Monitoring patients for bladder neoplasms: What can be expected of urinarycytology consultations in clinical practice

Objectives. To determine what practitioners could reasonably expect from ur inary cytology (UC) consultations by analyzing their role in our clinical p ractice. Methods. Reports of 227 consecutive interpretations on 130 patients collect ed during a 13-month period were correlated with all available follow-up in formation. Results. In our practice, UC consultations can predict the presence of blad der carcinoma in nearly 90% of patients, the major mitigating factor being the absence of tumor cells in specimens from patients harboring bladder neo plasms. High-grade neoplasms are most reliably detected with UC. Very low g rade neoplasms are difficult to detect, primarily because the cells of thes e lesions lack features of carcinoma. Significant interobserver variation d id not occur. Conclusions. Pathology consultations based on UC can be associated with hig h diagnostic yields provided that certain factors are understood. These inc lude that (a) the clinical import of diagnostic terms may vary among observ ers and should be mutually understood in individual practice settings; (b) UC specimens may not contain tumor cells even when patients have bladder ca ncer; (c) correlative information may be difficult to obtain and thus seem to inflate calculations for false-positive results; (d) interobserver varia tion can be reduced if cytopathologists use limited and uniform diagnostic terms; and (e) a high level of diagnostic expertise from cytopathologists s hould be expected. UROLOGY 54: 62-66, 1999. (C) 1999, Elsevier Science Inc.