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Chen L, He H, Zarka MA, Zhou M, Magi-Galluzzi C. Upper tract urinary cytology to detect upper tract urothelial carcinoma: Using the Johns Hopkins Hospital template and evaluation of its feasibility. Cytojournal 2015; 12:17. [PMID: 26288652 PMCID: PMC4527050 DOI: 10.4103/1742-6413.161608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/10/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Primary upper urinary tract (UT) urothelial carcinoma (UC) is rare. UT washing cytology is often used during UT surveillance. The Johns Hopkins Hospital template (JHHT) is primarily designed to use on lower tract urine cytology and the data on applying JHHT on UT cytology is limited. We herein study the value of UT cytology in detecting UTUC using JHHT in a cohort. MATERIALS AND METHODS One hundred UT cytologic specimens were retrieved from our database during a 10-year period (2001-2011). For each patient, the cytology specimen with the highest degree of abnormality was selected. Histologic sections of these cases were also studied. RESULTS Seventy-six cases of UT cytology had histologic follow-up by either serial (>2) endoscopic biopsies or nephroureterectomy or ureterectomy. Among them, the cytologic diagnosis of positive or suspicious for high-grade UC (HGUC) was made in 15 cases; suspicious for low-grade UC (LGUC) in 3 cases; atypical urothelial cells (AUCs) of undetermined significance in 19 cases; and negative in 39 cases. Of the 15 cases with diagnosis of positive for HGUC or AUC-HGUC (AUC-H), 10 had histologically confirmed HGUC, 1 had LGUC, and 4 had benign histology. All 3 cases of cytologically suspicious for LGUC had LGUC on concomitant histology. Among the 19 washings with AUCs with unknown significance, 7 were LGUC, 1 was HGUC, and 11 were benign on histology. Six of 39 cases with negative cytology had UC (3 low-grade and 3 high-grade) on histology. Combining positive and AUC-H for UC diagnoses, sensitivity, and specificity for detecting HGUC were 71.4% and 91.9%, while for LGUC were 21.4% and 100%, respectively. CONCLUSIONS UT washing cytology has high specificity for detecting UC, especially HGUC. Using JHHT on UT washing cytology is feasible, but the category of LGUC may need modification.
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Affiliation(s)
- Longwen Chen
- Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Huiying He
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathology, Peking University, Health Science Center, Beijing, China
| | - Matthew A. Zarka
- Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ming Zhou
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
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Brimo F, Xu B, Kassouf W, Ahmadi-Kaliji B, Charbonneau M, Nahal A, Kanber Y, Caglar D, Auger M. Urine cytology: does the number of atypical urothelial cells matter? A qualitative and quantitative study of 112 cases. J Am Soc Cytopathol 2015; 4:232-238. [PMID: 31051759 DOI: 10.1016/j.jasc.2015.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study presents a detailed and systematic morphological and quantitative analysis of urine cytology specimens in order to determine which qualitative and quantitative features are mostly associated with high-grade urothelial carcinoma (HGUCA). MATERIAL AND METHODS This study included 112 urine cytology cases with a surgical follow-up within 1 year that were originally reported as "atypical," "suspicious for HGUCA," or "positive for HGUCA." The morphological characteristics as well as the number of abnormal cells were correlated with a diagnosis of HGUCA on follow-up biopsy. RESULTS Multivariate analysis showed that the presence of hyperchromatic atypical cells with nuclear-cytoplasmic ratio ≥ 0.7 was an independent predictor of HGUCA. Similarly, irregular nuclear membranes, single cells, and pleomorphism correlated with surgical outcome whereas eccentric nuclear location, prominent nucleoli, nuclear-cytoplasmic ratio between 0.5 and 0.7 did not. Cases with ≤10 atypical cells had significantly lower rates of subsequent HGUCA than did those with >10 atypical cells (58% versus 77%). Cases with ≤5 atypical cells (n = 26) showed similar prediction rates (58%) for HGUCA than did those with 6 to 10 atypical cells (n = 12). CONCLUSIONS The number of atypical urothelial cells is an important criterion that should be taken into account when assigning cases to the "positive" or the "suspicious" categories. A preliminary cutoff of 10 cells appears to be easily applicable and valid from the clinical standpoint.
