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Cytological examination of urine sediment. When urine cytology is needed. What the results mean

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Speaking about the methods of laboratory diagnosis of early oncological pathology in the bladder, they should immediately be divided into routine methods, which are microscopic and cytological examination of urine sediment, and rather complex biochemical ones, which allow to identify certain states of homeostasis, not only characteristic of a particular form of malignant tumor, but and preceding its occurrence.

We mean the biochemical study of urine, which reveals the disturbed metabolism of tryptophan, manifested by the appearance of its carcinogenic metabolites in the urine.

This can be both in patients with bladder cancer and in practically healthy people, which indicates a certain predisposition to the onset of the disease and is considered one of the endogenous risk factors.

The same can be said about the significance of the increased activity of β-hyaluronidase, an enzyme of urine, under the influence of which the disintegration of non-carcinogenic complexes occurs in the bladder with the release of the active principle. So, a complex consisting of 2-amino-1-naphthol, combined with glucuronic or sulfuric acid in the liver and therefore lost its carcinogenic properties, under the action of β-hyaluronidase or urine sulfatase decomposes in the bladder with the formation of active 2-amino-1- naphthol, which has a carcinogenic effect on the uroepithelium.

Timely detection of early oncological pathology

Talking about early detection early oncological pathology (ROP) in the bladder, one should agree with the opinion of M. Mebel et al. that, despite significant progress in the field of diagnostics, routine methods - the study of erythrocyturia, examination of accessible parts of the urinary tract, rectal palpation - remain the basis for early diagnosis, but are clearly underutilized. Suffice it to point out that in many patients who went to the polyclinic with non-urological complaints, the presence of erythrocytes in the general analysis of urine was not a reason for referral to a urologist, either for general practitioners or for narrow specialists.

Meanwhile, conducting a prospective epidemiological study of a contingent of 3400 practically healthy people in order to detect ROP of the bladder in them, we performed a microscopic examination of urine sediment in 2143 persons (63.0%), and 696 (20.5%) - cytological and revealed a significant percentage of pathology in people who were not going to seek medical help, feeling practically healthy.

Hematuria was detected in 18.1% of men in the risk group and 7.9% in the control group, in women, respectively - 23.1 and 10.7%. Naturally, all these people need further urological examination, which will make it possible to establish the cause of urological pathology, including cancer. It should be emphasized here that laboratory diagnostics of early oncological pathology in the bladder cannot be an independent method; it, as a rule, must be supplemented by cystoscopic examination with a biopsy.

Indications for cytological examination of urine sediment are all forms of macro- and microhematuria, vague dysuria, cystalgia, abuse of analgesics, professional contacts with aromatic amines. Cytological examination is indispensable for intraepithelial type bladder tumors - cancer in situ, which cannot be detected endoscopically, as well as for bladder diverticulum cancer, urethral strictures, small organ capacity.

It should be emphasized once again that this theoretically ideal method cannot be independent either in the diagnosis of cancer recurrence in the bladder, or, even more so, in the detection of ROP. According to many authors, this confirms a rather high percentage of discrepancies between the cystoscopic picture and the results of urine cytology; only in 70.0% of patients with uroepithelial cancer, cytological examination reveals cancer cells.

J. Tostain et al., Analyzing 500 cytological studies in 342 patients with uroepithelial tumors, showed that in typical papillomas of the urinary bladder, cytological examination is ineffective, in infiltrative cancers of a low degree of malignancy, urinary cytology makes it possible to diagnose in 66.0% of cases, in high - in 80.0%.

A number of authors (Mansat A. et al., Droese et al.) Have established a clear correlation between the degree of cell anaplasia and cytological detection of a tumor. In particular, it was shown that when using the Bergevist classification of I, II, III degrees, depending on the anaplasia of cells, in the first degree, the tumor was detected only in 19.0%, in the second - 30.0, in the third - 70.0.

