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Urine Cytology in the Clinical Management of Bladder Cancer

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Comprehensive Diagnostic Approach to Bladder Cancer

Abstract

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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References

  1. Flezar MS. Urine and bladder washing cytology for detection of urothelial carcinoma: standard test with new possibilities. Radiol Oncol. 2010;44(4):207–14.

    Article  Google Scholar 

  2. Brown FM. Urine cytology. It is still the gold standard for screening? Urol Clin North Am. 2000;27(1):25–37.

    Article  CAS  Google Scholar 

  3. Papanicolaou GN, Marshall VF. Urine sediment smears as a diagnostic procedure in cancers of the urinary tract. Science. 1945;101(2629):519–20.

    Article  CAS  Google Scholar 

  4. Owens CL, Vandenbussche CJ, Burroughs FH, Rosenthal DL. A review of reporting systems and terminology for urine cytology. Cancer Cytopathol. 2013;121(1):9–14.

    Article  Google Scholar 

  5. Pierconti F, Rossi ED, Straccia P, Fadda G, Larocca LM, Bassi PF, et al. The risk of malignancy of atypical urothelial cells of undetermined significance in patients treated with chemohyperthermia or electromotive drug administration. Cancer Cytopathol. 2018;126(3):200–6.

    Article  CAS  Google Scholar 

  6. Zhang ML, Rosenthal DL, VandenBussche CJ. The cytomorphological features of low-grade urothelial neoplasms vary by specimen type. Cancer Cytopathol. 2016;124(8):552–64.

    Article  CAS  Google Scholar 

  7. VandenBussche CJ. A review of the Paris system for reporting urinary cytology. Cytopathology. 2016;27(3):153–6.

    Article  CAS  Google Scholar 

  8. Cowan ML, VandenBussche CJ. The Paris system for reporting urinary cytology: early review of the literature reveals successes and rare shortcomings. J Am Soc Cytopathol. 2018;7(4):185–94.

    Article  Google Scholar 

  9. Murphy WM, Crabtree WN, Jukkola AF, Soloway MS. The diagnostic value of urine versus bladder washing in patients with bladder cancer. J Urol. 1981;126(3):320.

    Article  CAS  Google Scholar 

  10. Wegelin O, Bartels DWM, Tromp E, Kuypers KC, van Melick HHE. The effects of instrumentation on urine cytology and CK-20 analysis for the detection of bladder cancer. Urology. 2015;86(4):772–6.

    Article  Google Scholar 

  11. McVey RJ, Persad RV, Brown SC, Robinson E, Payne SR. How long is urinary cytology abnormal after flexible cystoscopy? BJU Int. 2004;94(4):548–51.

    Article  Google Scholar 

  12. Todenhöfer T, Hennenlotter J, Kühs U, Tews V, Gakis G, Aufderklamm S, et al. Influence of urinary tract instrumentation and inflammation on the performance of urine markers for the detection of bladder cancer. Urology. 2012;79(3):620–5.

    Article  Google Scholar 

  13. Frees S, Bidnur S, Metcalfe M, Raven P, Chavez-Munoz C, Moskalev I, et al. Effect of contrast media on urinary cytopathology specimens. Can Urol Assoc J = Journal de l'Association des urologues du Canada. 2016;10(7–8):228–33

    Google Scholar 

  14. Knapik JA, WM Murphy. Urethral wash cytopathology for monitoring patients after cystoprostatectomy with urinary diversion. Cancer. 2003;99(6):352–6.

    Google Scholar 

  15. Chan Y, Fisher P, Tilki D, Evans CP. Urethral recurrence after cystectomy: current preventative measures, diagnosis and management. BJU Int. 2016;117(4):563–9.

    Google Scholar 

  16. Sherwood JB, Sagalowsky AI. The diagnosis and treatment of urethral recurrence after radical cystectomy. Urol Oncol. 2006;24(4):356–61.

    Google Scholar 

  17. Clark PE, Hall MC. Contemporary management of the urethra in patients after radical cystectomy for bladder cancer. Urol Clin North Am. 2005;32(2):199–206.

    Google Scholar 

  18. Lin DW, Herr HW, Dalbagni G. Value of urethral wash cytology in the retained male urethra after radical cystoprostatectomy. J Urol. 2003;169(3):961–3.

    Google Scholar 

  19. Boorjian SA, Kim SP, Weight CJ, Cheville JC, Thapa P, Frank I. Risk factors and outcomes of urethral recurrence following radical cystectomy. Eur Urol. 2011;60(6):1266–72.

    Google Scholar 

  20. VandenBussche CJ, Rosenthal DL, Olson MT. Adequacy in voided urine cytology specimens: the role of volume and a repeat void upon predictive values for high-grade urothelial carcinoma. Cancer Cytopathol. 2016;124(3):174–80.

    Article  Google Scholar 

  21. Jubber I, Shariat SF, Conroy S, Tan WS, Gordon PC, Lotan Y, et al. Non-visible haematuria for the detection of bladder, upper tract, and kidney cancer: an updated systematic review and meta-analysis. Eur Urol. 2020;77(5):583–98.

