Urine cytology is an unnecessary expense in the evaluation of adult haematuria

Abstract

Patients with microscopic and macroscopic haematuria undergo a series of investigations: the upper tracts are investigated with radiological investigations, the lower urinary tract with cystoscopy; urine is sent for microscopy, culture and sensitivity and cytological analysis. The aim of this study is to evaluate the role of urine cytology in adult patients with haematuria. A total of 6060 voided urine cytology specimens obtained from adults over the age of 18 who presented with haematuria in a single centre. Of the 6060 specimens sent for analysis, 5893 (97%) were reported to be benign, and 167 (3%) were not benign. Further analysis of the non‐benign results revealed 69 (41·3%) incomplete records and patients excluded. Of the 98 remaining results 34 (34·7%) were reported as repeat sample required; 44 (44·9%) were reported as suspicious for malignancy and 20 (20·4%) were reported as diagnostic. A total of 41 patients were finally diagnosed with cancer. All patients diagnosed with cancer were diagnosed on imaging or cystoscopy regardless of urine cytology result. This study has shown that urine cytology offers no unique information to adult patients being investigated for haematuria. It remains an expensive test and delays the haematuria pathway.

Nuclear matrix protein 22 is superior to voided urine cytology

“…We have previously shown that urine cytology is expensive, slows the patient pathway, lacks sensitivity and is unreliable at both detecting and excluding neoplasms of the urinary tract with a positive predictive value of only 41% (Turner et al , 2009).…”