Diagnostic Value of Cytology of Voided Urine

Abstract

In Croatia 961 new cases of urothelial carcinoma are estimated annually, with approximately 366 deaths. Exfoliative urinary cytology has important role in detection of high grade urinary tumors, not only invasive but in situ lesiones also, because of the possibilty to detect tumors on complete urothelium from pelvis to the urethra which can escape detection by endoscopy, uroradiology and biopsy. Moreover, urinary cytology is a noninvasive method of examination and can easily be repeated. A retrospective review was conducted to correlate urinary cytology and pathology findings in patients with bladder conditions. We analyzed all cytological urine samples (72 first examination specimens with cytological diagnosis of dyskaryosis, suspicious or malignant) at our Department of Clinical Cytology in a 6-year period between 2004 and 2009, which included Pathohistological verification obtained from biopsy specimens or resection material within the next six months. Cytological findings were compared to the gravest pathohistological results; the relationship was considered positive when a malignant or suspicious cytological finding matched a pathologically confirmed invasive or in situ transitional cell carcinoma according to the WHO histological classification of tumours of the urinary tract criteria. Patients with negative histological findings were followed for the next three years.There was total of 58 true positive cases or 80.6%. The sensitivity of cytological detection of malignant urothelial lesions was 95.1%. In 9 cases false positive report was made - 6 malignant and 3 suspected lesions, which was not confirmed at histopathological analysis and makes the total of 12.5% of false positive reports. In conclusion: cytology is very good tool in diagnostic of both the primary tumor and of recurrent disease. In order to make it more efficient we need to study its limits carefully, define diagnostic criteria, reach consensus in nomenclature, but also work on patient’s education in terms of providing quality material for a cytological analysis.