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Affiliation(s)
- Fadi Brimo
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.
| | - Bin Xu
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
| | - Babak Ahmadi-Kaliji
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
| | - Michele Charbonneau
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
| | - Ayoub Nahal
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
| | - Yonca Kanber
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
| | - Derin Caglar
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada
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McCroskey Z, Bahar B, Hu Z, Wojcik EM, Barkan GA. Subclassifying atypia in urine cytology: what are the helpful features? J Am Soc Cytopathol 2015; 4:183-189. [PMID: 31051752 DOI: 10.1016/j.jasc.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The diagnosis "atypical urothelial cells (AUC)" remains an unresolved problem, making many urologists dissatisfied and confused about the management strategy on these cases. To date, a few inspiring attempts were made to subclassify AUC into "atypical urothelial cells of undetermined significance" (AUC-US) and "atypical urothelial cells cannot exclude high grade" (AUC-H). The aim of our study was to investigate the most predictive for high-grade urothelial carcinoma (HGUC) cytomorphologic parameters and whether the proposed classification can be implemented in our institution. MATERIAL AND METHODS The electronic medical record system was searched for cytology specimens that were diagnosed as AUC from January 1, 2005 to March 1, 2013 and their relative clinical-pathological follow-up. All specimens were reviewed by an experienced cytopathologist by using 20 published "most predictive" for HGUC criteria. RESULTS A total of 162 AUC specimens were reclassified into 3 groups: AUC-H (n = 45), AUC-US (n = 51), and "negative for malignancy" (n = 66). The reclassification of AUC-H and "negative for malignancy" had 79% sensitivity, 77% specificity, 60% positive predictive value, and 89% negative predictive value to histologically proven HGUC diagnosis. CONCLUSIONS Our study demonstrated a good correlation between the presence of "HGUC-predictive" cytologic criteria and the final biopsy-proven HGUC in cytologic cases originally diagnosed as "atypical urothelial cells present." We identified 2 of the most predictive for HGUC on follow-up cytomorphologic parameters such as increased nuclear-cytoplasmic ratio >0.7 and coarse chromatin (16 abnormal cells per slide in average). These parameters, along with positive fluorescent in situ hybridization results can help during cytologic evaluation of urine specimens.
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Affiliation(s)
- Zulfia McCroskey
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois.
| | - Burak Bahar
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
| | - Zhihong Hu
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
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Wu HH, Redelman M, Chen S, Grignon DJ, Cramer HM. The application of the Johns Hopkins Hospital Template on urine cytology. Diagn Cytopathol 2015; 43:593-7. [DOI: 10.1002/dc.23257] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 01/14/2015] [Accepted: 01/31/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Howard H. Wu
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Megan Redelman
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - David J. Grignon
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
| | - Harvey M. Cramer
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis Indiana
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Onur I, Rosenthal DL, VandenBussche CJ. Benign-appearing urothelial tissue fragments in noninstrumented voided urine specimens are associated with low rates of urothelial neoplasia. Cancer Cytopathol 2015; 123:180-5. [PMID: 25586552 DOI: 10.1002/cncy.21501] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND The presence of urothelial tissue fragments (UTF) in voided urine (VU) is often considered an abnormal finding that may be associated with the presence of urothelial papillary neoplasms. In the current study, the authors reviewed VU specimens containing benign-appearing UTF (BUTF) to determine the associated rate of urothelial neoplasia at the study institution. METHODS A retrospective search of the electronic pathology database system over a 5-year period (2009-2013) revealed 1131 VU specimens containing UTF. Of these, 459 cases (40.6%) did not have a recent history of instrumentation. Fifteen cases were excluded because the slides were not available for review. In the remaining 444 cases, 274 cases (61.7%) had BUTF. A total of 170 cases (38.3%) had UTF with atypical cytologic features and were therefore excluded. RESULTS Of the 274 cases, 29 (10.6%) had follow-up surgical pathology specimens available. The overall rate of urothelial neoplasia on follow-up was 3.6% for low-grade urothelial neoplasia (10 cases) and 0.7% for high-grade urothelial carcinoma (2 cases). Forty-five cases (16.4%) were determined to have urinary tract stones on follow-up. CONCLUSIONS The presence of BUTF in VU specimens requires careful examination of the medical history because their presence may be explained by recent instrumentation. If recent instrumentation is not identified, the etiology of BUTF is not usually determined; in the current study, BUTF were found to be associated with urinary tract stones in 16.4% of cases. They also present a low risk of low-grade urothelial neoplasia (3.6%) and high-grade urothelial carcinoma (0.7%) when compared with the overall benign category at the study institution (2.3% [P =.15] and 0.7%, respectively).
