Bladder
Cytology
Cytology-general

Author: Rugvedita Parakh, M.D. (see Authors page)

Revised: 21 March 2016, last major update February 2013

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

Table of Contents
Definition / General
Definition / General
  • Cytology is useful to detect carcinoma in situ or marked chronic inflammation (i.e. when there is no specific lesion to biopsy), carcinoma hidden in diverticula, or for detecting residual tumor from urine specimens
  • Cystoscopic biopsy of visible lesions is more sensitive than cytology in most cases
  • Bladder irrigation is superior to collecting voided urine
  • Most sensitive and highly specific for high grade tumors (diagnosis or follow-up) whether flat (carcinoma in situ), papillary or mixed
  • Low sensitivity (difficult to diagnose) for papilloma and low malignant potential lesions because they have normal histology (Mod Pathol 1995;8:394)
  • Follow up examination of urine with FISH may improve sensitivity and specificity of cytology (Am J Clin Pathol 2001;116:79)


Types of specimen

Voided urine:
  • Non invasive, easiest to obtain
  • Obtaining three second “morning voided” midstream urine samples collected over three consecutive days appears to optimize the detection of urothelial malignancies

Instrumented urine:
  • Catheterization of the bladder or irrigation of bladder

Ileal conduit urine:
  • Ileal conduit and neobladder are the most common urine diversion techniques used in patients who have undergone cystectomy
  • A portion of the ileum is anastomosed with the ureters to the skin or to the urethra


Processing / preservation of specimen
  • Immediate processing is recommended or refrigerate if immediate processing cannot be done
  • If fixation if needed, use equal volumes of 50% ethanol or a methanol based fixative (Cytolyt® or similar)


Assessment of adequacy
  • Report the following parameters, if present: low cellularity, poor preservation, obscuring blood or inflammation