cytology will miss a significant number of muscle-invasive bladder cancer and high-risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.

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Section: Discussionsupporting

confidence: 73%

Does urinary cytology have a role in haematuria investigations?

et al. 2018

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“…Previous studies have shown that patients with hematuria do not require further workup because the NPV is very high (99.5%) and, generally, the clinical suspicion for malignancy is low . However, the lower NPV (90.1%) noted in patients with a history of UC suggests there are a significant number of FN findings.…”

Section: Discussionmentioning

confidence: 99%

“…Urinary tract cytology (UTCy) was proposed as early as 1856 by Lambl as a clinically useful method with which to diagnose bladder cancer, and entered widespread use as a method with which to diagnose urothelial carcinoma (UC) after the seminal 1945 article by Papanicolaou and Marshall . Studies performed in the last 30 years have demonstrated that UTCy has a high sensitivity for the diagnosis of high‐grade urothelial carcinoma (HGUC) but a low sensitivity for low‐grade urothelial carcinoma (LGUC) . Voided urine (VU) specimens generally are used in the clinical setting of hematuria and persistent irritative voiding symptoms, whereas washing specimens, in conjunction with cystoscopy, are more commonly used in patients with a history of UC.…”

Section: Introductionmentioning

confidence: 99%

Negative predictive value and sensitivity of urine cytology prior to implementation of The Paris System for Reporting Urinary Cytology

McIntire

Khan

Hussain

et al. 2019

Cancer Cytopathology

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Background Urinary tract cytology (UTCy) is used for screening urothelial carcinoma (UC) and it must have a high negative predictive value (NPV) to be an effective test. To the authors’ knowledge, the literature regarding the NPV of UTCy provides little information regarding the risk of malignancy, especially for patients with high‐grade urothelial carcinoma (HGUC). Methods Patients with negative UTCy specimens were identified in the pathology files at the study institution for the years 2012 through 2013. Cases were deemed true‐negative cases if there was at least 1 subsequent negative specimen or negative clinical follow‐up within 6 months of the index case. False‐negative cases were defined as HGUC or carcinoma in situ by surgical biopsy and/or any UTCy with suspicious for HGUC or HGUC follow‐up. Results A total of 2614 UTCy specimens from 2089 patients were identified. There was a disease prevalence of 6.5%. There were 87 false‐negative results for HGUC, which corresponded to an overall NPV of 96.7%. When categorized by clinical indication, hematuria resulted in the highest NPV of 99.5% followed by other indications (97.7%) and a history of UC (90.1%). When categorized by the specimen type, voided urine specimens were found to have the highest NPV of 98.7% followed by other indications (96.9%) and washing specimens (96.2%). Of the 717 patients with a history of UC, the NPV was lower for washing specimens (89.8%) than for voided urine specimens (96.2%). When including either low‐grade urothelial carcinoma or HGUC as a positive follow‐up, the NPV dropped to 93.3% from 96.7% (HGUC only). The sensitivity of the diagnostic category of atypical urothelial cells or higher was 93.0%. Conclusions Overall, UTCy appears to have a good NPV and a high sensitivity for HGUC. The clinical indication had a greater impact on NPV compared with the specimen type.

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“…7 Urine cytology should not be used in primary care because of its low sensitivity; hence, a negative urine cytology result does not exclude malignancy. 8 There is unit-by-unit variation in the chosen modality of upper tract imaging, but usually ultrasound, CT or CT urography are utilised. Abnormalities are found in about 20% of patients, including bladder cancer (10.3%), kidney stones (8.4%), renal cell carcinoma (1.5%) and upper tract urothelial cancer (0.3%).…”

Section: Investigationsmentioning

confidence: 99%