Urine Cytology Rarely Changes Management of Low-Risk NMIBC

Routine urine cytology is not warranted in patients with low-risk nonmuscle-invasive bladder cancer (NMIBC), investigators concluded in a poster presentation at the 22nd annual meeting of the Society of Urologic Oncology. A recent survey reported that 53% of urologists still order routine urine cytology for these patients.

In retrospective chart review of 214 patients with NMIBC from 2013-2020, Emily Barry, MD, of Albert Einstein College of Medicine in Bronx, New York, and colleagues analyzed 1045 surveillance cytologies. In the group with low-risk disease, none of the cytology findings were suspicious or positive for malignant cells and altered management, the investigators reported in a poster presentation.

The team compared cytology results with contemporaneous cystoscopy and pathology findings for the full cohort. They identified only 30 cases (2.9%) with positive cytology results in the absence of positive cystoscopy or pathology. Cytology findings changed clinical management in a mere 4 cases – or only 0.4% of all cytologies.

In the intermediate- and high-risk NMIBC groups, 3.4% and 0.5% of cytologies, respectively, and 6.7% and 5.2% of cytologies, were suspicious or positive for malignant cells.

“Urine cytology for surveillance of low-risk NMIBC did not change management in any cases and should continue to be strongly discouraged,” Dr Barry and colleagues concluded.

They also stated, “The cost/benefit ratio of this test should continue to be evaluated for intermediate/high risk disease.”

Reference

Barry E, Park JY, Feiertag N, et al. Urine in cytology does not escalate clinical management in the surveillance of non-muscle invasive bladder cancer. Presented at the 22nd annual meeting of the Society of Urologic Oncology. December 1-3, 2021. Poster 50.