Urine Cytology

What is a urine cytology test?

A urine cytology test screens your urine for precancer or cancer cells. A physician called a cytopathologist examines the cells in your urine sample under a microscope to look for abnormalities.

What is cytology?

Cytology is the examination of single cells from bodily tissues or fluids. A specialized physician called a cytopathologist examines the cells in the tissue or fluid sample under a microscope and looks for certain characteristics or abnormalities in the cells.

What is a urine cytology test used for?

A urine cytology test can help diagnose cancers of the urinary system, including:

• Bladder cancer.
• Cancer of the ureter (the narrow tube that carries urine from your kidney to your bladder).
• Cancer of the urethra (the narrow tube that carries your urine from your bladder out of your body.
• Kidney cancer, among others.

Healthcare providers often perform other tests and procedures alongside urine cytology tests to diagnose urinary system cancers.

Urine cytology tests can also detect cytomegalovirus, a herpes virus, and other viral diseases.

Is urine cytology the same as urinalysis?

While urine cytology and urinalysis are both diagnostic tests that involve your urine (pee), they are different.

Urine cytology is a more specific test that involves looking at cells in a sample of urine under a microscope. A pathologist most commonly looks for cancer cells specifically.

A urinalysis is a urine screening test. Healthcare providers use it to discover and manage many different diseases and conditions, such as urinary tract infections (UTIs), kidney disease and diabetes.

A urinalysis involves examining the appearance, concentration and content of the urine. It can detect cells, cell fragments or certain substances, like crystals, protein or glucose (sugar), in your urine.

Though your provider may ask you to have a urinalysis for a specific reason, providers often use urinalysis as a routine or yearly screening. On the other hand, urine cytology tests are less common and are often used for very specific reasons.

When would a urine cytology test be needed?

Your healthcare provider may want to do a urine cytology test if you’re experiencing signs or symptoms of a urinary system cancer, including:

• Having blood in your pee (hematuria).
• Experiencing frequent pain when you pee.
• Experiencing a burning sensation when you pee.

Urine cytology tests can help find some types of cancers, however, there are limitations. Just because a urine cytology test doesn’t find cancer cells, it doesn’t necessarily mean that the person is cancer-free. Because of this, healthcare providers often have the person have other tests alongside urine cytology tests and may repeat urine cytology at a later date.

Other reasons your healthcare provider might have you give a urine sample for a urine cytology test include:

• To check for cancer recurrence if you’ve had bladder cancer and have been treated for it.
• To monitor bacteria in your pee if you have frequent (recurrent) urinary tract infections (UTIs).
• To test for certain viral diseases.

Who performs a urine cytology test?

In most cases, the person who is having a urine cytology test will pee into a sterile cup in a private bathroom. This is known as a clean catch urine sample. Sometimes the person or a healthcare provider needs to insert a catheter (a narrow tube that’s inserted into your urethra to reach your bladder) in order to collect a urine sample

A healthcare provider can also collect a urine sample for a cytology test during a cystoscopy, which is a procedure in which the provider uses a thin scope to examine the inside of your bladder and urethra.

The healthcare provider then sends the urine sample to a laboratory for testing. A scientist called a pathologist, or cytopathologist, examines the cells in the urine sample under a microscope and determines and prepares a report.

How do I prepare for a urine cytology test?

You’ll need to take your urine cytology test after your first morning pee. This is because cells that are held in your bladder for a long period of time, or overnight, can break down over time, which can make it difficult for a pathologist to look for certain cells under a microscope. Thus, you don’t want your urine cytology test sample to be your first morning pee.

You’ll likely need to schedule an appointment at a hospital or laboratory to give your urine sample.

How is a urine cytology test performed?

There are four general steps involved in a urine cytology test, including:

• Collecting the urine sample.
• Processing the urine sample cells.
• Examining the urine sample cells.
• Sharing the results.

Here’s an explanation of the steps of a urine cytology test.

Collecting the urine sample

Most urine cytology test samples are collected by the person having the test.

Before you collect your urine sample, your healthcare provider may give you a special kit that includes a cleaning solution and sanitary wipes to use on your genital area. This is so germs from outside of your urinary tract, such as germs from your vulva or the skin on your penis, don’t get in your pee sample. It’s important to follow the instructions for the cleansing wipes carefully. You’ll then pee a little bit into the toilet and then finish peeing into a sterile container. Your provider will let you know how much pee they need in the container for the test.

In some cases, you or your provider might need to insert a catheter to collect your urine sample.

