Clinical Scenario: Microscopic Hematuria and Atypical Cytology
A 68-year-old man who was a former cigarette smoker was found to have atypical/suspicious cells on urinary cytology obtained during a work up for microscopic hematuria. Imaging (presumably a CT urogram) and cystoscopy did not identify an obvious tumor. He has three risk factors for urothelial cancer (UC): male, smoking history, and hematuria. The absence of a cytology that indicates “positive for cancer cells” is most important. Close follow-up by repeat cytology and possibly cystoscopy is reasonable but we would not proceed with bladder or prostatic urethra biopsies, upper tract cytology, ureteroscopy, or submitting the urine for the FISH analysis unless cells consistent with cancer are identified by an experienced cytopathologist. Such investigative procedures for an atypical report would, in our view, subject the patient to potential morbidity with a low likelihood of identifying a UC.
KeywordsBladder cancer Urinary cytology Hematuria Cigarette smoking
- 6.Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA Guideline. 2012.Google Scholar
- 16.Layfield LJ, Elsheikh TM, Fili A, Nayar R, Shidham V. Papanicolaou Society of Cytopathology. Review of the state of the art and recommendations of the Papanicolaou Society of Cytopathology for urinary cytology procedures and reporting : the Papanicolaou Society of Cytopathology Practice Guidelines Task Force. Diagn Cytopathol. 2004;30:24–30.PubMedCrossRefGoogle Scholar
- 20.Stenberg I, Rona R, Olsfanger S, Lew S, Leibovitch I. The clinical significance of class III (suspicious) urine cytology. Cytopathol Off J Br Soc Clin Cytol. 2011;329–33.Google Scholar