What is the role of urine cytology in the surveillance for recurrent bladder cancer?

Updated: Sep 10, 2019
  • Author: David A Levy, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Conventional urine cytology has been deemed the criterion standard to detect tumor markers, but its role has been questioned. [4, 5]

According to one review, the value of conventional cytology appears to have diminished in the last decade. The cause for this decline is unclear and does not appear to be a change in the criteria for determining malignancy through cytological examination, because specificity did not change appreciably during the interval. The authors theorized that a decrease in the specialization of cytopathologists reading urine specimens might be responsible.

Irrespective of the cause, the sensitivity of cytology in the published literature has diminished, as is shown in the data reported by Halling and associates in their review of the literature. According to the authors, the sensitivity of conventional cytology for grade 1 tumors was 37% before 1990 but only 11% afterward. Similarly, the sensitivity for grade 2 tumors fell from 75% to 31%. [6]

Of concern is that although it is widely believed that cytology might miss low-grade tumors but is the criterion standard for high-grade tumors, this sensitivity has apparently changed. Based on the Halling et al review of the literature, cytology found 94% of grade 3 tumors in the earlier era, but after 1990, cytology reportedly detected only 60% of even high-grade tumors. [6]

Fortunately, although the sensitivity of cytology has clearly declined, the specificity remains high and approaches 100%. Therefore, a positive cytology result should be regarded as a true positive; aggressive investigation for occult disease in both the lower and upper urinary tract should ensue.

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