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Affiliation(s)
- Irem Onur
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Onur I, Rosenthal DL, VandenBussche CJ. Atypical urothelial tissue fragments in noninstrumented voided urine specimens are associated with low but significantly higher rates of urothelial neoplasia than benign-appearing urothelial tissue fragments. Cancer Cytopathol 2015; 123:186-92. [PMID: 25586692 DOI: 10.1002/cncy.21519] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interpretation of urothelial tissue fragments (UTF) in voided urine (VU) specimens is controversial. If UTF contain cytomorphologically atypical cells, the diagnosis often becomes more challenging. The authors previously analyzed the outcome of patients with benign-appearing UTF in 274 noninstrumented VU specimens. In this retrospective study, noninstrumented VU specimens containing UTF with atypical cytomorphological features (AUTF) were evaluated and compared with the previous results. METHODS The Johns Hopkins Hospital electronic pathology database was searched for VU cases containing UTF over a 5-year period. RESULTS A total of 170 noninstrumented VU specimens containing AUTF were identified. Twenty-four specimens had subsequent or coincidental surgical pathology specimens with the following overall rates of neoplasia: high-grade urothelial carcinoma: 8.8% (15 specimens), low-grade urothelial neoplasia: 1.2% (2 specimens), and prostate carcinoma invading the bladder: 0.6% (1 specimen). A total of 49 specimens (28.8%) were diagnosed with urolithiasis on follow-up. Twenty-five cases had follow-up cytology specimens, all of which were negative for malignancy. Of 72 cases without histopathologic, radiologic, or cytopathologic follow-up, 62 (86.1%) had a mean clinical follow-up of 22.5 months and 10 cases did not have clinical follow-up. CONCLUSIONS The presence of AUTF in noninstrumented VU is associated with low rates of urothelial neoplasia but a statistically higher risk of urothelial neoplasia than the presence of BUTF (10.0% vs 4.4%; P<.05). In particular, the rate of high-grade urothelial carcinoma is significantly higher in noninstrumented VU specimens containing AUTF than those containing BUTF (8.8% vs 0.7%; P<.0001). In addition, urolithiasis is associated with AUTF in a substantial percentage of noninstrumented VU specimens.
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Affiliation(s)
- Irem Onur
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Wang L, Pambuccian SE, Wojcik EM, Barkan GA. Diagnosis of upper tract urothelial carcinoma-a comparative study of urinary cytology and surgical biopsy. J Am Soc Cytopathol 2015; 4:3-9. [PMID: 31051670 DOI: 10.1016/j.jasc.2014.09.203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Upper tract urothelial carcinoma (UTUC) is defined as urothelial carcinoma (UC) arising in the renal pelvis and ureter. Upper tract (UT) cytology and biopsy evaluation can be technically challenging. The aim of the study is to evaluate the diagnostic modality and sensitivity of urine cytology and ureteroscopic biopsy for the diagnosis of UTUC. MATERIAL AND METHODS All patients with UTUC who underwent radical nephroureterectomy or ureterectomy with preoperative cytology and/or biopsy from January 1, 2000 to September 30, 2011 at our institution were included in this study. The sensitivity of each diagnostic modality was calculated with respect to tumor grade, stage, and size. RESULTS A total of 143 cytology specimens and 54 biopsies from 65 patients were evaluated. For low-grade UTUC, the sensitivities for biopsy, lower tract cytology, and UT cytology were 68.4%, 27.3%, and 37.5%, respectively. These numbers were 82.9%, 40.7%, and 80.6% for high-grade UTUC. By combining the UT cytology and biopsy, the diagnostic sensitivities were increased to 87.5% for low-grade UTUC and 100% for high-grade UTUC. The consistency of tumor grade between biopsy and surgical specimen were 63.2% for low-grade UTUC and 68.6% for high-grade UTUC. CONCLUSIONS Both UT cytology and biopsy showed higher sensitivity in detecting high-grade UTUC versus low-grade UTUC. The sensitivities of UT cytology and ureteroscopic biopsy in detecting high-grade UTUC were comparable. The sensitivity was greatly improved when these diagnostic modalities were combined. As expected, the selective UT cytology evaluation had superior sensitivity in detecting UTUC than did the lower tract cytology sampling.
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Affiliation(s)
- Lu Wang
- Department of Pathology and Lab Medicine, Loyola University Medical Center, 2160 W. 1st Avenue, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Lab Medicine, Loyola University Medical Center, 2160 W. 1st Avenue, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Lab Medicine, Loyola University Medical Center, 2160 W. 1st Avenue, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Lab Medicine, Loyola University Medical Center, 2160 W. 1st Avenue, Maywood, Illinois.