Until now, there are no generally accepted cytological methods for studying bladder tumors. Some researchers consider the method of exfoliative cytology valuable in the study of the urinary sediment of freshly released urine (Enokhovich V.A., 1966; O.P. Ionova et al., 1972), others prefer aspiration biopsy (Volter D. et al, 1981), others indicate that the best results are obtained by the method of flushing the mucous membrane of the bladder (Lomonosov L.Ya., 1978).

Errors in cytological diagnostics

Errors in cytological diagnostics are determined by several factors: poor material obtained during the inflammatory process or tumor necrosis, its insignificant amount or mild atypia of cells. Therefore, naturally, the search for the most rational use of material for work is underway. So N. Holmguist indicates a high degree of detection of bladder cancer (1.2 per 1000) in cytological examination of wet preparations of urine sediment and suggests using this technique for screening.

L. Ya. Lomonosov recommends for mass preventive examinations of high-risk groups a method of active flushing of the bladder in its own modification, when the bladder is thoroughly washed with furacillin before flushing, then 50-100 ml of an alcohol solution of novocaine is injected at the rate of 15 ml of 96 ° alcohol per 100 ml of 1% solution of novocaine.

After 5-10 minutes, the solution is collected in a clean dish. After the macroscopic description of the washout, the material is centrifuged at 3000 rpm for 15 minutes, the supernatant is washed off, and smears are prepared from the centrifugate.

At the same time, a number of authors worked on a rational technique for preparing smears, since the delay in the introduction of cytological research is largely due to the difficulties in staining cells in urine. Therefore, C. Fiedler et al. several colors are carried out - methylene green, pyronine and chrome-laun according to the method modified by them.

False positive results are most often associated with an incorrect assessment of urothelial cells with dysplastic changes in urolithiasis, a chronic inflammatory process. Thus, out of 135 patients with upper urinary tract calculi, 7.2% had a cytological picture similar to highly differentiated cancer. In the urine of persons who have suffered from urolithiasis for a long time, C. Dimopoulos et al. observed the presence of cells of 3 and 4 degrees of malignancy according to Pappanicolaou and their disappearance after surgical removal of stones.

O.P. Ionova et al. in inflammatory processes, atypical cells were found in cytograms, which did not differ much from tumor ones. Interpretation of cytograms seems to be a rather complicated matter, perhaps that is why there are still no generally accepted criteria for malignancy of epithelial tumors of the urinary bladder.

The available numerous data on this issue relate mainly to the diagnosis of recurrent cancer and rather rare cases of recognition of "cancer in the cell" - cancer In situ. Only a few authors describe cytograms for simple and proliferating papillomas of the urinary bladder - G.A. Arzumanyan, V.A. Enokhovich, O.P. Ionova et al., L. Ya. Lomonosov.

Others - M. Beyer-Boon et al. indicate that papillomas cannot be diagnosed at all on the basis of cytograms, the latter for typical papillomas do not differ from normograms, and only the detection of papillary tumor fragments allows a diagnosis to be made.

The fact is that cytograms of urinary bladder washes are normally poor in cellular elements. Most of the cells encountered are cells of the integumentary zone of the transitional epithelium. They are large, polygonal or elongated. The nuclei are small, round or oval, centrally or slightly eccentric.

The cells of the intermediate zone are cylindrical in shape, located either in the form of papillary fern-like structures, or in the form of rosettes, or in the form of grape-like bunches. The nuclei are oval, chromatin is small-lumpy, evenly distributed over the area of ​​the nucleus. In some works, attention is drawn to the giant multinucleated cells specific for washes with frequent figures of mitosis.

Of the non-epithelial elements, erythrocytes, leukocytes, and salt crystals are found. In the work of A.V. Zhuravleva points out that there should be no shaped elements in the washes normally. With inflammation, an increase in the number of cellular elements is noted due to cells of the intermediate and basal zones, transitional epithelium and cells of an inflammatory nature.

