Which cytology findings are diagnostic 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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Answer

Because cytology is the most reliable urine test for detecting bladder cancer, a positive cytology finding should be treated as indicating cancer somewhere in the urinary tract until proven otherwise. If cystoscopy findings are negative in the setting of positive cytology findings, further evaluation of the urinary tract is required. The upper urinary tract should be evaluated with contrast imaging and possibly ureteroscopy. Cystoscopy with bilateral retrograde pyelography and bilateral ureteral washings should be performed. Additionally, in men the prostatic urethra should be examined.

Most patients with CIS have coexisting papillary cancer. In general, the papillary tumor is diagnosed first, and CIS is discovered during the evaluation and treatment of the papillary tumor. Only 10% of patients with bladder cancer have a pure CIS. The combination of CIS and papillary transitional cell carcinoma (TCC) is associated with a higher risk of recurrence and progression.

In cases of pure CIS, urinary cytology may lead to the diagnosis. CIS exfoliates cells that have an unusual appearance and are easy to identify via cytologic examination, prompting further evaluation. Unfortunately, even findings from urine cytology may be normal in some patients; in these cases the diagnosis is made only when the urologist maintains a high level of suspicion for CIS and obtains random bladder biopsy specimens from patients with worrisome symptoms. However, if the urinary cytology is performed properly, this should happen rarely.


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