Current Practice of Urinary Bladder Cytology

Summary

Six years of experience with the cytological diagnosis of carcinoma of the urinary tract are reviewed. This includes 2 years of participation in the National Bladder Cancer Project. With increasing experience of the cytopathologist and cytotechnologist, attention to detail of specimen collection and preparation, the increasing use of bladder washing and cystoscopic urine specimen, and the interest and cooperation of the urologist, the false-positive rate of diagnosis of transitional cell carcinoma of the urinary tract has decreased.

Papillomas and low-grade papillary, noninvasive transitional cell carcinomas have proven impossible to diagnose by cytology alone but may be diagnosed rarely from cell block material prepared from the bladder washings. A residual of cases of chronic cystitis, benign prostatic hyperplasia, renal calculi, chemotherapy effects, and cancer-associated atypias provide the cytopathologist with diagnostic problems, since they remain nearly inseparable from transitional cell carcinoma on the basis of cytology alone.

Cytology has proven sensitive to the detection of recurrent and persistent transitional cell carcinoma following treatment with chemotherapy, radiation, or surgery. In such cases the abnormal area of epithelium in the bladder may be extremely difficult for the urologist to find by biopsy. He should not be lulled by a normal-appearing bladder and negative biopsies in these cases into believing that the cytology report is incorrect.