Suspicious urine cytology (class III) in patients with bladder cancer: should it be considered as negative or positive?

Raitanen MP, Aine RA, Kaasinen ES, Liukkonen TJ, Kylmala TM, Huhtala H, Tammela TL; Finnbladder Group.

Department of Urology, Tampere University Hospital, Finland.

OBJECTIVES: Urine cytology is the gold standard in the diagnosis and follow-up of bladder cancer. Cytology, however, exhibits variable sensitivity depending on tumour grade and interpretation of urine specimens is highly dependent on the skill of the examiner. Positive cytology, classes IV and V by Papanicolaou classification, is a strong predictor for coexisting or subsequent malignancy, while the role of suspicious cytology, class III, is controversial. The objective of the study was to evaluate the role of the suspicious finding in cytological analysis, and whether it should be considered as a negative or positive sign for coexisting malignancy.

Class I : absence of atypical or abnormal cells.
Class II : atypical cytology but no evidence of malignancy.
Class III : cytology suggestive of, but not conclusive for malignancy.
Class IV : cytology strongly suggestive of malignancy.
Class V : cytology conclusive for malignancy.