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Effect of Contrast Media on Urine Cytology

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•Contrast media and cytopathology are used concomitantly during the evaluation of hematuria, abnormal upper tract filing defects or for surveillance post diagnosis of urothelial carcinoma.
•The accuracy of urine cytology from the upper tracts is poor false-negative or false-positive result (22% to 35%)(1) . 
•Both technical and histopathological characteristics may play a role in the poor results.
•Contrast media’s effect on cytology is relatively unknown.


•Three human cell lines were obtained from ATCCR tumor cell panels:
•SV-HUC, a benign human epithelial cell line as the control, group A (ATCC SV-HUC).
• UC-3 minimally aggressive, low grade human urothelial cancer cell as group B (ATCC CRL-1749).
• RT-2 an aggressive high grade urothelial cancer cell line as group C (ATCC HTB-2).
•Each cell line was reconstituted into 1 cc off1)water, 2) saline, 3) human urine, 4) ConrayTM 100), 5) ConrayTM 50%, human urine 50%, 6) Conray 10%/ human urine 90%, 7) OminpaqueTM  100%, 8) OmnipaqueTM 90%/Urine 10%, 9) OmnipaqueTM 10%/Urine 90%.
•Each cell line was exposed to each of the solutions for 10 seconds, 1 minute and 5 minutes.
Analyzed by a single pathologist.


•There was no cytological differences seen when cells of the same cell line were exposed to a variance of contrast mediums at for any of the exposure time.
•Cells exposed to water for greater than 10 seconds had hydropic degeneration.


•The presence of hydropic degeneration in the water group confirmed that our study design was valid.
•The use of contrast agent allows for safe upper genitourinary tract endoscopy without compromising results of cytopathological analysis.
Strengths: the use of human cell lines, with a true positive and negative control groups.
Weaknesses: lack of an objective measure of cellular change and only a single pathologist.  
•We recognize that many urinary markers and tests are able to evaluate urine for presence of urothelial carcinoma. The effect of contrast on these agents is still unknown and is an avenue for future research. 


Contrast does not have an effect on the cytopathological analysis of and contrast pre vs. post should not have an affect