Objectives: To review the current usefulness of urinary cytology in the diagnosis of upper urinary tract urothelial tumor in relation to conservative endoscopic treatment.
Methods: Bibliographic review of the published articles about urinary cytology of the upper urinary tract urothelial tumor and evaluation of the diagnostic efficacy obtained in various series. Review of the cytological diagnostic criteria for urothelial tumors.
Results: From 1960 to 2003, 26 series collecting results of the cytological diagnosis of urothelial tumors of the ureter and renal pelvis have been published. Results have been variable with a diagnostic accuracy between 23 and 100%. Such an ample variation depends on sampling techniques, preparation techniques, type of tumor, and the urologists and pathologist's experience. The collection of the sample by direct endoscopical visualization significantly proves the diagnostic efficacy of cytology for upper urinary tract urothelial tumors.
Conclusions: Urine cytology selectively obtained from the upper urinary tract with endoscopical techniques is a reliable method in the diagnosis of renal pelvis and ureter neoplasias. Urine cytology has a sensitivity close to 90% and specificity between 98-100% for carcinoma in situ and high-grade urothelial neoplasias, so that it can contribute in the therapeutic decision making process in a very effective manner. Despite its low sensitivity, it may be useful in the diagnosis of low grade urothelial neoplasias when samples are selectively obtained by catheterization, and it has not been excelled by any of the biomarkers molecular tests yet.