Your provider can also collect a urine sample for a cytology test during a cystoscopy, which is a procedure that examines the inside of your bladder and urethra.

Your provider will then send your urine sample to a laboratory for examination.

Processing the urine sample cells

Once the urine sample arrives at the laboratory, a pathologist or lab technician may use a machine called a centrifuge to separate the cells they want to examine from the urine. A centrifuge separates certain cells from the fluid by spinning the sample very quickly. The pathologist then puts the cells on a microscope slide and may stain the cells using special colored dyes. Stains help the pathologist see certain characteristics of the cells better under a microscope.

Examining the sample cells

After a pathologist or lab technician processes and stains the urine cytology sample, they examine the cells under a microscope, looking for abnormal cells. If they find abnormal cells, they mark them on the slides with a special pen. A pathologist then puts together a report.

Sharing the results

After a pathologist creates a report, they will send it to your healthcare provider. Your provider will go over the results with you and determine the next steps.

What should I expect after a urine cytology test?

It may take a while to get your test results. Since there are limitations to urine analysis tests, your healthcare provider will likely ask you to have other tests or procedures to look for urinary system cancer. Because of this, your provider may want to get the results of all the tests before they share the results with you. Your provider will let you know their process for how they’ll determine and share the results.

Are there any risks or side effects to a urine cytology test?

Most people who have a urine analysis test do so by peeing into a sterile container, which doesn’t have any risks or side effects.

If your healthcare provider has to collect your pee using a catheter (a narrow tube that’s inserted into your urethra), you may be at risk of a urinary tract infection (UTI). UTIs are a common and treatable condition.

What type of results do you get from a urine cytology test and what do they mean?

Pathologists can use many different terms on a urine cytology report. Your healthcare provider will explain the results to you. Don’t be afraid to ask questions.

In general, the results will reveal if the urine sample cells were negative or positive for abnormal cells, pre-cancer cells and/or cancer cells.

Some terms that may be included in your results include:

• Unsatisfactory specimen: This may mean that there weren’t enough cells in your urine sample for the pathologist to examine. You may need to do another urine sample if you get this result.
• Negative for high-grade urothelial carcinoma: This means the pathologist found no cancer cells or abnormal cells in your urine sample.
• Atypical urothelial cells: This means that the pathologist found some abnormalities in your urine sample, but the cells weren’t abnormal enough to be considered cancer.
• Suspicious for high-grade urothelial carcinoma: This means that the pathologist found abnormal cells in your urine sample that might be cancer.
• Positive for high-grade urothelial carcinoma: This means that the pathologist found cancer cells in your urine.

Abnormal cells in your urine could also be a sign of inflammation in your urinary tract. You may also have abnormal cells in your urine if you’ve had radiation therapy near your bladder.

A urine cytology test can only help diagnose cancer. Healthcare providers don’t use it solely to diagnose urinary system cancers. If you have atypical, suspicious or cancer cells in your urine, your healthcare provider will likely want you to have further testing such as a cystoscopy or a CT scan to examine your bladder and urinary tract.

When will I know the results of my urine cytology test?

The time it takes to get the results of your urine cytology test depends on certain factors, including:

• If the pathologist needs to look at more samples.
• If the test requires special stains or procedures.
• If your healthcare provider or the pathologist needs a second opinion.
• If you had other tests done.
• Processing time.

Every situation is unique, so your healthcare provider will give you a better idea of when to expect your results.

How accurate is a urine cytology test?

Urinary cytology is most helpful in diagnosing invasive high-grade (the cancer cells grow and spread quickly) tumors and carcinoma in situ (a group of abnormal cells that are found only in the place where they first formed in the body). It has a 95% accuracy rate for diagnosing these two conditions.

Urine cytology isn’t as successful in determining low-grade carcinoma. It has a 10% to 50% accuracy rate for low-grade (the cancer cells grow and spread slowly) carcinoma and has a significant false-negative rate for this condition, meaning the urine cytology results are negative for low-grade carcinoma, but other tests show that the person does, in fact, have low-grade carcinoma.

A note from Cleveland Clinic

Urine cytology tests can be a helpful tool in diagnosing urinary system cancers. It’s important to remember that you’ll likely have a few tests, not just a urine cytology test if your healthcare provider suspects you might have a type of urinary tract cancer. While it can be stressful to wait for the results of a diagnostic test, know that your healthcare team is there to support you no matter what the results are. Don’t be afraid to ask your provider questions throughout the process.