How can the accuracy of urine cytology for detecting bladder cancer be improved?

Updated: Feb 23, 2021
  • Author: Kara N Babaian, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Perform urine cytology at the same time as cystoscopy, although its routine use for screening is controversial. If the cystoscopic examination yields normal findings but the urine cytology result is positive, further evaluation should include an upper tract study and random biopsies of the bladder. Obtain biopsy samples of the prostatic urethra in men.

Fluorescence in situ hybridization (FISH) may improve the sensitivity and specificity of routine cytology. The US Food and Drug Administration (FDA) has approved a FISH assay for the detection of recurrent bladder cancer in voided urine specimens from patients with a history of bladder cancer, as well as for the detection of bladder cancer in voided urine specimens from patients with gross or microscopic hematuria but no previous history of bladder cancer. [75]

Cytoimmunologic techniques have been developed using cytokeratin 20 as a target molecule. This assay may be more sensitive than conventional cytology, although the ability to detect low-grade tumors tends to be poor in all cytologic examinations. In contrast, the positive predictive value in patients with CIS tends to be around 75%.


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