Urinary cytology is undoubtedly effective for the detection of urothelial carcinomas, especially in high-grade cancer. Although technological improvements have been introduced to the process, urinary cytology has so far been limited to a mean sensitivity of ~50% for the detection of urothelial carcinoma.
Urine cytology is usually diagnostic when there is urothelial carcinoma of the renal pelvis and ureter, particularly when the cancers are high grade. With low-grade urothelial malignancies, the same diagnostic problems are encountered as in the bladder. Urine cytology rarely identifies renal cell carcinoma.
Urothelial carcinoma is the most common cancer detected by urine cytology and the most common site of origin is the bladder. Worldwide, over 390 000 bladder cancers are detected annually. In most parts of the world, 90% of bladder cancers are urothelial in origin, 5% squamous and 5% mixed urothelial and squamous.