Available data provide less support for cystoscopy in women with asymptomatic microscopic hematuria than in men. No cases of bladder cancer were found in one prospective, referral-based study involving 177 women (mean age, 57.2 years) with asymptomatic microscopic hematuria who underwent cystoscopy.
In another referral-based study,involving 1034 adults (75 percent of whom were female),only two cases of bladder cancer were identified
in women with microscopic hematuria (one 54 years old and the other 70 years old).
In contrast,in a referral-based study involving 484 women with microscopic hematuria, 12 cases of urologic cancer were identified in women between 60 and 89 years of age, and 5 cases were found in women between 40 and 59 years of age. The specific types
of cancer and the number of diagnoses made with cystoscopy were unclear.
Cytologic analysis of voided urine is less sensitive(66 percent and 79 percent in two large series) than cystoscopy in the detection of bladder cancer but has high specificity (95 percent and 100 percent in the two series).
The sensitivity is improved if specimens of urine from the first voiding in the morning on three consecutive days are obtained.
The sensitivity is higher for the detection of highgrade bladder cancer and carcinoma in situ but lower for the detection of cancers of low histologic
grade, and cytologic analysis is insensitive for the detection of renal-cell cancer. Cystoscopy itself had 87 percent sensitivity for the detection of bladder cancer in one large series and is especially limited for the diagnosis of carcinoma in situ.
Urinary molecular markers for the noninvasive detection of bladder cancer are currently being evaluated but have not yet been validated.
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