Is it necessary to perform urine cytology in screening patients with haematuria?

UNLABELLED

All patients with gross haematuria and those older than 50 years with microscopic haematuria need investigations to rule out the presence of a urological malignancy.

OBJECTIVE

To study the role of urine cytology in the evaluation of patients with haematuria.

METHODS

Two hundred and eighty-five patients were evaluated. All patients underwent evaluation including urine cytology, flexible cystoscopy, ultrasonography and/or IVU.

RESULTS

The mean age of the patients was 62.4 years. Sixty-five percent had gross and 35% microscopic haematuria. Fifty-five tumours were discovered (19.2%); of these 48 were transitional cell carcinomas, 3 renal cell carcinomas and 3 carcinomas of the prostate. Thirty-seven urinary cytologies were abnormal. The overall sensitivity of urinary cytology was 42.4% and specificity 94.3%. Of 18 patients with positive cytology, all were found to have transitional cell carcinomas on cystoscopy or imaging. Of 19 patients with suspicious cytologies, only 6 were found to have tumours. The remaining 13 patients had no evidence of tumour on combined upper tract imaging (IVU and ultrasound) or on rigid cystoscopy and bladder biopsy. Whilst all the other investigation modalities contributed to diagnoses (and/or exclusion of tumours), no additional tumours were discovered solely by urinary cytology. A moderate cost saving could be made without compromising diagnostic accuracy.

CONCLUSION

Our study suggests that performing routine urine cytology is not relevant in the investigation of patients with haematuria, its role is at best supportive.