Urine Cytology

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What is Urine Cytology testing? 

Urine cytology definition is the study of cells of the body from urine. This test is done not only to detect the cancerous cells but also many severe conditions of inflammation and disorders. Here the doctors inspect the urine sample to check their aberrant condition and the function of the urinary tract. This is a test that is done with other tests to examine cancerous, precancerous, or any other disorder. 

Sometimes blood appears in the urine, called hematuria, in such conditions too, doctors ask the patients to do a urine cytology test.

Urinalysis vs Urine Cytology test

This test may seem to be the same as the urine cytology atypical cells test, but it is not. Here the analysis is not done to detect cancer cells but to detect other abnormalities like kidney disease, leukemia, diabetes etc. Also, to diagnose the overall health, monitor medical conditions. For this test, you have to collect the sample in the morning as the dilution rate is minimum, and it is latent to get the abnormal results. In urinalysis, three types of tests are done, namely, visual exam, dipstick test, and microscopic examination.

Understanding Urine Cytology

As we know, cytology is the study of cells and their role. Urine cytology report or test is a screening test that takes nearly 15 to 20 min. The result of this test is not very accurate but also not wholly false; this test has significance to a particular level. Although for low-grade carcinoma it is 10- 50% accurate, it is mainly used for carcinoma in situ (CIS). We cannot use the morning urine as the cells are clutched overnight, they might get degraded, which will make the process more challenging to analyze.

Urine cytology collection instructions:

1. When you wish to urinate, wash your hands thoroughly.
2. Use the sterile screw cap bottle without preservative given by the laboratory.
3. Urinate a little in the toilet and halfway through urination, fill up the bottle half full.

Procedure for urine cytology test 

Firstly, urine samples are collected in a sterile container, or the urine is collected by a hollow tube called a catheter. Then it is diagnosed using the dipstick test and microscopic examination. A dipstick test is done to validate pH and check its acidity. A pathologist is a person who performs all the screen tests.

Pathology labs & Pathologists

There are millions of pathology labs over the globe, in which different types of tests are done, such as liver function test, full blood examinations, TSH test, urinalysis and urine cytology test. A cytopathologist is a qualified doctor who diagnoses tissues and cells in the body and helps physicians to interpret results or diseases faster. They work in hospitals, laboratories, companies, etc.

Tests to detect abnormal urine cytology:

• Visual examination: Here, the urethra is seen using a cystoscope; it is a thin tube with a small camera at the end. From this device, it’s easy to see the cells and their structure.
• Dipstick test: A plastic stick containing chemicals is dipped into the urine to test the color change and aberrant condition.
• Microscopic examination: Here, the microscope is used to see the abnormal particles that are causing infection or inflammation.
• FISH: This test is called Fluorescence in situ Hybridization, also popularly known as Fish Urine Cytology. This test is done for diagnosing or monitoring urothelial cancer.

After the procedure

The pathologist diagnoses the samples of the urine and checks for the abnormal signs or warnings that indicate carcinoma. Urine cytology results can take 1-2 or even more days. Understanding the samples may require time and other tests such as routine biopsy is also performed to know the exact conditions of cells. Urine cytology results from pathology lab reports include terms such as unsatisfactory specimen, negative, positive, urine cytology atypical cells or suspicious, which means:

• Unsatisfactory specimen: The sample is taken at the wrong time because cells are degraded and cannot be used for further procedure. Therefore, you have to repeat the test if your cells are not visible.
• Negative: this indicates no cancerous or precancerous cells are present.
• Atypical specimen: some of the abnormalities are present, but that is not equivalent to cancer.
• Suspicious sample: here, cells are abnormal; they may or may not be cancerous.
• Positive: urine contains cancer cells.

 Cells responsible for contamination of urine:

1.     Squamous epithelium cells: Cells in the outer part of the epidermis. If these cells are present in urine, it means there is contamination. These cells are related to chronic irritation of the urinary bladder.

Chronic irritation happens when the inner parts are not cleaned well during the use of the clean catch method. However, these cells discard the old cells as new cells are formed, when the cell multiplication becomes unmanageable; they give rise to squamous cell skin cancer.

Usually, one to five squamous cells in urine cytology are there in the high-power field. Still, when there are more cells than the usual, i.e. in moderate numbers then, it may indicate any disease or disorder.

2.     Transitional epithelial cells: These are the cells present in the kidney of our body. It is normal to have a standard amount of transepithelial cells in the urine, but when the number exceeds, it gives rise to infection; however, it can be a minor infector or a significant malignancy.

As these cells are capable of changing shape, they can stretch to any extent when they can form large clumps or sheets, and such a condition is called transitional cell carcinoma.

Voided urine cytology bladder cancer, test:

Void means to urinate. However, the elimination of solid waste is also the meaning in some contexts. Here voided urine cytology test means a quality method which is non-penetrating and detects the bladder carcinoma. The susceptibility of this type of abnormal urine cytology is low. However, first voided urine is always discarded as it is not stable because of degraded cells; this happens in the morning.

Malignant cells in urine cytology

Also called cancerous cells. They can undergo metastasis locally and destroy other tissues and cells. These cells do not die a natural death due to changes in their genetic makeup. 

Urine cytology collection report:

A report consisting of values of carcinoma-in-situ (CIS), low-grade urothelial neoplasm (LGUN), high-grade urothelial neoplasm (HGUN), positive predictive value (PPV). Also, the number of atypical urothelial cells (AUC) and suspicious for high-grade urothelial carcinoma (SHGUC) is called a urine cytology report.

High-grade cancer cells that become tumor after growing at a particular extent is called high-grade urothelial neoplasm (HGUN). These cells multiply and are predicted to have a worse condition.

Low-grade urothelial neoplasm is linked to atypical urothelial cells. Low-grade urothelial carcinoma is also reported where the cells grow very slowly as a result of low malignant potential of the tumor.

Sometimes there may be cancer cells detected in high-grade urothelial neoplasm, but the number of cancer cells may be not as much as required for a malignancy. Therefore, the report indicates suspicion for high-grade urothelial neoplasm. 

FAQ

Why is urine cytology test done? 

This test is done to look for abnormal cells in the urine, and to determine the possibility of bladder cancer, Urinary tract cancer, or blood in the urine.

How long will the test take to be carried out?

Urine Cytology test is finished in just 10-15 mins. As it involved providing a sample in a sample container or petri dish.

Side effects of the test?

If the urine is collected by employing a catheter, then there may be minor chances of injury and infection.

When will the test results be available?

Urine cytology results can take up to a day, depending on the laboratory where you have performed the tests.

How will the results be given?

The test results will be presented to you in the form of a hospital or laboratory diagnosis report. Although you also have the option to know the results through a phone call or email if you want it to be earlier.

What does the result say?

The urine cytology report will state whether you have any cancerous diseases like bladder cancer or urinary tract cancer. However, a positive urine cytology test is not the only determining parameter for cancer diagnosis. There are also other allied procedures performed like biopsy & CT Scan.