Urine Cytology Discrepancies (original) (raw)
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Asian Pacific journal of cancer prevention : APJCP, 2014
The aim of this study was to evaluate 10 years of false positive urine cytology records, along with follow-up histologic and cytologic data, to determine the significance of suspicious urine cytology findings. We retrospectively reviewed records of urine samples harvested between January 2002 and December 2012 from voided and catheterized urine from the bladder. Among the 21,283 urine samples obtained during this period, we located 1,090 eligible false positive findings for patients being evaluated for the purpose of confirming urothelial carcinoma (UC). These findings were divided into three categories: atypical, indeterminate, and suspicious of malignancy. Of the 1,090 samples classified as false positive, 444 (40.7%) were categorized as atypical, 367 (33.7%) as indeterminate, and 279 (25.6%) as suspicious of malignancy. Patients with concomitant UC accounted for 105 (23.6%) of the atypical samples, 147 (40.1%) of the indeterminate samples, and 139 (49.8%) of the suspicious of mal...
Utility of Urine Cytology in Urinary Tract Neoplasm with Histopathological Correlation
https://ijshr.com/IJSHR\_Vol.4\_Issue.3\_July2019/IJSHR\_Abstract.0031.html, 2019
Background: Urinary bladder tumor is the sixth most common tumor diagnosed worldwide. Urine cytology is an important screening tool of patients for urothelial carcinoma (UC) and follow-up of patients with treated disease. The aim of this study to determine the sensitivity of urine cytology in detection of urinary tract neoplasms with its clinical and histopathological correlation. Material & Methods: A five years prospective study includes 73 cases of urine cytology from January 2014 to December 2018 at a tertiary care hospital in the Department of Pathology. Urine cytology slides were reviewed and were correlated with histopathological diagnosis. Results: Out of 73 cases, histopathological follow up received only in 43 cases. Out of that, 33 were male and 10 were female. Male to female ratio is 3.3:1. Maximum age incidence was found 5th-6th decade. Hematuria was most common and presenting complaint found in 90% of cases. Urothelial carcinoma was most common neoplasm comprising for 87.5% of bladder tumors, Squamous cell carcinoma comprising 7.5%. The overall urine cytology sensitivity combining with the positive and suspicious result was 77.5%. Conclusion: Urine cytology, despite its variable sensitivity remains a useful tool in evaluating suspected urothelial malignancies. Positive urine cytology requires confirmation with cystoscopy and biopsy before instituting any form of definitive therapy and a negative cytology does not always exclude malignant disease. Keywords: Urothelial carcinoma, Urine cytology.
Cancers
In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, p < 0.01). Three cases with an N/C ratio near 0.5 were overe...
Cytopathology, 2007
Is urinary tract cytology still useful for diagnosis of bladder carcinomas? A large series of 592 bladder washings using a five-category classification of different cytological diagnoses Background: The aim of this study was to estimate the efficiency of a recent five-category urinary cytological classification. Methods: A total of 592 bladder washings were fixed immediately with Saccomanno's fixative. All samples were centrifuged in a Hettich cyto-centrifuge. For each sample, the reference standard was the histology when a lesion was present at the time of cystoscopy. A five-category cytological classification was used: negative, suspicious of low (S-Lg) or high (S-Hg) grade neoplasia and consistent with low (Lg) or high (Hg) grade neoplasia. Results: For cytological diagnoses of S-Lg and Lg, sensitivity was 37% and specificity was 95% for the histological diagnosis of low-grade non-invasive urothelial papillary tumour (Lg-UPT), which included papillary urothelial neoplasm of low malignant potential and low-grade urothelial carcinoma. For cytological diagnosis of S-Hg and Hg, sensitivity was 44% for high-grade non-invasive urothelial papillary carcinoma (Hg-UPC), 70% for carcinoma in situ (CIS) and 81% for invasive carcinoma (T1 and higher). Specificity was 99% in each case. Cytological diagnosis of S-Hg or Hg was not found for Lg-UPT (0/59) and no cytological diagnosis of S-Lg or Lg was found for invasive carcinoma, but was seen for Hg-UPC in 10% (3/28) and for CIS in 6% (3/50) of cases. Conclusion: Despite the absence of international consensus, the recent five-category cytological classification for urine is accurate for current urological practice.
