[446] 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.

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)

The prostate cancers were mass lesions involving the bladder. The sensitivity, specificity, negative predictive value, positive predictive value, false positive rate and accuracy of urine cytology was 44.9%, 98.4%, 93.2%, 78.9%, 1.4% and 92.2% respectively. 69/71 (97.2%) patients with true positive urine cytology had abnormal FC or USS. In the other 2 cases FC had not been performed. Urine cytology did not pick up even a single case of cancer in which both FC and USS had shown no evidence of malignancy.
Conclusions: Urine cytology has no clinical utility in the investigation of hematuria if the patients are investigated with FC and USS. However urine cytology could still have a role in the surveillance of patients with urothelial carcinoma who would have a higher risk of urothelial carcinoma in situ that may not be identified by FC and USS.
Category: Cytopathology

Tuesday, March 20, 2012 9:30 AM

Poster Session III # 77, Tuesday Morning