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Vergara-Lluri ME, Hu E, Rao JY, Levin M, Apple SK, Moatamed NA. Comparative evaluation of ProEx C and ImmunoCyt/uCyt assays in atypical urine cytology. Arch Pathol Lab Med 2014; 138:1215-22. [PMID: 25171704 DOI: 10.5858/arpa.2013-0433-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Detection of urothelial carcinoma by urine cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of urothelial carcinoma. ProEx C is an assay targeting expression of topoisomerase II-α and the minichromosome maintenance protein-2 and is used to assist in diagnoses of gynecologic specimens. OBJECTIVE To evaluate the utility of ProEx C and uCyt in atypical urine cytology. DESIGN Sixty-eight specimens with a diagnosis of atypical urine cytology, concurrent uCyt testing, and surgical biopsy follow-up were included. Slides were restained with ProEx C. ProEx C was recorded as positive when nuclear staining was seen in at least one morphologically atypical urothelial cell. The uCyt was scored as positive if at least one morphologically atypical urothelial cell showed positive fluorescence staining. Thirteen cases (19%) had benign histologic diagnoses, 18 (26%) had low-grade papillary urothelial carcinoma, and 37 (54%) had high-grade urothelial carcinoma. RESULTS The overall sensitivity was 85% for ProEx C, 85% for uCyt, and 93% for the combination of the 2 assays. The overall specificity was 69% for ProEx C, 31% for uCyt, and 23% for the combination of the 2 tests. In predicting high-grade urothelial carcinoma, sensitivity was 92% for ProEx C, 86% for uCyt, and 92% for both tests. In predicting low-grade papillary urothelial carcinoma, sensitivity was best with the combination of the 2 tests at 94%. CONCLUSION ProEx C has superior specificity to uCyt. The combination of the 2 tests yielded high sensitivity not only for high-grade urothelial carcinoma but also for low-grade papillary urothelial carcinoma.
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Affiliation(s)
- Maria E Vergara-Lluri
- From the Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles. Dr Vergara-Lluri and Ms Hu are now with the Department of Pathology & Laboratory Medicine, University of Southern California, Los Angeles
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Morency E, Antic T. Atypical urine cytology and the Johns Hopkins Hospital template: the University of Chicago experience. J Am Soc Cytopathol 2014; 3:295-302. [PMID: 31051719 DOI: 10.1016/j.jasc.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/24/2014] [Accepted: 06/27/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The rate of atypical diagnoses in urine cytology can be high depending on the screening population. Unlike thyroid and cervical cytology, there is a lack of standardized criteria to stratify them into more clinically meaningful categories. MATERIALS AND METHODS A set of diagnostic criteria described by Johns Hopkins Hospital (JHH) provided a tool to divide atypical urine specimens into those that were low risk and those likely to be predictive of high-grade urothelial carcinoma (HGUC). In this study, the JHH template was applied to a cohort of atypical urine cytology specimens from the University of Chicago (U of C) to compare it to existing U of C terminology and determine whether it should be formally adopted. RESULTS Sixty-eight percent of patients classified as atypical urothelial cells, favor high-grade lesion (AUC-H) were diagnosed with HGUC during the study. Correlation was noted between the JHH diagnostic categories and the U of C diagnostic categories, with 49% of patients reclassified as AUC-H being diagnosed with atypical urothelial cells, suspicious for neoplasia and 83% of cases of patients reclassified as atypical urothelial cells of unknown significance being diagnosed as atypical, urothelial cells. The JHH category of AUC-H had a higher positive predictive value for HGUC than the U of C category atypical urothelial cells, suspicious for neoplasm did (69% versus 58%, p = 0.0087). Unlike the JHH study, AUC-H showed higher correlation with HGUC in the hematuria group (90%) than in the surveillance group (66%). CONCLUSIONS JHH criteria demonstrated a higher rate of predicting HGUC than U of C diagnostic categories, supporting the adoption of these criteria at U of C.
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Affiliation(s)
- Elizabeth Morency
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois.
