Document Detail

Utility of urine cytology in the workup of asymptomatic microscopic hematuria in low-risk patients.
MedLine Citation:
PMID:  20138655     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To evaluate performance and cost-effectiveness of voided cytology in patients with pure asymptomatic microscopic hematuria (AMH). Although voided cytology has been validated for use in patients with a history of urothelial carcinoma (UC), its use in low-risk patients with AMH is controversial.
METHODS: A total of 200 consecutive low-risk patients (median age, 64 years) with AMH were referred to the urology clinic between 2005 and 2007. All underwent cystoscopy, upper tract imaging, and voided urinary cytology. Results of voided cytology were classified as positive, atypical, or negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and costs were calculated.
RESULTS: None had positive cytology, 23 (11.5%) had atypical cytology, and 177 (88.5%) had negative urinary cytology. Of 200 patients, 8 (4%) were found to have low-grade UC of bladder via cystoscopy; the cytology was negative in 4 patients and atypical in 4. Of 8, 4 were Ta and 4 were pT1 tumors. There was no upper urinary tract or renal malignancy identified. If atypical cytology was considered as positive, the sensitivity, specificity, PPV, and NPV of cytology were 50%, 90%, 17%, and 98%, respectively. If atypical cytology was considered as negative, the sensitivity, specificity, PPV, and NPV of cytology were 0%, 100%, 0%, and 96%, respectively. Cost of performing urinary cytology was estimated at $262.50 per patient.
CONCLUSIONS: Although this study supports evaluating patients with AMH because a significant percentage of patients will have UC, voided urine cytology added a significant cost without any diagnostic benefit in the work-up of low-risk patients with AMH.
Andrew H Feifer; Jordan Steinberg; Simon Tanguay; Armen G Aprikian; Fadi Brimo; Wassim Kassouf
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-02-07
Journal Detail:
Title:  Urology     Volume:  75     ISSN:  1527-9995     ISO Abbreviation:  Urology     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-01     Completed Date:  2010-06-25     Revised Date:  2011-03-08    
Medline Journal Info:
Nlm Unique ID:  0366151     Medline TA:  Urology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1278-82     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Elsevier Inc. All rights reserved.
Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
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MeSH Terms
Aged, 80 and over
Ambulatory Care
Cohort Studies
Confidence Intervals
Cystoscopy / methods
Cytodiagnosis / utilization
Diagnostic Imaging / methods
Hematuria / diagnosis*,  urine*
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Tomography, X-Ray Computed
Urinalysis / methods
Urinary Bladder Neoplasms / diagnosis,  urine
Urine / cytology*
Urologic Diseases / diagnosis,  urine
Comment In:
Urology. 2011 Feb;77(2):513-4   [PMID:  21295261 ]
Urology. 2010 Jun;75(6):1282; author reply 1282-3   [PMID:  20513488 ]
Urology. 2010 Jun;75(6):1283; author reply 1283-4   [PMID:  20513490 ]

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