Urine Cytology

NAME OF PROCEDURE

Urine Cytology

TEST CODE

NGYN

CPT CODE

88112 – Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal

APPLIES TO

Bladder Washings Cytology; Catheterized Urine Cytology; Renal Cyst Fluid; Renal Pelvic Washings Cytology; Ureteral Washings Cytology; Voided Urine Cytology

TEST INCLUDES

Thin layer preparations and cell Block, when indicated.

SPECIAL INSTRUCTIONS

A first morning voided specimen is not suitable, because of cellular degeneration.

Bladder washings should not be collected in a hypotonic solution.

Do not send 24 hour collections.

If specific sites are sampled, label specimen and requisition appropriately.

Indicate whether the specimen is voided or catheterized.

If patient is menstruating, write “menstruating” on the requisition.

Information regarding type of specimen, admitting diagnosis, and pertinent clinical history (i.e., age, clinical impression, past diagnosis, radiographic findings, and history of radiation or chemotherapy) is essential to interpretation and should be noted on the requisition.

Clinical evidence of immunosuppresion should be indicated where appropriate.

Special handling requirements (isolation) should be clearly noted on the requisition.

SPECIMEN

Random collection specimen, voided or catheterized; intraoperative washings of urinary bladder, ureters, or renal pelvis.

Volume: 20 ml.

Minimum volume: 5 ml.

CONTAINER

Urine cytology container prefilled with fixative (available from the laboratory) or capable plastic container. Cytolyt is the preferred fixative for urine cytology. If FISH for bladder cancer is requested, please include an additional specimen in Preservcyt fixative.

PATIENT PREPARATION

Patient should not have had mineral oil cathartics.

COLLECTION TECHNIQUE

A user friendly patient information sheet describing the proper collection of urine for cytologic study can be found in the Special Forms section of this manual.  Please be sure to give patients a copy of this instruction sheet to ensure proper collection of the specimen.

Ideally, specimen should be as fresh as possible.  Urine which has been in the bladder for prolonged periods shows extensive cellular degeneration.

For detection of upper urinary tract lesions: Catheterize ureters to pelvis for suspected renal or pelvic lesions.  Repeat procedure using either ureter for control.  Collect urine for 30 minutes.

Use a Clean Catch procedure for voided specimens.

Label specimen container with a minimum of two patient identifiers, date, and time of collection. Indicate specimen type; right and left ureteral, or right and left pelvic specimen on the container. Add equal amounts of Cytolyt cytology fixative to the container or use the prefilled containers available from the laboratory. Keep refrigerated until delivery to the laboratory.

REQUEST FORM

Complete a Uropathology Requisition as indicated in the Test Ordering section of this manual.  The patient information as well as the Non-Gyn Cytology portion of the form should be completed.

CAUSES FOR REJECTION

Specimen container not properly identified.                

24 hour collection.

Excessive delay in transport.

Prolonged period at room temperature

Contaminated container.

LIMITATIONS

Low grade papillary transitional cell carcinomas may not be diagnosed by cytologic examination.

Recent instrumentation and calculi may produce atypical changes in urothelial cells simulating malignancy.

Numerous chemotherapeutic agents produce cell changes that may mimic urothelial abnormalities.

ADDITIONAL INFORMATION

Voided urine is much preferred over a catheterized sample due to atypical cell changes caused by trauma.

Although poorly-differentiated cancers are diagnosed with relative ease, well-differentiated neoplasms may not be diagnosed by routine methods. Detection of aneuploid cell lines or increased proliferative fraction by flow cytometry or Urovysion FISH may help in this dilemma.

METHODOLOGY

Thin layer preparations and/or slides examined cytologically using the Pap stain method.