BJU International, 2011
and 47% had invasive disease ( ≥ pT2). Lowgrade and high-grade cancers were present in 33% and 67% of patients, respectively. • Positive, atypical and negative urine cytology was noted in 40%, 40% and 20% of cases. Positive urinary cytology had sensitivity and PPV of 56% and 54% for high-grade and 62% and 44% for muscleinvasive UTUC. • Inclusion of atypical cytology with positive cytology improved the sensitivity and PPV for high-grade (74% and 63%) and muscle-invasive (77% and 45%) UTUC. Restricting analysis to patients with selective ureteral cytologies further improved the diagnostic accuracy when compared with bladder specimens (PPV > 85% for highgrade and muscle-invasive UTUC).
A review of urinary cytology in the setting of upper tract urothelial carcinoma
Journal of the American Society of Cytopathology, 2020
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Accuracy of Urine Cytology and the Significance of an Atypical Category
American Journal of Clinical Pathology, 2009
The "atypical urothelial cell" cytologic category is nonstandardized. We subclassify atypical cases to "atypical, favor a reactive process" or "atypical, unclear if reactive or neoplastic." We evaluated the predictive significance of atypical cases by looking at their histologic follow-up. Among the 1,114 patients and 3,261 specimens included, 282 specimens had histologic follow-up. An atypical diagnosis did not carry a significant increased risk of urothelial neoplasia compared with the benign category. Although an "atypical unclear" diagnosis carried a higher rate of detection of high-grade cancer on follow-up biopsy in comparison with "atypical reactive" or "negative" diagnoses (26/58 [45%] vs 15/52 [29%] and 16/103 [15.5%], respectively), this difference was not statistically significant. These results suggest that dividing atypical cases into 2 categories based on the level of cytologic suspicion of cancer does not add clinically relevant information within the atypical category. They also raise the question of the significance of the atypical category altogether.
How Important is Urinary Cytology in the Diagnosis of Urological Malignancies?
European Urology, 2003
Objective: To audit clinical usefulness of urine cytology examination in a subspecialised urological unit setting. Patients and Methods: Data from the hospital information support system on urinary cytology examinations carried out at one centre was audited over a period of 15 months. Source of urine cytology specimens, clinical profile of patients and the findings of urinary cytology were analysed and collated. Results: A total of 1400 urinary cytology specimen on 900 patients were requested during 15 months study period. Urologists requested 1092 (78%) and non-urologists (general practitioners, physician or general surgeons) requested 318 (22%) specimens. The majority of specimens, 1115 (80%) did not show any cytological evidence of malignancy. 83 specimens (6%) showed cytological evidence of malignant cells consistent with origin from a urothelial malignancy. Among this group 87% (72) were more than 50 years of age and 60 (72%) had history of gross heamaturia. 159 (11.35) cases were reported as being suspicious of malignancy or showing atypical cells requiring further evidence. A total of 43 (3.04%) specimens were poorly preserved or insufficient for diagnosis. The positivity rate amongst urologist and non-urologists request was 56% and 6% respectively ( p ¼ 0:00001 value). The source in 37 (86%) specimens reported, as poorly preserved or insufficient for diagnosis was non-urologists compared to 6 (14%) from urologists with significant p value (0.00001). Conclusions: Urinary cytology for malignant cells is a contributory investigation in the diagnosis of urological malignancy. It should be only ordered in the proper clinical situation. #
FISHing and beyond in urinary cytology
Diagnostic Cytopathology, 2004
Voided urine and bladder washings are amongst the most common non-gynecologic specimens received in cytology laboratories. Whereas light microscopic examination has been the mainstay of screening and diagnosis for decades, problems with sensitivity for detecting low-grade urothelial neoplasms have always been a major source of limitation and frustration to cytopathologists as well as urologists. Recently, new ancillary techniques have been flooding the literature and scientific meetings, all promising a magic answer and leading one to believe that the days of morphologic urinary cytology are numbered. So are we there yet? Should we give up on urinary cytology and advise our urology colleagues to send their specimens for ancillary testing? This editorial is an overview of the salient problems of urinary cytology and a critical appraisal of the status of its challengers.