Urine cytology is of little clinical value in detecting urothelial cancers and should not be used routinely for first-line investigations of hematuria, according to a study published in the April issue of the Journal of Urology. The authors call for removal of urine cytology from current clinical hematuria guidelines. The U.K. researchers analyzed data from 2,778 consecutive patients investigated for hematuria at a teaching hospital (January 1999 to September 2007). Patients underwent standard hematuria investigations including upper tract imaging (ultrasound and subsequent excretory urogram [IVP] or computerized tomography urogram, if necessary) and cystoscopy. Cytology findings were classified as negative (76.4 percent), malignant cells identified (4.5 percent; 124 patients), atypical/suspicious cells identified (9.4 percent; 260 patients), or unsatisfactory specimen (2.3 percent). In the analysis, suspicious and atypical cytology were combined with malignant samples. In this study, the sensitivity for diagnosing urothelial carcinoma was 45.4 percent and the specificity was 89.5 percent with a false-positive rate of 10.5 percent, a false-negative rate of 54.6 percent, a positive predictive value of 40.9 percent, and a negative predictive value of 89.5 percent. Of the 2,778 patients, only two had a negative cystoscopy, ultrasound, and IVP with a positive cytology that was eventually diagnosed as […]
Urine cytology is of little clinical value in detecting urothelial cancers and should not be used routinely for first-line investigations of hematuria, according to a study published in the April issue of the Journal of Urology. The authors call for removal of urine cytology from current clinical hematuria guidelines.
The U.K. researchers analyzed data from 2,778 consecutive patients investigated for hematuria at a teaching hospital (January 1999 to September 2007). Patients underwent standard hematuria investigations including upper tract imaging (ultrasound and subsequent excretory urogram [IVP] or computerized tomography urogram, if necessary) and cystoscopy. Cytology findings were classified as negative (76.4 percent), malignant cells identified (4.5 percent; 124 patients), atypical/suspicious cells identified (9.4 percent; 260 patients), or unsatisfactory specimen (2.3 percent). In the analysis, suspicious and atypical cytology were combined with malignant samples.
In this study, the sensitivity for diagnosing urothelial carcinoma was 45.4 percent and the specificity was 89.5 percent with a false-positive rate of 10.5 percent, a false-negative rate of 54.6 percent, a positive predictive value of 40.9 percent, and a negative predictive value of 89.5 percent. Of the 2,778 patients, only two had a negative cystoscopy, ultrasound, and IVP with a positive cytology that was eventually diagnosed as urothelial carcinoma, meaning only two patients benefited from urine cytology.
“However, in the era of cost conscious medicine these rare and anecdotal cases cannot justify the routine use of a test with such a limited net contribution,” writes Badar M. Mian, from the Stratton VA Medical Center in Albany N.Y., in an accompanying editorial.
The authors argue that urine cytology is not cost-effective in a low-risk population both for the cost of the test itself as well as the additional costs associated with false positives. Based on European estimates, the cost of urine cytology is approximately $61 per test. The further invasive endoscopic assessment, repeat cytology, and radiological upper tract imaging costs resulting from false positives total an estimated $18,400 per patient.
