Cytology is not recommended for every case by the AUA AMH guidelines but rather is only suggested as an option in those with persistent AMH after a negative evaluation or in those with risk factors for carcinoma in situ (CIS), such as irritative voiding symptoms, tobacco use, and chemical exposures.29 Cytology remains the adjunct test of choice due to its overall high specificity of 95%–99%.34 There are many limitations to the use of cytology, including its low sensitivity especially for low-grade cancer, interobserver variability, and atypical findings. Here, AMH is linked to cancer.