Introduction: Urothelial carcinoma of the bladder is the 7^th most common cancer presenting in majority of the patients as painless hematuria.

Objectives: To compare urine cytology, ultrasonography and cystoscopy as screening tests for bladder cancer. To recommend a diagnostic protocol that improves the overall sensitivity and specificity of detection of carcinoma bladder in patients.

Subjects and Methods: A prospective analysis of 165 patients with painless hematuria was done in at a urology centre in North India from June 2016 to April 2020. Patients were subjected to voided urine cytology, ultrasonography and cystoscopy. The results were compared with histopathological examination of the biopsy or resected tumor, whichever applicable considering it to be gold standard.

Results: The sensitivity of urine cytology, ultrasonography and cystoscopy was (30.8%), (63.1%) and (78.5%) respectively, whereas the specificity of urine cytology, ultrasonography and cystoscopy was (100%), (96%) and (97%), respectively. Urine cytology was found to have least sensitivity in low grade cases with only 10% cases being positive whereas ultrasonography and cystoscopy had a sensitivity of 60% and 77% respectively. Sensitivity for high grade carcinoma for urine cytology, ultrasonography and cystoscopy were 49%, 66% and 80% respectively.

Conclusions: Best technique amongst the three is cystoscopy. However, ultrasonography can be used as the initial investigation for patients presenting with hematuria. Voided urine cytology can be used along with these two owing to its high specificity. Therefore, to further increase the sensitivity and specificity, a combination of these diagnostic modalities may be considered.

Keywords: Urine cytology, ultrasonography (USG), cystoscopy, bladder carcinoma.

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Dr Vijeta Tomar

MD, DNB Pathology, SMS Medical College, Jaipur