The Importance of Urine Cytology
The authors provide a good overview of the current treatment options and supplementary developments for patients with bladder carcinoma (1). ‘The specificity for low-grade and high-grade carcinomas is overall 90–100%, while sensitivity is only 20–50%’, however, is a statement cited in the article which requires further explanation for a proper understanding of the diagnostic value of urine cytology in the management of patients with bladder carcinoma.
According to current statistical information provided by Rosenthal et al. in 2016 (2) and Rathert et al. in 2018 (3), these percentages should be corrected. The sensitivity of urine cytology in patients with prognostically important high-grade tumor (previously G3) has been reported to be over 90%. Unfortunately, statistical pooling of the sensitivity in high-grade tumors with that in low-grade tumors (about 30%) is a practice, which, although common in studies, does not do justice to the high value of urine cytology. This pooling is not useful. The new classification, the Paris system (2), takes this into consideration.
As the only urine-based examination recommended in an S3-level clinical practice guideline, the method of urine cytology (which can be performed by both pathologists and trained urologists) is of particular importance as a contactless screening and aftercare method as well as for the differential diagnostic evaluation of hematuria in the context of the contact restrictions related to the current corona pandemic.
Delayed diagnosis of bladder or urothelial carcinomas and omission of or failure to order urine cytology has led to the filing of expert commission applications (4) and should be avoided.
By offering sensitive cytological detection or exclusion of (high-grade) urothelial carcinoma, urine cytology ensures that patients in whom cystoscopy cannot be performed at that time or only with delay receive safe medical care, without delaying the detection of bladder and urothelial carcinomas with the highest relevance for prognosis.
Dr. med. Ines Rathert
Institut für Urinzytologie, Klinik für Urologie und Kinderurologie,
Urologische Onkologie, Akademisches Lehrkrankenhaus, Düren, Germany
Conflict of interest statement
The author declares no conflict of interest.
|1.||de Wit M, Retz MM, Rödel C, Gschwend JE: The diagnosis and treatment of patients with bladder carcinoma. Dtsch Arztebl Int 2021; 118: 169–76 VOLLTEXT|
|2.||Rosenthal DL, Wojcik EM, Kurstycz: The paris system for reporting urinary cytology. Berlin, Heidelberg: Springer International 2016; p. 73.|
|3.||Rathert P, Roth S; Hakenberg O, Neuendorf J: Urinzytologie und Sedimentanalyse. 5th edition. Berlin, Heidelberg: Springer 2018; p. 2.|
|4.||Lent V, Baumbusch F, Hannappel J: Versäumnisse bei der Diagnostik des Harnblasenkarzinoms. Rheinisches Ärzteblatt 2009; 9: 24–5.|