The usefulness of urinary cytology testing in the evaluation of irritative voiding symptoms.
OBJECTIVE
The purpose of this study was to assess the clinical usefulness of urinary cytology testing for the evaluation of urothelial cancer in women with irritative voiding symptoms who were examined at a urogynecology service.


METHODS
Urinary cytology studies results that were obtained from January 1, 2000, to December 31, 2002, were cross-matched with the Rhode Island Department of Health Cancer Registry to identify those women who were diagnosed with urinary tract malignancies. The prevalence of urothelial cancer was determined, and the sensitivity, specificity, and positive and negative predictive values of urinary cytologic testing were calculated for 2 common classification strategies: (1) consideration of atypical cytologic test results to be normal and (2) consideration of atypical cytologic test results to be abnormal.


RESULTS
Among 1516 cross-matched cytologic test results from 1324 patients, 5 urothelial cancers were identified. Two of the 5 malignancies were associated with positive cytology results. The prevalence of urothelial cancer was 0.38% (95% CI, 0.1%, 0.9%). When atypical cytology studies were classified as normal, the sensitivity of urinary cytology was 40% (95% CI, 7.2%, 83.0%); the specificity was 99.9% (95% CI, 99.5%, 100%); the positive predictive value was 66.7% (95% CI, 12.5%, 98.2%), and negative predictive value was 99.8% (95% CI, 99.2%, 100%). In contrast, when atypical cytology results were classified as abnormal, the sensitivity and negative predictive value remained the same, but the specificity declined to 93.6% (95% CI, 92.1%, 94.8%), and the positive predictive value decreased to 2.3% (95% CI, 0.4%, 8.8%).


CONCLUSIONS
The low prevalence of urothelial cancers and low sensitivity of urinary cytology studies severely limit the usefulness of this test in the evaluation of women with irritative voiding symptoms.
Sokol
Eric R
ER
Department of Obstetrics and Gynecology, Division of Urogynecology and Pelvic Reconstructive Surgery, Women and Infants Hospital, Brown Medical School, Providence, RI, USA. ericsokol@yahoo.com
Patel
Sutchin R
SR
Clemons
Jeffrey L
JL
Sung
Vivian W
VW
Rardin
Charles R
CR
Myers
Deborah L
DL
D016001:Confidence Intervals; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014555:Urination Disorders / Q000473:pathology* / Q000652:urine*; D014556:Urine / Q000166:cytology; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000473:pathology*