The significance of atypical urine cytology in the face of normal investigations—Is extended investigation and follow-up required?

Summary 

Objective

To examine the natural history of patients identified with atypical urine cytology in the face of normal investigations, and thus provide guidance on the need for extended follow-up and investigation of such patients.

Patients and methods

All patients identified over a 2-year period to have atypical urine cytology on Cytospin analysis and Papanicolaou staining were audited over a 5-year follow-up period. Clinical records, histopathology and radiology databases were independently searched. Patients were intensively investigated with cystoscopy and a range of upper tract imaging.

Results

126 patients were identified to have atypical urine cytology, and 77 of these had no urothelial tumour found. In these normal patients, only 12/48 who had further samples taken showed persistent atypia. 11/77 normal patients had another urological pathology which may have explained their atypical urine cytology. No patient presenting for the first time later went on to develop urothelial malignancy in the face of negative initial investigations.

Conclusion

In the group of patients in which cystoscopy and urography show no urothelial malignancy, the finding of atypical urinary cytology does not predict the development of later urothelial tumour, and does not require prolonged follow-up, repeat cytological testing or further imaging.

Keywords: Urine cytology, Atypia, TCC, Bladder cancer