What is the role of lab tests in the workup of renal transitional cell carcinoma?

Updated: Nov 05, 2019
  • Author: Bagi RP Jana, MD, MBA, MHA, FACP; Chief Editor: E Jason Abel, MD  more...
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Answer

Urinalysis and urine culture are indicated. The presence of microscopic hematuria suggests urinary tract tumors, which must be ruled out even if the hematuria resolves. The presence of more than 2-5 red blood cells (RBCs) per high-power field (HPF) is considered sufficient to warrant further investigation to rule out upper urinary tract renal transitional cell carcinoma (TCC). Evaluate for urinary tract infections.

Cytologic studies may be helpful. Voided-urine cytology is a convenient and noninvasive method of diagnosis, but it is subjective and lacks the necessary sensitivity for diagnosing upper urinary tract urothelial tumors, especially low-grade neoplasms. Fluoroscopically guided brush biopsy increases the diagnostic accuracy to 80-90%.

A 2012 study concluded that urine cytology and fluorescence in situ hybridization (FISH) are the single tests with best overall performance for the detection of urothelial carcinoma. Combining cytology and FISH improved the sensitivity; failure of cytology to detect grade 3 carcinoma in situ tumors decreased by 62.5% when FISH was performed in cytology-negative patients. [12]


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