October-November
Shelly has shown the pictures to colleagues at Exeter, but has urgent family issues to deal with. So I'll be waiting a while.

October
Have had a quick look at the reports and pictures with Shelly, and she intends to take them to her work colleagues for further views. Thence we will look at the slides.

September 19th
Spoke to Shelly and will call her when I get the piccies.

September 17th
Spoke to Laura and she said the loan of the slides is to avoid them lending me the microscope etc.

September 16th
Yesterday I paid to have pictures taken of the dodgy cells in my June tests.

The option will be to:

• Take more pictures of the slides: Must check my compact flash cards are viable.
• Take the slides to Exeter for further analysis.
• Do another cytology test. Have to chase up the staining procedure.

From : Roger Lovejoy
User-Agent: Thunderbird 2.0.0.14 (Windows/20080421)
To: plamkom@labcore.com
Subject: cytology and haematuria

Hi. Matthew

I just spoke to you from the UK about the ability to assess the origin of red blood cells by microscopic analysis. I had found this option via an associated website of yours: http://www.carepathonline.com/Topic.aspx?Nav=0&Rel=166

"If red blood cells are present in your urine sample, the pathologist will examine them closely with a high-powered microscope to observe their shape. The shape of the cells tells the pathologist whether they came from the kidney or from another part of your urinary tract."

As I mentioned the common options available to the punter, here is rather sketchy and it has taken me some months to get this far. Even the medical professionals seem to be bemused at my discoveries. (BTAStat, NMP22) and now this. The only view on cytology that I have extracted locally is being used to find cancer cells. My query is to know where the blood is coming from at this stage.

My queries are:

1. Is the analysis by an optical microscope or it some other higher tech. apparatus needed.
2. Can you provide me with any examples of how you discover the source, i.e. the differences in red blood cells. A description and/or images would be great. If it is done using an optical microscope I am thinking of buying one and doing regular checks myself.

Please let me know you get this so I can confirm I have the correct email address.

All the best

Roger Lovejoy

1. wikipedia.org

The gold standard of diagnosing bladder cancer is urine cytology and transurethral (through the urethra) cystoscopy.

2. Cytology exam of urine

How the test is performed:

Collect a urine specimen and send it to the laboratory.

Collect a "clean-catch" (midstream) urine sample. To obtain a clean-catch sample, men or boys should wipe clean the head of the penis. Women or girls need to wash the area between the lips of the vagina with soapy water and rinse well. As you start to urinate, allow a small amount to fall into the toilet bowl (this clears the urethra of contaminants). Then, in a clean container, catch about 1-2 ounces of urine and remove the container from the urine stream. Give the container to the health care provider or assistant.

How to prepare for the test:

Collect a clean catch urine sample 3 hours after the last voiding. The first morning voided specimen should not be used.

3. www.cancerbackup.org.uk

A test for cancer cells in the urine. This is called a cytology test or voided urinary cytology test (VUC). It involves a specialist examining a sample of urine under the microscope to look for cancer cells. It may take up to 2 weeks to get the results.
Cytology tests can be helpful to doctors in diagnosing some types of bladder cancer, such as cancer in situ (CIS), that are more difficult to detect with a cystoscopy. However, not all samples of urine contain cancer cells, even when there is cancer in the bladder. This means the test may give a negative result even if there is a cancer. This is called a false negative result. A false negative result is more likely for early bladder cancers and for bladder cancers that are slow growing (low grade). So, if a cytology test is negative ,for cancer further tests may still need to be done.

4. healthline.com

Why the test is performed

The test is done to detect cancer and inflammatory diseases of the urinary tract. The test is often done when bladder lesions are noted on an x-ray.

The test may occasionally be ordered for individuals who are at high risk of developing bladder cancer. The test can also detect cytomegalovirus and other viral diseases.

Normal Values

The urine shows normal cells and is relatively free of debris.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
What abnormal results mean

Abnormal cells in the urine may be a sign of inflammation of the urinary tract orcancer of the kidney, ureters, bladder, or urethra.

From: clinicalanswers.nhs.uk

" A 2003 article reviewed as part of the NHD Centre for Reviews and Dissemination DARE programme [1]. It reported:

“Cytology had a pooled specificity of 94% (95% confidence interval, CI: 90, 96), which was statistically significantly higher than for other tests”

And reported the sensitivity of cytology as 55% (95% CI: 48, 62). The author of the original article concludes:

“Cytology had the best specificity and telomerase the best sensitivity. None of the tests reached a level of sensitivity that would be acceptable to clinical practice.”

An American guideline “Screening for bladder cancer in adults: recommendation statement” [2] has a Q&A section and one of the questions was "What are the accuracy and reliability of feasible screening tests for bladder cancer?" which answers:

“Several studies examined the accuracy of hematuria, bladder tumor antigen, NMP22 urinary enzyme immunoassay, and urine cytology. All had important flaws, especially involving screening patients from urology clinics (as opposed to average risk populations from primary care clinics) or not applying "gold standard" tests (cystoscopy with or without biopsy) to those who screened negative for bladder cancer. As a result, these studies do not provide high-quality evidence about the accuracy of screening tests in the general primary care population.” "