In smears with a typical papilloma, cells of a cylindrical, oval, round and fusiform shape of the same size are found. Tailed cells may be encountered. Their nuclei are monomorphic with a compact structure of chromatin, contain 1-2 nucleoli. The nuclear-cytoplasmic relationship is not disturbed.

According to G.A. Arzumanyan, the absence of multinucleated cells characteristic of the upper, differentiated layer of the transitional epithelium is characteristic. M.P. Ptokhov considers the presence of elongated caudate cells to be the most characteristic feature.

Cytological criteria for papilloma malignancy

Cytograms of proliferating papillomas are distinguished by more pronounced polymorphism and polychromasia of cells. The nuclei are enlarged, the number of nucleoli increases in them. V.A. Enokhovich finds the presence of oval and rounded tumor cells characteristic of this group of papillomas. N. Hanschke notes a large number of binucleated cells.

L. Ya. Lomonosov identifies the following cytological criteria for papilloma malignancy:

Increased mitotic activity of cells;
polymorphism of nuclei with coarsening of the structure;
a decrease in the content of glycogen in the cytoplasm;
an increase in cell layers of more than five.

He points out that sometimes incipient malignancy is easier to detect in cytograms than histological preparations.

In transitional cell carcinoma of the bladder, all authors note polymorphism, polychromasia of cytogram cells, a violation of the nuclear cytoplasmic ratio in favor of the nucleus, and a change in the structure of chromatin. hypertrophy and hyperplasia of the nucleoli and dystrophic changes in the cytoplasm. B.L. Polonsky and G.A. Arzumanyan is considered to be characteristic of cancer by the multinucleation of cells.

Naturally, such research must be carried out by an experienced specialist and is relatively time-consuming. Therefore, in order to turn into an automatic screening method, they began to use pulse cytophotometry, which allows one to count 1000 cells stained with fluorescent dye in one second.

A number of works (Klein F. et al., 1982; Frankfurt O. et al., 1984; Dean P. et al., 1986) indicate a promising role in the diagnostic relation of the state of cytological examination of urine and the method of flow cytometry in which the measurement the content of DNA, RNA and the size of the nuclei.

Pulse cytometry was used to quantitatively study DNA and proteins in epithelial cells of free flowing urine, lavage forms of the bladder, and suspension from tumor tissue. Thus, a relationship was revealed between the presence of aneuploid cells in the washings of the bladder and the development of invasions in patients.

It was found that most superficial bladder tumors are diploid, and invasion is accompanied by aneuploidy. Therefore, flow cytometric analysis of DNA content is a quantitative measure for predicting the degree of malignancy of a tumor, as well as for diagnosing cancer in situ.

In the work of K. Nielsen, a stereological assessment of the volume of the nuclei of the iley membrane of the bladder in normal and malignant processes is given. The author examined 27 biopsies from the bladder: 10 - normal, 5 - with infection, 12 - with tumors. Morphometric study established the average volume of the nucleus in norm and during infection, equal to 133 and 182 μm3, with cancer in situ - 536 μm3.

The test offered by the "CYTODIAGNOSTIKA" company, based on the quantitative determination of fluorescence, can help to identify cells with an increased DNA content. The applied dye binds cells with an increased DNA content, and this circumstance makes it possible to identify one cancer cell among thousands of normal ones. The firm proposes to use this test to screen populations at increased risk of bladder cancer.

But it should be noted that the use of the proposed methods for the prevention of bladder tumors encounters great difficulties, which begin immediately, already when urine is taken - in stale urine, the cells change significantly. It is clear that for preventive examinations, the most acceptable cytological study can be the study of freshly released urine sediment, neither the aspiration biopsy method, nor the method of flushing from the bladder mucosa can become massive.

