Diagnostic Value of Urine Cytology in Bladder Cancer. A Meta-Analysis.

Objective: To evaluate the diagnostic value of urine cytology in detecting bladder cancer using meta-analysis.

Study design: Public databases, including PubMed, Embase, Springer, Elsevier Science Direct, Cochrane Library, and Google Scholar, were searched before February 2015. Sensitivity, specificity, positive likelihood ratio (LR), negative LR, and diagnostic odds ratio (DOR) of urine cytology in individual studies were calculated using random effects model or fixed effect model. The summary receiver operating characteristic (SROC) curve was applied for performance of urine cytology. Publication bias of the included studies was evaluated by Egger's test.

Results: A total of 17 separate studies consisting of 5,908 patients with bladder cancer were included in the meta-analysis. Significant heterogeneity between the studies (I2 = 98.6%, p < 0.01) and effect sizes were pooled using random effects model. Overall sensitivity, specificity, positive LR, negative LR, and DOR of urine cytology were 0.37 (95% CI 0.35-0.39), 0.95 (95% CI 0.94-0.95), 7.39 (95% CI 4.97-10.98), 0.56 (95% CI 0.47-0.68), and 15.76 (95% CI 9.03-27.50), respectively. The area under the curve (AUC) and Q* index were 0.80 and 0.74, respectively. No publication bias was observed (p = 0.12).

Conclusion: Our data indicate that urine cytology might be more suitable as an assistant method in bladder cancer detection by combining with other diagnostic methods with high sensitivity.