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Cytology Limits Seen in Low-Risk Patients With Hematuria

Urine cytology adds cost without diagnostic benefit in low-risk asymptomatic microscopic hematuria

THURSDAY, June 24 (HealthDay News) -- During evaluation of low-risk patients with asymptomatic microscopic hematuria (AMH), voided urine cytology is associated with a substantial cost without providing a diagnostic benefit, according to research published in the June issue of Urology.

Andrew H. Feifer, M.D., of McGill University in Montreal, and colleagues analyzed data from 200 nonsmoking AMH patients without risk factors for urothelial carcinoma who underwent cystoscopy, upper tract imaging, and voided urinary cytology.

The researchers found that none of the patients had positive cytology, and 23 had atypical cytology. Eight patients had low-grade urothelial carcinoma of the bladder on cystoscopy, and the cytology was negative in four of these patients and atypical in four. When the atypical cytology was considered positive, the sensitivity, specificity, and positive and negative predictive value of cytology were 50, 90, and 17 and 98 percent, respectively. When considered negative, these measurements were 0, 100, and 0 and 96 percent, respectively. The cytology cost an estimated $262.50 per patient.

"The American Urological Association (AUA) Best Practice Policy recommends cystoscopy for all adults aged >40 years with microscopic hematuria and for those aged <40 years with risk factors for developing bladder cancer. There are several issues that need to be considered before modifying evaluation of patients with AMH, [such as] how are urologists to be assured that they did not miss lesions if they do not use cytology? The sensitivity of cystoscopy is not 100 percent," writes the author of one of two accompanying editorials. In one of two replies, the study authors note that "avoiding unnecessary investigation without affecting care is paramount. Although we support the use of AUA recommendations for AMH, which are designed to minimize under diagnosis, our series underscores the unproven nature of cytology in this specific population."

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