The cytological study of urine sediment used by us in order to identify early oncological pathology of the bladder in the prophylactically examined contingents did not justify our hopes - not once during the examination of 696 practically healthy individuals, of which 185 (38.6%) belonged to the risk group, and 511 (17.4%) - to the control, there were no signs of cell atypia, although the study was carried out by experienced cytologists in the central cytological laboratory of the city

Separate methods of laboratory research

Certain methods of laboratory research can reveal a known predisposition to the occurrence of this form of cancer. We mean endogenous risk factors - impaired tryptophan metabolism with the appearance in the urine of its carcinogenic metabolites - 3-hydroxyanthranilic acid, 3-hydroxykynurenine, kynurenine, etc., as well as an increase in urine β-hyaluronidase activity.

The presence of carcinogenic metabolites of tryptophan in the urine indicates an increased risk of the disease, is often determined in patients with bladder cancer, including recurrent ones, indicates the need to correct the metabolism of tryptophan, i.e. to engage in biochemical prevention of a tumor.

When forming risk groups according to epidemiological tests, identifying individuals with the presence of carcinogenic tryptophan metabolites in urine helps to further narrow the circle of individuals. in need of the close attention of a urologist.

To determine the spectrum of tryptophan metabolites in the urine of the subjects, the method of one-dimensional descending chromatography on paper can be used. Extraction of metabolites is performed once from 100 ml of morning urine according to the Makino method modified by Wachstein, Lobel.

To do this, the urine is saturated with ammonium sulphide to precipitate proteins and salts. Then the urine is filtered. To the resulting filtrate add 20 ml of molten phenol and shake for 20-25 minutes on a universal shaker. The resulting mixture is defended in a separating funnel, where two layers are quickly separated: the upper one is yellow with a brown tint - the phenol layer, the lower one is colorless - the urine layer.

The lower one is removed, 20 ml of sulfuric ether is added to the upper one and the mixture is shaken vigorously to improve the dissolution of phenol in the ether. In this case, phenol passes into the upper, lighter layer, and the ether-insoluble aqueous fraction containing aromatic derivatives of tryptophan remains in the lower part of the separating funnel in the form of a dark oily layer with a volume of 0.5-0.7 ml.

This layer is carefully poured into an evaporation dish and dried in a fume hood. The dried extract is dissolved in 0.2 ml of distilled water and applied in an amount of 0.02 ml on chromatographic paper ("Leningradskaya slow"), previously washed with a mixture of ether and alcohol in a ratio of 3: 1.

After drying, the paper is placed in a chamber pre-saturated with solvents. The following solvent system is used as a solvent - N-butyl alcohol: glacial acetic acid: water - 4: 1: 1. Acceleration is carried out at room temperature for 20-24 hours.

After that, the chromatograms are dried and treated with Ehrlich's reagent (12 g of paradimethylaminobenzaldehyde + 20 ml of 6NHCI + 80 ml of ethyl alcohol). Immediately after that, spots of yellow-orange color appear on the chromatograms, which with this reagent give urea and aromatic derivatives of tryptophan, and spots of bluish-lilac color due to the indole derivatives of the latter.

By the characteristic color with the Ehrlich reagent, the Rf value and comparison with the standards, the described method allows one to identify the following tryptophan metabolites - urea, tryptamine, indican, tryptophan, 3-hydroxykynurenine, kynuranin, 3-hydroxyanthranilic acid. The latter is the most potent endogenous carcinogen for uroepithelium, gives a characteristic pinkish-orange coloration with Ehrlich's reagent and an Rf value of 0.75-0.8.

Determination of urine kialuronidase activity is carried out for the same purpose. But this method makes it possible to differentiate bladder papillomas from invasive cancer and is regarded by most authors as auxiliary in the diagnosis of epithelial tumors of the bladder.

The enzyme activity in urine is determined by the generally accepted phenolphthalein method. For this, urine is collected per day under a thin layer of toluene, which protects it from decomposition; then its total volume, specific gravity, presence of protein, leukocytes, sugar is determined and sowing on microflora is obligatory.

The latter is necessary due to the fact that various microorganisms, especially Escherichia coli, can be a source of β-hyaluronidase. In cases of bladder infection, urine is excluded from further research.

