Urine cytology is a test to look for abnormal cells in your urine. It looks at the cells under a microscope. It's used with other tests and procedures to diagnose urinary tract cancers, most often bladder cancer.
Your doctor might recommend a urine cytology test if you have blood in your urine (hematuria).
For people who've been diagnosed with bladder cancer and have undergone treatment, a urine cytology test can help detect a recurrence.
Every time you have a cystoscopy (a scope of your bladder) you can expect that a urine cytology will be run as well. When your doctor is doing the cystoscopy they will spray saline in your bladder, pull out urine and spray it back in again. They will try and agitate the cells in the lining of the bladder. They want to get as many cells in the sample as possible, so if there are any cancer cells, it would be obvious to find them.
Your doctor is doing this usually without you even realizing he/she is. It doesn't hurt at all, and it's done very quickly.
Why is it Done?
Urine cytology is used with other tests and procedures to diagnose cancers of the urinary tract, including:
- Bladder cancer
- Kidney cancer
- Cancer of the ureter
- Cancer of the urethra
Urine cytology can best detect larger and more-aggressive urinary tract cancers. It might not detect small urinary tract cancers that grow more slowly.
What do the Test Results Mean?
Because I've had so many cysto's I'm getting much better at understanding the results of a urine cytology.
My latest one said:
"Negative for high-grade urothelial carcinoma. Urothelial cells without diagnostic abnormality."
So it's saying that there are no cancer cells found that are high grade (also known as grade 3). Urothelial carcinoma is another name for stage 0 bladder cancer cells (called Ta or CIS). These cells are only found in the first layer, or lining of the bladder wall, called the urothelium layer or transitional epithelium.
In other words this is saying it's clear, kind of.
Although the urine cytology was negative for high grade cancer cells, during the cystoscopy we found new tumors 😢 A 14 month battle with bladder cancer, and we have to start this whole thing over. I can't even begin to tell you how disappointing this is.
My urologist oncologist, Dr. Liam McLeod, left a note about it in my patient portal "No high grade cancer cells were found - it is possible your recurrence is low grade which does not show up well in cytology, we will know more when your pathology is back."
That is better news hopefully. The fact they didn't pick up high grade cells will hopefully mean that I don't have any high grade tumors growing, including CIS high grade tumors. My pathology will come back next week, and I'll find out more information.
Another cytology result:
"Negative for high-grade urothelial carcinoma. Urothelial cells with reactive features."
What is reactive features? That sounds worrisome. My awesome doctor left me a note about this as well: " Reactive features means inflammation. No cancer in the urinary cells. Good news."
I love my doctor, and the fact that he takes the time to write a note with these results to help me understand them better. The inflammation in my bladder is from all the BCG irritating the hell out of my bladder. That is totally normal and expected.
This the the cytology result from the first cysto after doing BCG for 6 weeks.
"Negative for high-grade urothelial carcinoma. Please see comment...... Comment: Although no diagnostic abnormality is identified, the Paris System for Urinary Cytology Reporting establishes cellularity standards for instrumented urines to help minimize the risk of a false negative study. This sample falls below that cellularity standard. Repeat collection may be considered."
This one really threw me for a loop. The next time I went in to talk with Dr. McLeod I asked him if we needed to get a repeat cytology, because there were not enough cells in the sample.
He told me this is a normal result, and really good news in fact.
My urologist did a fellowship specializing in urology oncology. During that time he was part of a study that looked at urine cytology and CIS tumors. They wanted to know how accurate the test was in catching CIS tumor cells, especially after washing out the bladder, and removing all the urine in the bladder, and taking another sample.
Meaning, there should be a lot less of any cancer cells in there, and maybe the test would not be able to catch them.
The results were really interesting! He said they did 3 washes in the bladder with these patients that had a CIS tumor (high grade, stage 0 bladder cancer). ALL 3 washes showed cells in the urine cytology.
So what does that mean? It means that these tests are REALLY awesome at picking up urology high grade cancer cells.
So Dr. McLeod explained to me that we didn't need to repeat the test, because if they didn't find enough cells in the sample, and didn't find cancer cells, that means it was negative and it's great news! My bladder was still not very irritated at this point and was not shedding many normal cells.
