Invasion cannot be reliably predicted since blood and inflammatory debris may be seen with benign cystitis as well as invasive carcinoma (Figs. 3.40, 3.41). Both in situ and invasive urothelial carcinoma have essentially identical cytologic criteria. Rarely, spindle cells reminiscent of the "fiber cells" of invasive squamous carcinoma of the cervix will be noted, but this feature is infrequent enough to be of no practical use (Figs. 3.42, 3.43). Biopsy is necessary to determine involvement of detrusor muscle invasion that cannot be predicted by any cytomorphologic criteria.
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