Then, 4-5 ml of urine is taken from each sample, which is centrifuged in a TsNL-2 centrifuge at 8-9 thousand revolutions for 8-10 minutes. Subsequently, according to the number of test samples, 0.5 ml of 0.1 M acidate buffer is poured into graduated glass centrifuge tubes with a volume of 10 ml, 0.5 ml of a 0.05% solution of femolphthaleinglucuronide substrate (Sigma firm) and pre-centrifuged urine.

The addition of alkali made the PH of the mixture equal to 10, 2-10, 4, i.e., the optimum at which the most intense crimson-red coloration of phenolphthalein released under the influence of urinary β-hyaluronidase occurs. Further determination is carried out on an SF-4 spectrophotometer at a wavelength of 540 mm

The stained samples are compared to the so-called "blank" baths, which contained the same solutions and in the same concentrations and quantities, but were not incubated and were prepared just before the determination of phenolphthalein in each test sample.

The amount of released phenolphthalein is determined according to a previously compiled calibration scale with subsequent recalculation per 1 ml for 1 hour of incubation.

The level of enzyme activity in the analysis of urine of healthy individuals ranged from 0.4 to 1.1 and averaged 1.0 U. Fishman at 1 ml / hour. With papillomas of the urinary bladder, an increase in the activity of the enzyme is noted by 1.2-1.4 times. Moreover, this increase is constant and does not depend on the ongoing treatment. In cancer of the bladder, the activity of β-hyaluronidase in the urine is increased by at least 2-3, and sometimes more times reaching 5 units of Fishman.

When determining the activity of this enzyme, one should take into account, firstly, concomitant diseases in patients. This applies, first of all, to hepatitis and pancreatitis, which in themselves give a sharp increase in its activity in the urine. Secondly, it should be emphasized that even carrying out only one cystoscopy, not to mention more complex surgical interventions, immediately leads to an increase in the level of enzyme activity in the urine compared to the initial data, and only after 8-10 days the activity of β-lucuronidase reverts to original numbers.

According to M.N. Vlasova et al., Which we cite here, there are no differences in the increase or decrease in the enzyme activity depending on the age and sex of the patients, as well as chemotherapeutic or radiation methods of treatment.

The authors use this method as an auxiliary for the diagnosis of epithelial tumors in the bladder. It can also be recommended when carrying out measures for the biochemical prevention of bladder cancer, aimed at reducing the activity of β-lucuronidase in the urine to control this activity.

Naturally, due to its laboriousness and complexity, the method cannot be used as a screening method, but in risk groups its use is fully justified in order to identify individuals who have an important endogenous risk factor and, in this regard, need appropriate preventive measures.

Pryanichnikova M.B.

Urine cytology is the examination of urine using a microscope to look for abnormal or cancer cells. Urine cytology is used when a tumor of the urinary tract is suspected. Urine cytology is most commonly used in the diagnosis of bladder cancer, although urine cytology can also suspect kidney cancer, prostate cancer, ureteral cancer, and urethral cancer.

Your doctor will order a urine cytology if you have had episodes of blood in your urine (hematuria). Urine cytology is also used to monitor patients with bladder cancer. In these cases, urine cytology helps detect recurrent bladder cancer.

Urine cytology is used along with other tests and procedures to diagnose tumors of the urinary tract, including:

  • bladder cancer
  • kidney cancer
  • prostate cancer
  • ureteral cancer
  • urethral cancer.

Urine cytology can detect large and malignant tumors of the urinary tract. Small tumors of the urinary tract, as well as most benign tumors, cannot be diagnosed with urine cytology.

Risks of urine cytology

The risks of urine cytology depend on the method of collection. Usually, one portion of urine collected in a clean container is sufficient for urine cytology. However, if urinalysis for cytology was obtained using a catheter, then there is a risk of urinary tract infection.

How to prepare for urine cytology?

