Atypical Urine Cytology, but negative cystoscopy?

[jweston347]

Hi.  I had an atypical cytology report, stating altered N/C ratio, enlarged nuclei, clusters, but INDETERMINIATE for malignancy.  Follow-up cytoscopy was NEGATIVE for anything.  Doc wants to repeat in 3 months.  My question is, is this a precursor for cancer?  Will I get cancer eventually?  Is it just that it's too small to find and it has to grow some more before it can be detected?  OR, is it common to have atypia in the urine, but not go into cancer?
Thank you.
Mark

[Ketan K Badani]

Hi Mark,

Atypical cells on cytology can be very difficult to interpret.  Although malignant cells can be atypical (as opposed to "SUSPICIOUS") inflammation and infection can have atypical cells as well.  Repeating the cystoscopy, cytology in 3 months is a good idea.  I would also suggest a CT scan of the kidneys to complete the work-up.  A history of smoking would also make me more suspicious.  Atypia does not necessarily mean pre-cursor, it does not correlate well with "pre-malignant" conditions.

[jweston347]

Thank you for your response.  The second cytology following the "atypical" cytology was "negative for malignancy."  The Pathology Dept. here rates urine cytolgy results as: 1. Negative for Malignancy  2. Indeterminate for Malignancy  3. Positive for Malignancy.  Although my second urine cytology was Negative for Malignancy, and for all intents and purposes a "normal" urine cytology, there were red and white blood cells present, but apparently no atypical cells as in the first report.  He made no comment on the presence of the white blood cells.  My urologist seems to play his cards close to his chest, and only recommends another cystoscopy and urine cytology in 3 months, which I will do.  There was also no mention of CT of kidneys, which I would support.  Yes, I am a smoker, as well.  I spoke with an excellent Radiologist who is treating my wife for Breast Cancer, and he read my first and second cytology reports and said everything was normal, and likely nothing to be concerned about.  Strange stuff, these urine cytologies.  
Thanks again for your time and for providing a better picture of urine cytology results.