Association Between Urinary Cytology and Pathology for Nontransitional Cell Malignancies of the Urinary Tract (original) (raw)
Related papers
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.
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.
Diagnostic Cytopathology, 2003
The 1998 World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification of urothelial neoplasms introduced a category called papillary neoplasm of low malignant potential (LMP) and separated it from low-grade papillary urothelial carcinoma (LGPUC), which was thought to yield abnormal cells in cytology specimens. The objective of our study was to evaluate the effectiveness of urine cytology in diagnosing these lesions. Eighty-six paired transurethral surgical biopsy and corresponding urine cytology specimens representing the spectrum of urothelial papillary lesions were examined. Consensus diagnosis on each biopsy was made, and the distribution was as follows: 16 benign urothelium, 27 LMP, 28 LGPUC, and 15 high-grade papillary urothelial carcinoma (HGPUC). This was followed by a blinded independent review of the urine cytology specimens by three observers. Each cytology case was marked as negative, atypical, suspicious, or positive for malignant cells by using previously published cytologic criteria. When the negative and atypical diagnoses were grouped together as "benign" and the suspicious and malignant diagnoses as "malignant," the detection rate of "malignancy" of the lesions was as follows: LMP, 37%; LGPUC, 25%; and HGPUC, 53%. The false positive rate was 6%, and the positive predictive value (PPV) was 94%. Detection rates of cells that were at least "atypical" were as follows: LMP, 74%; LGPUC, 79%; and HGPUC, 100%. While most of the LMP and LGPUC cases yielded cells that were at least "atypical," there was no significant difference in the distribution of cytologic diagnoses for LMP and LGPUC cases (P Ͼ 0.05). Urine cytology in the context of the 1998 WHO/ISUP classification appears to be useful as a screening tool but does not appear to discriminate LMP effectively from LGPUC.
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).
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. #
Urology annals
Non-transitional cell carcinomas (non-TCC) of the upper urinary tract as squamous cell carcinoma (SCC), adenocarcinoma, and small cell carcinoma (SmCC) are rare with few case reports in the literature. We retrospectively reviewed our patients who surgically treated for upper tract urothelial carcinoma from 1983 to 2013 for non-TCC pathological cancer characteristics and survival. Among 305 patients, only 5 (1.6%) cases were found: One case of SmCC, another had adenocarcinoma, and 3 SCC cases. None of them had intravesical recurrence and the cancer-specific survival for non-TCC cohort is markedly decreased (log-rank = 0.01) compared to TCC patients.
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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Histopathological Evaluation of Patients with Bladder Urothelial Carcinoma Diagnosed in Our Clinic
Istanbul Medical Journal, 2017
In our study, the age and gender of patients and the stage and grade of conventional bladder urothelial carcinoma (UC) and bladder UC variants were investigated. Methods: Patients with UC diagnosed in our pathology clinic between 2010 and 2015 were identified using an electronic database. They were reexamined according to the World Health Organization 2004 (WHO) classification system, and the grade and stage of UC and concomitant UC variants were documented for each patient. In addition to these data, the age and gender of each patient were obtained from the electronic database. Results: Between 2010 and 2015, 1355 biopsies from 1081 different patients were present with the diagnosis of UC. Totally, 676 patients with recurrence were excluded. Finally, 679 patients were included. When all patients were screened in terms of newly identified variants in the WHO 2004 classification system, 153 patients (22.6%) had UC variants, forming at least 10% of the biopsy specimen. We identified 15 UC variants: squamous differentiation, glandular differentiation, and small cell, micropapillary, sarcomatoid, lymphoepithelioma-like, nested, large nested, large cell neuroendocrine, plasmacytoid, pleomorphic, trophoblastic, rhabdoid, chordoid, and undifferentiated carcinomas. Conclusion: Our study is the largest case series on UC in Turkey. Due to the large number of patients, we believe that the results reflect the present status of the frequency and stage of UC variants and the gender and age of patients at diagnosis.
Cytopathology, 2013
Diagnostic terminology for urinary cytology reports including the new subcategories 'atypical urothelial cells of undetermined significance' (AUC-US) and 'cannot exclude high grade' (AUC-H) Objective: We studied whether atypical, non-superficial urothelial cells (AUC) could be separated into new subcategories including AUC 'of undetermined significance' (AUC-US) and 'cannot exclude high grade'' (AUC-H) in order to help to standardize urine cytopathology reports, as it is widely accepted in the Bethesda system for gynaecological cytopathology. Methods: We investigated whether AUC-US and AUC-H, defined by distinctive cytological criteria, might be separated with statistical significance according to actual diagnosis and follow-up data. A series of 534 cytohistological comparisons taken in 139 patients, including 221 AUC at various steps of their clinical history was studied. There were 513 (96.1%) postcystoscopy and 469 (87.8%) ThinPrepâ liquid-based specimens (95.9% and 89.1% of AUC cases, respectively). Patients viewed between 1999 and 2011 had histological control in a 0-to 6-months delay and were followed-up during an additional 5.9 AE 9.2 (0-to 56-) months period. Results: The 221 AUC represented 0.8-2% of the specimens viewed during the study period. Among AUC-H cases, 70 out of 185 (37.8%) matched with high-grade lesions, compared with 3 of 38 (8.3%) of AUC-US cases (P = 0.0003). Conservatively treated patients with AUC-H more frequently developed high-grade lesions than those with AUC-US (54.1% versus 16.7%, P = 0.0007) with a 17.6-months mean delay. Nuclear hyperchromasia, a nuclear to cytoplasm (N/C) ratio > 0.7 and the combination of both were the more informative diagnostic criteria, all with P < 0.01. Conclusion: We conclude that the new subcategories could help to standardize urine cytopathology reports and contribute to the patient's management, provided it is validated by multicentric studies.