Is urinary tract cytology still useful for diagnosis of bladder carcinomas? A large series of 592 bladder washings using a five-category classification of different cytological diagnoses.
BACKGROUND
The aim of this study was to estimate the efficiency of a recent five-category urinary cytological classification.


METHODS
A total of 592 bladder washings were fixed immediately with Saccomanno's fixative. All samples were centrifuged in a Hettich cyto-centrifuge. For each sample, the reference standard was the histology when a lesion was present at the time of cystoscopy. A five-category cytological classification was used: negative, suspicious of low (S-Lg) or high (S-Hg) grade neoplasia and consistent with low (Lg) or high (Hg) grade neoplasia.


RESULTS
For cytological diagnoses of S-Lg and Lg, sensitivity was 37% and specificity was 95% for the histological diagnosis of low-grade non-invasive urothelial papillary tumour (Lg-UPT), which included papillary urothelial neoplasm of low malignant potential and low-grade urothelial carcinoma. For cytological diagnosis of S-Hg and Hg, sensitivity was 44% for high-grade non-invasive urothelial papillary carcinoma (Hg-UPC), 70% for carcinoma in situ (CIS) and 81% for invasive carcinoma (T1 and higher). Specificity was 99% in each case. Cytological diagnosis of S-Hg or Hg was not found for Lg-UPT (0/59) and no cytological diagnosis of S-Lg or Lg was found for invasive carcinoma, but was seen for Hg-UPC in 10% (3/28) and for CIS in 6% (3/50) of cases.


CONCLUSIONS
Despite the absence of international consensus, the recent five-category cytological classification for urine is accurate for current urological practice.
Garbar
C
C
Department of Pathology, AZ-VUB, Free University of Brussels, Brussels, Belgium. christian.garbar@az.vub.ac.be
Mascaux
C
C
Wespes
E
E
D000368:Aged; D002278:Carcinoma in Situ / Q000145:classification / Q000175:diagnosis* / Q000652:urine; D002295:Carcinoma, Transitional Cell / Q000145:classification / Q000175:diagnosis* / Q000652:urine; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D007507:Therapeutic Irrigation; D001743:Urinary Bladder / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000652:urine; D014556:Urine / Q000166:cytology