The fate of an unsatisfactory urine cytology test among patients with urothelial carcinoma

OBJECTIVE: To determine the outcome of patients with a urinary cytology test that is unsatisfactory (UUCyt) for evaluation (<50 urothelial cells) to guide the clinical decision-making process, as currently there are no guidelines to aid in interpreting this result and directing further investigations. PATIENTS AND METHODS: We retrospectively reviewed 142 patients, with 265 instances of UUCyt, in our bladder cancer database and by chart review. The cytology, cystoscopy and pathology results in the subsequent 12 months after a UUCyt result were reviewed, and the incidence of new and recurrent genitourinary tract cancers was calculated. RESULTS: All patients had a previous history of, or developed, urothelial carcinoma during the follow-up. There were 41 instances (16.3%) in which bladder cancer was evident at the time of the UUCyt and 29% of these tumours were high-grade. There were another 44 instances (17.5%) in which new or recurrent bladder cancer developed in the subsequent year after a UUCyt test, and many (38.6%) of these tumours were high-grade. CONCLUSION: The incidence of urothelial carcinoma after a UUCyt was high (33.9%) with a substantial number of high-grade (34%) tumours, implying that a UUCyt result cannot be interpreted as negative for malignancy. Therefore, in these cases, the urologist must depend on cystoscopy to make a diagnosis.