To prepare for a urine cytology test, try to collect urine for cytology after urinating in the morning. Urine collected during morning urination is not used for urine cytology. Cells that have remained in the bladder overnight can be destroyed, which can lead to difficulties in urine cytology in the laboratory.

A urine sample is required for urine cytology. Most often, a urine sample is obtained by collecting a portion of urine during urination in a sterile container. In some cases, a urine sample is obtained using a catheter that is inserted through the urethra into the bladder.

Your doctor may ask you to collect urine samples over the next several days. Examination of more urine samples collected over several days improves the accuracy of urine cytology.

Testing a urine sample in a laboratory

A urine sample is sent to the laboratory for cytology. A doctor who specializes in examining body tissues (histologist or pathologist) will analyze all of the cells in a urine sample under a microscope. The pathologist will describe the cell types and identify changes in the cells that indicate cancer.

Urine cytology results

The pathologist will provide the results of urine cytology to your doctor, who will share them with you. Ask your doctor, how long will it take for urine cytology results to be ready?

Each laboratory has its own way of describing the results of urine cytology. General terms that are used in describing urine cytology results include:

  • Unsatisfactory sample - This means that insufficient cells or abnormal cell types were found in the urine sample. You must repeat the urine cytology
  • Negative urine cytology - this means there are no cancer cells in your urine sample
  • Atypical urine cytology - This means that few changes have been found in the cells of the urine sample. While the cells weren't normal, they didn't look like cancer cells enough.
  • Suspicious Urine Cytology - This term indicates that cells in the urine sample were not normal and may be cancerous.
  • Positive urine cytology - this indicates that cancer cells have been found in the urine sample.

For the diagnosis of urinary tract cancer, only urine cytology is not used. If a cytological examination of urine reveals atypical cells or cells of a malignant tumor, your doctor will order you a cystoscopy in order to examine the bladder and urinary tract.

My husband has early bladder cancer. What are the risk factors that trigger the onset of the disease? How is it treated? Albina Ivanovna, Grodno.

In recent years, the incidence of bladder cancer has been increasing worldwide. In European countries since 1950 it has increased by almost 1.5 times. At the same time, mortality from this disease during this period decreased by more than 30%, which is explained by early diagnosis and effective treatment.

Risk factors

Smoking. Those who like to raise the disease occur 2 times more often. This bad habit is "responsible" for almost half of the deaths from bladder cancer among men and about 30% among women. Carcinogens enter the lungs, into the blood, and when filtered by the kidneys, they penetrate into the bladder and damage the epithelium lining it.

Professional risks... Certain chemicals, such as aromatic amines (benzidine and betanaaphthylamine) used in the dyeing industry, are hazardous. Increased risk among workers in the rubber, leather, textile, printing industry.

Age. The threat has grown over the years.

Floor. Men get sick 2 times more often.

Chronic inflammation. Urinary infection, kidney and bladder stones and other causes of persistent organ irritation.

Family history... If the disease occurs in family members, the risk of pathology is increased.

Congenital defects of the bladder. In the womb, the baby has a connection between the navel and the bladder. This compound (urachus) normally disappears after birth. Cancer cells can develop in the remaining part of the urachus.

According to the WHO, bladder cancer accounts for up to 4% of all malignant neoplasms, yielding to tumors of the stomach, esophagus, lungs and larynx. In the list of the most common pathologies in men, bladder cancer is in 4th place, in women - in 10th.

How to "track down" pathology

Blood in the urine or poor urination is cause for concern. An urgent need to see a doctor.

Analysis of urine for abnormal cells. The urine is examined under a microscope to look for tumor cells or precancerous diseases.

Cystoscopy. Using a thin tube equipped with an illuminator, the doctor examines the bladder and, upon finding a suspicious area or tumor, takes a piece of tissue. Based on the results of the analysis, one can judge the presence of cancer and its type.

Today, ultrasound of the bladder is successfully replacing cystoscopy at the first stage of the examination.

