Urine cytology

A urine cytology test is used to diagnose urinary cancers and viral diseases. It detects cancerous or precancer cells in the urine. It is a screening test for urinary cancer. The collected urine is examined under the microscope to detect abnormal cancer or precancer cells. Cytology is the study of cells. Urine cytology is the study of abnormal urine cells or the cell characteristics that help to diagnose various diseases. 

Indications: 

Urinary cytology test is done to detect urinary tract cancers. Cancers of the urinary tract can be high-grade cancers or low-grade cancers and can affect any part of the urinary tract. High-grade cancers are life-threatening. They recur after the treatment and spread to the muscles of the bladder and other areas in the body and also to the lymph nodes. Low-grade cancers recur but rarely spread to the bladder muscles or the other body parts. 

It is used to detect urinary tract cancers. These include:

• Cancers of the urinary bladder, ureters, and kidneys 
• Viral infections of cytomegalovirus, herpes, and other diseases 
• Detect recurrence of cancers
• Monitor bacterial infections of the urinary tract 
• Other viral diseases

Clinical symptoms that need a urinary cytology test are:

• Blood in urine 
• Frequent pain while urinating 
• Burning sensation while urinating 

Advantages:

• It is easy to perform 
• Does not cause any discomfort 
• No serious complications associated with the procedure 
• It is a safe and cost-effective diagnostic test 

Technique:

Urine cytology tests can be performed in various ways. They are:

• Clean catch technique: Collecting the urine in a sterile cup. 
• Catheter technique: collecting the urine from the catheter which is a thin tube placed in the urethra
• Cytoscopy: collecting urine samples during the cystoscopy procedure. 

Before the procedure:

The urine cytology test can be performed in a hospital or a laboratory. The first urine sample is not suitable for the test. It contains cells secreted into the urine after being held for a long time. Hence it is not advisable for the test. One can schedule an appointment with the healthcare provider (HCP) to get the test. 

During the procedure:

There are four steps involved in the test. They are collecting, processing, examining, and results. 

Collecting the sample is done by the individual. An individual gets a special kit that contains a cleaning solution and wipes. First, clean the genital area with the solution and the wipes. In females, the labia area should be cleaned and in males, the tip of the penis should be cleaned so that there are no microorganisms that interfere with the results. 

After cleaning one has to start peeing in the toilet. Collect the urine into the container mid-stream. The amount of urine needed for appropriate results will be specified by the HCP. Sometimes, the urine will be collected from the catheter or during the cystoscopy procedure. The collected sample is shipped to the laboratory for processing. 

The urine sample is processed in the centrifuge. A centrifuge is a machine that precipitates the cells needed for examination. It runs at high speed to separate the cells from urine. The separated cells are collected and placed on a microscopic slide. Then, the cells are stained by using special-colored dyes. The staining method helps the HCP to identify the cells and their characteristics better when observed under a microscope.   

The stained cells are observed under higher magnification microscopes for abnormal cells. Special pens are used to mark the slides with abnormal cells. Based on the types of cells the reporting is done. 

After the procedure:

One can return to the activities of daily living after the tests. It takes a few days for the reports to be obtained. 

Interpretation:

Urine cytology reports can detect high-grade cancers and in-situ cancers but not low-grade cancers. Based on The Paris System for grading the urinary cytology there are various types of reporting. These include: 

• Nondiagnostic: This means an unsatisfactory specimen. A required number of cells are not there in the specimen for the pathologist to examine. One has to repeat the test to get a proper diagnosis. 
• Negative for high-grade Urothelia carcinoma: This indicates no abnormal cells in the specimen. There is no cancer in the given sample. 
• Atypical Urothelial cells: This suggests that there may be potentially malignant aberrant cells in the urine. 

• Suspicious for high-grade urothelial carcinoma (SHGUC): This indicates the presence of abnormal cells in the urine that can be cancerous. 
• High-grade urothelial carcinoma: This indicates the cells present in the urine are cancer cells. They are life-threatening and can spread to adjacent muscles and lymph nodes. 
• Low-grade urothelial neoplasm (LGUN) and other malignancies: This indicates cancer cells that did not spread to muscles and adjacent body parts. 

Abnormal cells in the urine also indicate infection of the urinary tract. It also can be seen after radiation therapy for the cancer. The time taken to deliver the report depends on various factors like the necessity of special stains, the necessity to look at more samples, and conforming again with a second observer. Urine cytology reports should be confirmed with other reports. 

Risks and complications:

No risks or complications are associated with the procedure. False-negative and false-positive results may come if the sample is not taken properly. 

Conclusion:

Urine cytology is a useful diagnostic tool in detecting urinary cancers and other infections. It involves a simple collection of urine and submitting it to the laboratory which is analyzed and interpreted. It helps to detect and manage cancers and infections.