The fate of an unsatisfactory urine cytology test among patients with urothelial carcinoma.
OBJECTIVE
To determine the outcome of patients with a urinary cytology test that is unsatisfactory (UUCyt) for evaluation (<50 urothelial cells) to guide the clinical decision-making process, as currently there are no guidelines to aid in interpreting this result and directing further investigations.


METHODS
We retrospectively reviewed 142 patients, with 265 instances of UUCyt, in our bladder cancer database and by chart review. The cytology, cystoscopy and pathology results in the subsequent 12 months after a UUCyt result were reviewed, and the incidence of new and recurrent genitourinary tract cancers was calculated.


RESULTS
All patients had a previous history of, or developed, urothelial carcinoma during the follow-up. There were 41 instances (16.3%) in which bladder cancer was evident at the time of the UUCyt and 29% of these tumours were high-grade. There were another 44 instances (17.5%) in which new or recurrent bladder cancer developed in the subsequent year after a UUCyt test, and many (38.6%) of these tumours were high-grade.


CONCLUSIONS
The incidence of urothelial carcinoma after a UUCyt was high (33.9%) with a substantial number of high-grade (34%) tumours, implying that a UUCyt result cannot be interpreted as negative for malignancy. Therefore, in these cases, the urologist must depend on cystoscopy to make a diagnosis.
Ordon
Michael
M
Department of Pathology, University Health Network, Toronto, Canada. michael.ordon@utoronto.ca
Boerner
Scott
S
Zlotta
Alexandre R
AR
Jewett
Michael A
MA
Fleshner
Neil
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000652:urine; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D003558:Cystoscopy / Q000379:methods*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D019459:Urothelium / Q000473:pathology
D014408:Biomarkers, Tumor