Urine Cytology for Investigation of Primary Hematuria: A Redundant Test?
Murali Varma, Muhammad A Rahman, Amanda Jones, Elizabeth Harris, Sonia Sloan, Varsha I Shah. University Hospital of Wales, Cardiff, United Kingdom; Royal Gwent Hospital, Newport, United Kingdom
Background: It is standard practice to use urine cytology in conjunction with flexible cystoscopy (FC) and radiology to investigate patients with hematuria. We evaluated the clinical utility of urine cytology in this setting.
Design: 1360 consecutive patients with primary hematuria underwent urine cytology, FC and ultrasound scan (USS) of the urinary tracts in rapid diagnosis hematuria clinics in two hospitals during a 1 year period. The electronic notes of these patients were reviewed for the results of these investigations and for follow-up information during a period ranging from 22-34 months. Urine cytology results were classified as U1: unsatisfactory; U2: negative for malignancy; U3: atypia uncertain significance; U4: suspicious for malignancy and U5: malignant. U4 and U5 urine cytology diagnoses were considered positive as patients with U4-5 cytology and negative initial histology would be subjected to further investigations such as rigid cystoscopy, random bladder biopsies, CT urography and ureteroscopy. The positive end point was a histological diagnosis of malignancy.
Results: The distribution of cytological diagnosis and the frequency of malignancy (bladder, kidney or prostate) on follow-up are shown in Table 1.
|Diagnostic category||Number of cases (%)||Number of cases with cancer on follow-up|
|U1||16 (1.2)||0 (0)|
|U2||977 (71.8)||36 (3.7)|
|U3||277 (20.4)||52 (18.8)|
|U4||56 (4.1)||10 (71.4)|
|U5||34 (2.5)||31 (91.2)|