The use of microscopic haematuria can reduce the need for staging cystoscopy to exclude invasion of the urinary bladder by cervical carcinoma

Abstract

Previous literature indicates that the detection of haematuria on urine microscopy, to exclude bladder invasion by cervical cancer, has a high specificity. It also aids the evaluation of whether a patient needs a staging cystoscopy or not. The purpose of this study was to replicate these findings, and also to determine whether a urinary dipstick test for microscopic haematuria can be used as a screening test to identify bladder invasion by cervical cancer. Methods: A prospective observational study was conducted from January 2015 until December 2016 at a tertiary referral centre. It included all patients with newly diagnosed stage 2 or higher cervical cancer who received a staging cystoscopy at the authors' institution. Urine was collected by means of catheterisation and sent for urinary dipstick test and urine microscopy. Microscopy results were compared with cystoscopy findings. Results: Urinary dipstick testing for microscopic haematuria was performed on 143 patients. The sensitivity of the test was 1 and the specificity was 0.85. The negative predictive value was 1 and the positive predictive value was 0.5. With urine microscopy for haematuria, if more than 10 000 erythrocytes per millilitre was used for defining microscopic haematuria, the sensitivity was 1, the specificity 0.8, the positive predictive value 0.43 and the negative predictive value 1. Conclusion:The presence of microhaematuria can be used as a screening test to predict possible invasion of the urinary bladder by cervical cancer, and can thus be used to identify patients needing cystoscopy. Urine dipstick testing (Bayer Multix 10SG dipstick) provided statistically similar results to urine microscopy (if >10 000 erythrocytes equates microhaematuria) to identify patients needing cystoscopy.