Does urinary cytology have a role in haematuria investigations?

作者：Wei Shen Tan, Rachael Sarpong, Pramit Khetrapal, Simon Rodney, Hugh A. Mostafid, Joanne Cresswell, Dawn Watson, Abhay Rané, James B Hicks, Giles O. Hellawell, Melissa Clare Davies, Shalom J. Srirangam, Louise Dawson, David G. Payne, Norman R. Williams, Chris Brew‐Graves, Andrew Feber, John D. Kelly, DETECT I trial collaborators · 发表于：British Journal of Urology · 年份：2018 · DOI：10.1111/bju.14459 · 被引用次数：45 · 研究领域：Bladder and Urothelial Cancer Treatments、Urinary and Genital Oncology Studies、Urinary Tract Infections Management

OBJECTIVES: To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. PATIENT AND METHODS: The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub-analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. RESULTS: Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3-33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed acco...