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Open Access Highly Accessed Research article

Utility of serial urinary cytology in the initial evaluation of the patient with microscopic hematuria

Kogenta Nakamura1, Ali Kasraeian4, Kenneth A Iczkowski2, Myron Chang3, John Pendleton1, Satoshi Anai1 and Charles J Rosser1*

Author Affiliations

1 Division of Urology, The University of Florida, Jacksonville, Florida, USA

2 Department of Pathology, The University of Florida, Gainesville, Florida, USA

3 Department of Epidemiology and Health Policy Research, The University of Florida, Gainesville, Florida, USA

4 Department of Urology, The University of Florida, Gainesville, Florida, USA

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BMC Urology 2009, 9:12  doi:10.1186/1471-2490-9-12

Published: 10 September 2009

Abstract

Background

We determine the utility of serial urinary cytologies in patients presenting with microscopic hematuria who were evaluated with upper and lower urinary tract studies to rule out a malignancy.

Methods

Two hundred and thirty-seven patients with the diagnosis of microscopic hematuria were evaluated at an inner-city tertiary care hospital. Of these 239 patients, 182 patients had 405 cytologies obtained as part of their evaluation for hematuria. In addition, all patients had their lower urinary tract and upper tract thoroughly evaluated.

Results

Two hundred and seventy four cytology samples were read as normal, 104 (26%) as atypia, 7 (2%) as suspicious/malignant, and 20 (5%) as unsatisfactory. Seventeen patients (9.3%) had biopsy confirmed bladder cancer. Of these 17 patients, 2 had normal cytology, 11 had atypia, and 5 had suspicious/malignant. No patient had a positive cytology and a negative biopsy. Overall the number of hematuric patients harboring bladder cancer was small (7%). Cytology #1 detected 4 cases of cancer, cytology #2 detected an additional case and cytology #3 did not detect any additional cancers.

Conclusion

Because of this low prevalence of bladder cancer in patients presenting with microscopic hematuria and the low sensitivity of detecting bladder cancers, the utility of urinary cytology in the initial evaluation of patients with hematuria may be minimal. The exact role of urinary cytology in the evaluation of hematuria is unknown.