    Google Scholar 

  22. Farrow GM. Urine cytology in the detection of bladder cancer: a critical approach. J Occup Med. 1990;32(9):817–21.

    Google Scholar 

  23. Grossman HB, Soloway M, Messing E, Katz G, Stein B, Kassabian V, et al. Surveillance for recurrent bladder cancer using a point-of-care proteomic assay. JAMA. 2006;295(3):299–305.

    Google Scholar 

  24. Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol. 2016;196(4):1021–9.

    Google Scholar 

  25. Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, et al. Does urinary cytology have a role in haematuria investigations? BJU Int. 2019;123(1):74–81.

    Google Scholar 

  26. Garbar C, Mascaux C, E W. 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. Cytopathology. 2007;18(2):79–83.

    Google Scholar 

  27. Halling KC, King W, Sokolova IA, Meyer RG, Burkhardt HM, Halling AC, et al. A comparison of cytology and fluorescence in situ hybridization for the detection of urothelial carcinoma. J Urol. 2000;164(5):1768–75.

    Google Scholar 

  28. Moonen PM, Merkx GF, Peelen P, Karthaus HF, Smeets DF, Witjes JA. UroVysion compared with cytology and quantitative cytology in the surveillance of non-muscle-invasive bladder cancer. Eur Urol. 2007;51(5):1275–80.

    Google Scholar 

  29. Strittmatter F, Buchner A, Karl A, Sommer M-L, Straub J, Tilki D, et al. Individual learning curve reduces the clinical value of urinary cytology. Clin Genitourin Cancer. 2011;9(1):22–6.

    Article  Google Scholar 

  30. Barocas DA, Boorjian SA, Alvarez RD, Downs TM, Gross CP, Hamilton BD, et al. Microhematuria: AUA/SUFU guideline. J Urol. 2020;204(4):778.

    Google Scholar 

  31. NICE. 2020 Surveillance of suspected cancer: recognition and referral (NICE guideline NG12). 2020.

    Google Scholar 

  32. Kassouf W, Aprikian A, Black P, Kulkarni G, Izawa J, Eapen L, et al. Recommendations for the improvement of bladder cancer quality of care in Canada: a consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015. Can Urol Assoc J = Journal de l'Association des urologues du Canada. 2016;10(1–2):E46–E80.

    Google Scholar 

  33. Mishriki SF, Aboumarzouk O, Vint R, Grimsley SJ, Lam T, Somani B. Routine urine cytology has no role in hematuria investigations. J Urol. 2013;189(4):1255–8.

    Google Scholar 

  34. Sutton JM. Evaluation of hematuria in adults. JAMA. 1990;263(18):2475–80.

    Article  CAS  Google Scholar 

  35. Chang SS, Bochner BH, Chou R, Dreicer R, Kamat AM, Lerner SP, et al. Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO guideline. J Urol. 2017;198(3):552–9.

    Google Scholar 

  36. Palou J, Brausi M, Catto JWF. Management of patients with normal cystoscopy but positive cytology or urine markers. Euro Urol Oncol. 2020;3(4):548–54.

    Google Scholar 

  37. Daneshmand S, Schuckman AK, Bochner BH, Cookson MS, Downs TM, Gomella LG, et al. Hexaminolevulinate blue-light cystoscopy in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on appropriate use in the USA. Nat Rev Urol. 2014;11(10):589–96.

    Google Scholar 

  38. Witjes JA, Babjuk M, Gontero P, Jacqmin D, Karl A, Kruck S, et al. Clinical and cost-effectiveness of hexaminolevulinate-guided blue-light cystoscopy: evidence review and updated expert recommendations. Eur Urol. 2014;66(5):863–71.

    Google Scholar 

  39. Palou J, Sylvester RJ, Faba OR, Parada R, Peña JA, Algaba F, et al. Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with bacillus Calmette-Guérin. Eur Urol. 2012;62(1):118–25.

    Google Scholar 

  40. Herr HW, SM D. Prostatic tumor relapse in patients with superficial bladder tumors: 15-year outcome. J Urol. 1999;161(6):1854–7.

    Google Scholar 

  41. Herr HW. Extravesical tumor relapse in patients with superficial bladder tumors. J Clin Oncol Off J Am Soc Clin Oncol. 1998;16(3):1099–102.

    Google Scholar 

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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

Authors
  1. Andrew T. Gabrielson
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  2. Christopher J. VandenBussche
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  3. Max R. Kates
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Correspondence to Max R. Kates .

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Editors and Affiliations

  1. Department of Urology, Lineberger Comprehensive Cancer Center & University of North Carolina, Chapel Hill, NC, USA

    Marc A. Bjurlin

  2. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Richard S. Matulewicz

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Gabrielson, A.T., VandenBussche, C.J., Kates, M.R. (2021). Urine Cytology in the Clinical Management of Bladder Cancer. In: Bjurlin, M.A., Matulewicz, R.S. (eds) Comprehensive Diagnostic Approach to Bladder Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-82048-0_9

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  • DOI: https://doi.org/10.1007/978-3-030-82048-0_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-82047-3

  • Online ISBN: 978-3-030-82048-0

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