The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens (original) (raw)
Related papers
Asian Journal of Medical Sciences
Background: Urine cytology is an important screening tool of patients for urothelial carcinoma and follow-up of patients. Ease of procurement, cost-effectiveness, and lower turnaround time are the advantages. Aims and Objectives: The aim of the study was to identify the accuracy of TPS criteria in diagnosing HGUC, considering biopsy as the gold standard and to describe the cytomorphological features in atypical urine specimens and categorization as per reference to TPS of reporting urine cytology. Definition – Atypical urine sample: Urine samples of patients with macroscopic hematuria and other unexplained urinary symptoms, suspicious of urothelial malignancy. Materials and Methods: The study was performed on patients attending urology OPD with macroscopic hematuria and other unexplained urinary symptoms, which were suspicious of urothelial malignancy and whose urine cytology and subsequent biopsy specimens were submitted to the Department of Pathology. Continuous sampling of 56 pat...
APMIS : acta pathologica, microbiologica, et immunologica Scandinavica, 2018
In this study, we have examined 67 cytology specimens from patients from 2014 to 2016. The ratio man to women was 4:1 with a median age of 75 years (range: 55-87 years). Thin-Prep processed urinary cytology specimens demonstrated large urothelial cells, with cytologic features of malignancy, thus including hypochromatic nuclei with occasional peripherally accentuated chromatin rim. The cytological diagnosis of High Grade Urothelial Carcinoma (HGUC) was made in 55 patients while 12 specimens were classified as Atypical Urothelial Cells (AUC). This cases represent the 15% of the HGUC and the 4% of the AUC cases diagnosed in our department between 2016 to 2018. Of note, is the fact that in AUC cases, hypochromatic irregular urothelial cells were the only type of cells with malignant features observed in the specimen, and therefore, according to the Paris System criteria, the absence of nuclear hyperchromasia precludes a diagnosis of suspicious high grade urothelial carcinoma (SHGUC) or...
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.
A review of urinary cytology in the setting of upper tract urothelial carcinoma
Journal of the American Society of Cytopathology, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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.
Urinary Cytology in the Diagnosis of Bladder Cancer
2021
The examination of urine is an ancient medical procedure dating back thousands of years. Microscopic examination of cells in the urine is being done since the invention of microscope. Presently the cytological examination of urine or other fluid samples from the urinary tract is a routine non-invasive diagnostic procedure to detect cancer of the urinary tract, especially in patients with painless haematuria. It is also used in the follow-up of patients previously treated for bladder cancer to detect recurrence or a new primary. It is a highly specific method for the diagnosis of invasive and in situ urothelial carcinoma and high-grade papillary carcinoma. However, it is unreliable for the detection of low-grade papillary neoplasms. Malignant cytomorphological characteristics of the exfoliated cells in urine or bladder washing can facilitate the diagnosis of bladder cancer. The Paris System (TPS) Working Group has proposed. The Paris System (TPS) authorities have proposed a standard ...
Curēus, 2024
Background: Urothelial carcinoma, a prevalent and aggressive urological malignancy, necessitates early detection for improved prognosis. Urine cytology serves as a cost-effective screening tool, but inconsistencies in reporting due to the lack of standardized criteria limit its efficacy. The Paris System for reporting urinary cytology (TPS) was introduced to address this issue, aiming to improve diagnostic accuracy. This retrospective study investigates the effectiveness of urine cytology in detecting high-grade urothelial carcinoma (HGUC) using TPS classification, specifically focusing on atypical urothelial cells (AUC) categorized as TPS-III and suspicious for high-grade urothelial carcinoma (SHGUC) categorized as TPS-IV. Methods: We reviewed 470 urine cytology samples collected over two years at a tertiary healthcare center in Bahrain. All samples were re-evaluated using TPS classification by two independent consultant cytopathologists blinded to the original cytology report. The analysis included only samples categorized as TPS-III or TPS-IV with corresponding histopathology reports from confirmatory biopsies performed within four months of urine collection. Biopsy results were categorized as either benign/low-grade urothelial carcinoma (non-HGUC) or malignant (HGUC). The positive predictive value (PPV) of urine cytology for HGUC detection was calculated for both TPS-III and TPS-IV categories. Statistical significance was assessed using Fisher's exact test. Results: Among the 470 urine cytology samples, 40 (8.5%) were classified as TPS-III or TPS-IV. Within this subset, 16 patients underwent confirmatory biopsies. Histopathological analysis revealed HGUC in 12 (75%) patients and non-HGUC (benign or low-grade) in 4 (25%) patients. The PPV of TPS-III for HGUC was 50%, while TPS-IV demonstrated a higher PPV of 90%. However, the difference between these values was not statistically significant (p = 0.25). This study explored the utility of TPS classification in urine cytology for HGUC detection. While SHGUC (TPS-IV) exhibited a numerically higher PPV compared to AUC (TPS-III), the lack of statistical significance necessitates further investigation. Our findings highlight the potential of TPS to improve the accuracy of urine cytology. TPS implementation has been shown to reduce the number of inconclusive "atypical" diagnoses, leading to more targeted investigations. Conclusion: Our study suggests that SHGUC (TPS-IV) within TPS classification framework might hold promise as a more specific indicator for HGUC compared to AUC (TPS-III). However, further research with larger cohorts is necessary to definitively establish the clinical significance of this observation. This investigation paves the way for future studies exploring the potential of TPS, particularly the SHGUC category, as a reliable screening tool for HGUC, potentially leading to earlier diagnoses and improved patient outcomes.
2018
Background: Bladder cancer is one the most common lesion treated by urologists. Since decades cystoscopy has been the gold standard for the diagnosis of primary and recurrent urothelial cancers. Exfoliative urinary cytology of fresh voided urine and bladder washings is usually performed to preceding or to complement cystoscopy. This study aims to determine the role of exfoliative cytology of fresh voided urine and bladder washings in the diagnosis of primary and recurrent urothelial malignancy and to compare the diagnostic efficacy (sensitivity, specificity) of bladder washings cytology with voided urine cytology in the diagnosis of urothelial carcinoma. Patients and methods: The study was performed in the department of Pathology, Allama Iqbal Medical College, Lahore in collaboration with the department of Urology, Jinnah Hospital, Lahore. Sixty patients of both genders above 45 years of age presenting with painless hematuria, imaging evidence of urinary bladder lesion or recurrent ...