Urine Cytology in the Clinical Management of Bladder Cancer

Urinary tract cytology, which involves microscopic examination of exfoliated cells within a patient’s urine, continues to play an important role in the diagnosis and surveillance of urothelial malignancies. Advances in cytopathological technique as well as the advent of robust classification systems such as the Paris System have led to improvements in the diagnostic accuracy and reliability of urinary tract cytology to identify clinically significant urothelial carcinoma. Overall, urinary tract cytology has a low sensitivity and high specificity for the detection of any urothelial carcinoma of the bladder. However, when stratified by pathologic grade, urinary tract cytology has significantly higher sensitivity and specificity for high-grade disease. As such, guidelines currently support the use of urinary tract cytology in the surveillance of intermediate and high-risk urothelial carcinoma of the bladder, but not in low-risk disease. Likewise, urinary tract cytology is not recommended in the evaluation of patients with microscopic hematuria but may be considered in patients with gross hematuria. Although cystoscopy continues to be the gold standard for diagnosis and surveillance of patients with bladder cancer, urinary tract cytology can serve as a valuable and cost-effective adjunctive test, particularly in high-risk patients.

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Author information

Authors and Affiliations

  1. The James Buchannan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, MD, USA Andrew T. Gabrielson & Max R. Kates
  2. Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA Christopher J. VandenBussche
  1. Andrew T. Gabrielson