Does Urine Cytology have any role in bladder cancer diagnosis?
BAUS ePoster online library. Moore M. 06/22/21; 319017; p10-9
Disclosure(s): None
Ms. Madeline Moore
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Abstract
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Introduction
Despite NICE guidelines suggesting the use of urine cytology (UC) for diagnosis of bladder cancer, it is infrequently performed due to sub-optimal sensitivity, cost, and uncertainty with results interpretation, particularly atypical UC. Nevertheless, anecdotally, suspicious/malignant UC when other investigations are normal, occasionally leads to cancer diagnosis. We retrospectively assessed our haematuria patients to determine the clinical significance of atypical UC, and the number of cancer cancers identified by UC that may have been missed by standard haematuria investigations.
Patients and Methods
We identified a random sample of 500 two-week wait haematuria cases presenting to our teaching hospital/tertiary cancer centre between 2010-2016. Clinical outcome data were collected.
Results
Median follow-up was 32 months. Urological malignancy was diagnosed in 92/500 patients (bladder, renal and prostate). All bladder cancers were identified by cystoscopy or routine imaging, i.e. irrespective of UC. 0/54 atypical UC cases re-presented with a 'missed' cancer within a two-year period following initial investigation. 44 of 46 suspicious and malignant cytology cases were associated with high-grade/aggressive tumours or subsequent tumour recurrence.
Conclusion
Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for TURBT. However, it did not identify any cancers that were not already found by imaging or cystoscopy; therefore, we conclude that UC has no role in bladder cancer diagnosis.
Despite NICE guidelines suggesting the use of urine cytology (UC) for diagnosis of bladder cancer, it is infrequently performed due to sub-optimal sensitivity, cost, and uncertainty with results interpretation, particularly atypical UC. Nevertheless, anecdotally, suspicious/malignant UC when other investigations are normal, occasionally leads to cancer diagnosis. We retrospectively assessed our haematuria patients to determine the clinical significance of atypical UC, and the number of cancer cancers identified by UC that may have been missed by standard haematuria investigations.
Patients and Methods
We identified a random sample of 500 two-week wait haematuria cases presenting to our teaching hospital/tertiary cancer centre between 2010-2016. Clinical outcome data were collected.
Results
Median follow-up was 32 months. Urological malignancy was diagnosed in 92/500 patients (bladder, renal and prostate). All bladder cancers were identified by cystoscopy or routine imaging, i.e. irrespective of UC. 0/54 atypical UC cases re-presented with a 'missed' cancer within a two-year period following initial investigation. 44 of 46 suspicious and malignant cytology cases were associated with high-grade/aggressive tumours or subsequent tumour recurrence.
Conclusion
Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for TURBT. However, it did not identify any cancers that were not already found by imaging or cystoscopy; therefore, we conclude that UC has no role in bladder cancer diagnosis.
Introduction
Despite NICE guidelines suggesting the use of urine cytology (UC) for diagnosis of bladder cancer, it is infrequently performed due to sub-optimal sensitivity, cost, and uncertainty with results interpretation, particularly atypical UC. Nevertheless, anecdotally, suspicious/malignant UC when other investigations are normal, occasionally leads to cancer diagnosis. We retrospectively assessed our haematuria patients to determine the clinical significance of atypical UC, and the number of cancer cancers identified by UC that may have been missed by standard haematuria investigations.
Patients and Methods
We identified a random sample of 500 two-week wait haematuria cases presenting to our teaching hospital/tertiary cancer centre between 2010-2016. Clinical outcome data were collected.
Results
Median follow-up was 32 months. Urological malignancy was diagnosed in 92/500 patients (bladder, renal and prostate). All bladder cancers were identified by cystoscopy or routine imaging, i.e. irrespective of UC. 0/54 atypical UC cases re-presented with a 'missed' cancer within a two-year period following initial investigation. 44 of 46 suspicious and malignant cytology cases were associated with high-grade/aggressive tumours or subsequent tumour recurrence.
Conclusion
Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for TURBT. However, it did not identify any cancers that were not already found by imaging or cystoscopy; therefore, we conclude that UC has no role in bladder cancer diagnosis.
Despite NICE guidelines suggesting the use of urine cytology (UC) for diagnosis of bladder cancer, it is infrequently performed due to sub-optimal sensitivity, cost, and uncertainty with results interpretation, particularly atypical UC. Nevertheless, anecdotally, suspicious/malignant UC when other investigations are normal, occasionally leads to cancer diagnosis. We retrospectively assessed our haematuria patients to determine the clinical significance of atypical UC, and the number of cancer cancers identified by UC that may have been missed by standard haematuria investigations.
Patients and Methods
We identified a random sample of 500 two-week wait haematuria cases presenting to our teaching hospital/tertiary cancer centre between 2010-2016. Clinical outcome data were collected.
Results
Median follow-up was 32 months. Urological malignancy was diagnosed in 92/500 patients (bladder, renal and prostate). All bladder cancers were identified by cystoscopy or routine imaging, i.e. irrespective of UC. 0/54 atypical UC cases re-presented with a 'missed' cancer within a two-year period following initial investigation. 44 of 46 suspicious and malignant cytology cases were associated with high-grade/aggressive tumours or subsequent tumour recurrence.
Conclusion
Atypical UC in the presence of negative haematuria investigations does not appear to be associated with malignancy, and therefore should not alter patient management nor prompt further investigation. Suspicious and malignant UC was associated with higher risk cancers and could therefore be used to prioritise waiting lists for TURBT. However, it did not identify any cancers that were not already found by imaging or cystoscopy; therefore, we conclude that UC has no role in bladder cancer diagnosis.
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