The five-year survival rate for patients with bladder cancer varies widely and depends on the stage of the disease:
at zero stage - 95%, I - 85%, II - 65–75%, III - 30–65%, IV - 10–15%.

Treatment

Surgical, radiation, medicinal and immunological methods are used. The choice depends on the stage (degree of spread) of the disease and the morphological structure of the tumor.

Operation. More than 70% of the first-time patients have prognostically favorable superficial tumors. They are successfully healed. The intervention is performed using endoscopic equipment, without opening the bladder. Some have so-called invasive cancer - an aggressive formation. It grows into the muscular layer of the organ, prone to metastasis to the lymph nodes of the pelvis, lungs, liver, bones. The optimal treatment for invasive tumors is complete removal of the bladder and pelvic lymph nodes (cystectomy). At the same time, in men, the prostate and seminal vesicles are removed, and in women, the anterior wall of the vagina and the uterus with appendages. One of the sections of the intestine is cut off, a reservoir for urine is formed from it. The ureters are transplanted there, the "construction" is sutured to the urethra. Spontaneous emptying of the new bladder is preserved. If necessary, use other methods of urine diversion.

Radiation therapy. Helps to destroy or shrink the tumor, which facilitates subsequent surgery.

Chemotherapy. Indicated for patients with advanced cancer. Usually, drugs are injected into a vein, sometimes inside the bladder. The method is shown only in the early stages.

Intravesical immunotherapy. The most commonly used vaccine is BCG. Its introduction directly into the bladder activates the immune system and helps the body fight tumor cells.

The best way to protect yourself against bladder cancer is by eliminating the risk factors that can influence the development of the disease:

  • give up cigarettes;
  • avoid exposure to chemicals at work. When dealing with aromatic amines, follow the safety instructions;
  • drink plenty of fluids. This leads to more frequent urination and dilution of carcinogenic substances in the urine, and also limits the time of their contact with the mucous membrane of the organ;
  • follow a diet. Brussels sprouts and cauliflower can reduce the risk of developing the disease: they contain an enzyme that protects cells and prevents them from turning into tumor cells.
Igor Masansky, Head of Oncosurgical Department No. 3 of the Minsk City Clinical Oncology Dispensary, Candidate of Medical Sciences. sciences.

Cytological examination of urine is a method of microscopic examination, which consists in determining the presence and number of modified cellular structures in the composition of urine. It is performed simultaneously with oncological and general clinical examination.

Among the main indications, there are disorders in the work of the genitourinary system, oncological diseases of the bladder, and it is also carried out for people who are at increased risk for this pathology. In a normal state, as a rule, the result will be negative.

What

Urine analysis for cytology is a laboratory method for studying the elements of urine at the cellular level using a microscope. Assessment of biological material is necessary when it becomes necessary to establish the presence or absence of signs of degeneration or other atypical changes in cellular structures.

Thanks to this technique, specialists have the opportunity to assess the characteristics of individual cell structures by morphological characteristics. This allows in the future to refute or confirm the setting of the primary diagnosis. In addition, if necessary, an additional diagnostic examination can be carried out.

Cytological analysis of urine is one of the most effective and informative in the detection of malignant tumor formations, as well as oncological pathologies.

To study the sample taken, a special coloring agent is introduced into the urine sediment. Urine centrifugation is mandatory beforehand. Only after these manipulations is the study of cells by morphological characteristics.

It is important to remember that it is necessary to investigate the cytoplasm, the nucleus, as well as the state in which they interact with each other.

Upon completion of the laboratory study, all data are recorded in detail in a special form. An important component is the changes in the cellular structures.

The interpretation of the results obtained is exclusively carried out by the leading specialist.

Indications

It is important to understand that urine analysis for atypical cells is prescribed not only in order to identify or confirm the absence of progression of the oncological process, but also as a preventive measure, for example, when a person undergoes an annual medical examination.

