Suspicious Urine Cytology (Class III) in Patients with Bladder Cancer: Should it be Considered as Negative or Positive?

Abstract

The poor sensitivity of voided urine cytology improved significantly when suspicious samples were determined as positive while the specificity remained high, a clear advantage compared with most of the new tumour marker tests. In addition, nearly half of the follow-up patients with suspicious class III cytology had recurrence implying that this patient category is at substantial risk for co-existing malignancy. Therefore, it is recommended that suspicious class III cytology together with class IV and V specimens should be considered positive.

Systematic review of the clinical effectiveness and cost-effectiveness of photodynamic diagnosis and urine biomarkers (FISH, ImmunoCyt, NMP22) and cytology for the detection and follow-up of bladder cancer

“…A total of 47 studies, reported in 56 papers, were diagnostic cross-sectional studies, 45,80,97,98,100-103,105, 109-129,131-133,135,136,139-141, 145,146,148-153,165-174 of which 11 45,101,109,110,112,116,118,126,127,165,174 reported consecutive recruitment. Nine studies 107,108,155,[157][158][159][162][163][164] were case-control studies and 11 studies 103,108,111,116,126,127,135,149,165,170,174 were multicentre ( Table 19).…”

“…Nine studies 107,108,155,[157][158][159][162][163][164] were case-control studies and 11 studies 103,108,111,116,126,127,135,149,165,170,174 were multicentre ( Table 19). …”

“…Eight studies 80,114,120,121,151,155,167,171 involving at least 872 patients reported bladder wash cytology. In 46 studies 45,80,97,[101][102][103]105,[107][108][109][110][111][112][113][114]116,118,[122][123][124][126][127][128][129]131,132,135,136,[139][140][141][148][149][150][151]153,158,159,162,164,165,168,[170][171][172]174 7888 participants (45%) presented with a suspicion of bladder cancer and 9487 (55%) had previously diagnosed bladder cancer. In 10 103,118,…”

“…In total, 30 studies 80,102,103,108,[111][112][113][114]118,119,121,122,126,127,135,136,139,150,151,153,155,158,159,162,[164][165][166][167][168]174 gave details of when they took place, with an earliest start date of 1990 165 and latest end date of July 2007. 118 Fifteen studies took place in the USA, 97,103,105,108,111,126,127,129,139,148,149,153,158,159,165 seven in Germany, 80,98,107,118,132,168,171 four in the UK, 45,141,166,…”

Clinical Value of Dividing False Positive Urine Cytology Findings into Three Categories: Atypical, Indeterminate, and Suspicious of Malignancy

“…In our study, we found that among the samples categorized as atypical, indeterminate, and suspicious of malignancy, the numbers of concommitant cancerous lesions were 105 (23.6%), 147 (40.1%), and 139 (49.8%), respectively. Raitanen et al (Raitanen et al, 2002) addressed the question of whether, in a population of patients diagnosed with bladder cancer, class III urine cytology should be considered as a negative or positive indication for the presence of cancerous lesions; these investigators recommended that class III cytology should be considered as positive. Several reports have shown that assuming class III reports to be positive instead of negative improves sensitivity while maintaining acceptable specificity.…”