What is the role of urinary cytology in the diagnosis of bladder cancer?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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All patients with gross hematuria should undergo cystoscopy, upper tract imaging, and urinary cytology (preferably barbotage urine for cytology). It is no longer recommended to use urine cytology in the initial evaluation of patients with microscopic hematuria unless the patient has risk factors for carcinoma in situ (CIS). Additionally, cytology can be used in patients with microhematuria who have irritative urinary symptoms after a negative workup. [65]    

Urinary cytology is most helpful in diagnosing high-grade tumors and CIS. Low-grade, noninvasive tumors may be missed by routine cytologic analysis.

Endoscopic biopsies are used to establish the diagnosis and determine the extent of the cancer. However, a study by Cha et al found that immunocytology outperforms urine cytology and increases the accuracy of predictive models by a statistically and clinically significant margin for patients with painless hematuria. [66]

Strittmatter et al found that the quality of urinary cytology is impacted by the individual learning curve. Specificity of cytology and sensitivity for low-grade tumors significantly changed when performed by a local cytologist at the beginning of the learning period. This suggests that in the diagnosis of bladder cancer, the cytologist’s level of experience has an important impact on the clinical value of urinary cytology. [67]

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