Most often, the main indications for conducting this laboratory study are the following conditions:

  • suspicion of development oncological diseases;
  • possible defeat organs of the urinary system by tumor formations;
  • need to define location tumors;
  • control a patient who has already been diagnosed with urinary tract cancer;
  • the need to identify cell structures in urine blood liquids;
  • refutation or confirmation of the primary pathology;
  • evaluation of the effectiveness of the results from the assigned therapeutic activities;
  • inspection after the surgical intervention.

In addition, it is important to understand that conducting a cytological study of urine without an apparent reason is inappropriate. It is for this reason that most of the necessary information is obtained by specialists in the course of general clinical analysis.

Analysis for cytology is used only in situations where there is a suspicion of the development of an oncological process.

Contraindications

The only limitation to the appointment of a cytological analysis of urine is the absence of obvious clinical signs of a cancer that affects the organs of the genitourinary system.

Experts do not identify other contraindications.

Preparation

In order for the results obtained in the process of cytology to be as reliable as possible, you need to know how to properly prepare for it. In general, regardless of what kind of analysis you need to pass, the preparatory activities have almost a similar principle.

First of all, you need to follow the rules for performing hygienic procedures, and use exclusively sterile dishes for the collection of biological material. Differences in preparation can only be in the amount and time of collection of the liquid intended for the study.

For analysis for cytology, urine must be collected in the morning and only after complete emptying of the bladder from the fluid accumulated overnight. Thus, if the awakening was, for example, at 6 in the morning, then you need to immediately visit the toilet.

For cytological examination, urine is collected only about 2 hours after the first emptying.

After the urine has been collected, it must be immediately taken to the laboratory. In this case, it is possible to obtain a reliable result. The container for urine must be purchased at the pharmacy, since it is there that it will be as sterile as possible, which does not require additional measures for its processing.

If we are talking about seriously ill patients or patients who do not get up, then urine collection is carried out using a catheter. Before this, the patient is obliged to undergo hygiene procedures. After washing the perineum, it is wiped dry with a towel, a catheter is inserted and the biomaterial is collected.

Often, there are cases when a specialist prescribes more than one such procedure, which makes it possible to make a diagnosis as accurately as possible and determine the presence of an oncological process.

The material is examined only under laboratory conditions. Cytology can take about five days.

What diseases does it reveal

Thanks to this test, specialists are able to study the state of the patient's microflora, confirm the presence or absence of pathologies of an infectious nature of origin and others. In addition, this type of study makes it possible to detect and diagnose oncological diseases of the kidneys, urethra, prostate gland, ureters and bladder.

The importance of the technique lies in its effectiveness and the possibility of determining cancerous degenerations of cells at the beginning of the development of the pathological process.

Decoding the result

Only a qualified pathologist or histologist should interpret the data obtained. After all the cells have been studied in detail, he makes the necessary records, taking into account all changes in cell structures and identifies cancer episodes.

If we talk about the terms during which cytology is carried out, then in each clinic they can be different, since each laboratory uses its own methods and technologies for studying biological fluid.

The data obtained are described in special terms that are used in medicine. Thus, if the result was stated to be unsatisfactory, this is evidence that a sufficient number of atypical cells are absent or abnormal episodes are present. If the patient received just such a conclusion, then he is prescribed a second urine test for cytological examination.

Obtaining a negative indicator indicates the complete absence of atypical cellular structures in the human body. In this case, the sample will not be the norm, but also there are no cancerous episodes in it.

When a suspicious indicator is established, one can talk about the effect of a malignant neoplasm on the cells, as a result of which they have changed. In such situations, after a certain period of time, a second study is carried out.

A positive result will indicate the presence of cancer cell structures in the biological fluid.

Urine cytological examination is one of the most common types of analysis that is used in case of suspicion of the development of cancer. Despite its effectiveness and high information content, it is not recommended to carry it out for no apparent reason, since this action will be useless.

If, during the laboratory study of urine, the result turned out to be positive, then the patient is prescribed an additional diagnostic examination with a biopsy and cystoscopy.