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois
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Ton Nu TN, Kassouf W, Ahmadi-Kaliji B, Charbonneau M, Auger M, Brimo F. The value of the “suspicious for urothelial carcinoma” cytology category: A correlative study of 4 years including 337 patients. Cancer Cytopathol 2014; 122:796-803. [DOI: 10.1002/cncy.21449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Tuyet Nhung Ton Nu
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Wassim Kassouf
- Department of Urology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Babak Ahmadi-Kaliji
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Michele Charbonneau
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Manon Auger
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Fadi Brimo
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
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Bostwick DG, Hossain D. Does subdivision of the “atypical” urine cytology increase predictive accuracy for urothelial carcinoma? Diagn Cytopathol 2014; 42:1034-44. [DOI: 10.1002/dc.23159] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/23/2014] [Accepted: 03/18/2014] [Indexed: 11/08/2022]
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Barasch S, Choi M, Stewart J, Das K. Significance of atypical category in voided urine specimens prepared by liquid-based technology: Experience of a single institution. J Am Soc Cytopathol 2014; 3:118-125. [PMID: 31051734 DOI: 10.1016/j.jasc.2013.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/16/2013] [Accepted: 10/07/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the clinical significance of atypical cytology in voided urine samples. We also studied any differences in outcome that may exist between the patients being surveyed versus high risk for urothelial carcinoma (UC). MATERIALS AND METHODS This was a retrospective study of all voided urine specimens with "atypical" cytology over a 10-year period. The patients were categorized into those with and without a prior diagnosis of UC as the "surveillance" and "de novo" (DG) groups. Follow-up was obtained. Clinical impact and outcomes of the 2 groups were compared. RESULTS In this study, 5.7% of voided urine specimens were atypical. Mean age of patients in years, male/female ratio, and time to diagnosis in days was 59 versus 71, 23:15 versus 22:1, and 95 versus 43 in the DG and surveillance group, respectively. Rate of progression to UC was similar in both groups. High-grade UC was significantly higher in the DG. CONCLUSIONS Approximately 20% of patients in the DG were subsequently diagnosed with UC. The common causes for the atypical diagnosis that did not progress to UC were stones and benign prostatic hyperplasia. In the absence of an etiology for the atypia, further investigations are warranted.
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Affiliation(s)
- Samuel Barasch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Michael Choi
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jimmie Stewart
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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Olson MT, Novak A, Boonyaarunnate T, Trotter J, Sachs S, Kelly D, Ford S, Cornish TC, Toll A, Tatsas AD, Maleki Z, Erozan YS, Rosenthal DL. Reproducibility of the Johns Hopkins Hospital template for urologic cytology samples. J Am Soc Cytopathol 2014; 3:156-164. [PMID: 31051740 DOI: 10.1016/j.jasc.2014.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/21/2014] [Accepted: 02/24/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Cytologic screening for urothelial carcinoma is fraught with low sensitivity, a high indeterminate rate, and until recently, poor standardization of terminology. The Johns Hopkins Hospital John K. Frost Cytopathology Laboratory has recently developed and published a template for reporting urine cytopathology; herein, we evaluate its interobserver reproducibility. MATERIALS AND METHODS Two sets of 100 cases each were deidentified; each set was reviewed by 5 of 10 observers in a randomized order at the direction of computerized data collection software that tracked observation time as well as observer classification of the atypia-no atypia, atypia (AUC-US), or atypia suggestive of high-grade urothelial carcinoma (AUC-H). Specific morphologic features were also recorded. Cases were grouped into low-, intermediate-, and high-agreement based on the number of observers who made the assessment. The findings were correlated against clinical outcomes. RESULTS High agreement among observers about the presence or absence of high-grade features was possible in approximately two-thirds of indeterminate urine cases. Time and order did not factor significantly into observer propensity for identifying atypical features or favoring either AUC-US or AUC-H, and cases with high agreement about the presence of high-grade features were more likely to have a malignant follow-up. Furthermore, AUC-H diagnoses based on 2 or more high-grade features had a significantly higher malignancy risk than AUC-US diagnoses did. CONCLUSIONS AUC-H is a valid diagnostic category with specific, reproducibly identified features that portend a higher risk of malignancy than the findings of AUC-US.
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Affiliation(s)
- Matthew T Olson
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Anna Novak
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Thiraphon Boonyaarunnate
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland; Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jessi Trotter
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Sharon Sachs
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Deidra Kelly
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Sterling Ford
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Toby C Cornish
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Adam Toll
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Armanda D Tatsas
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Zahra Maleki
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Yener S Erozan
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland
| | - Dorothy L Rosenthal
- Department of Pathology, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, Maryland; Department of Obstetrics and Gynecology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Considerations on the use of urine markers in the management of patients with low-/intermediate-risk non-muscle invasive bladder cancer. Urol Oncol 2014; 32:1061-8. [PMID: 24411790 DOI: 10.1016/j.urolonc.2013.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/13/2013] [Accepted: 10/14/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many molecular assays for bladder cancer diagnosis and surveillance have been developed over the past several decades. However, none of these markers have been routinely implemented into clinical decision making. Beyond their potential for screening high-risk populations, urine markers likely have the greatest potential in the follow-up of patients with non-muscle invasive bladder cancer (NMIBC). METHODS Here, we discuss the current options and limitations of the use of urine markers for patient surveillance, focusing on patients with low-/intermediate-risk NMIBC. RESULTS As these patients have a very low risk of tumor progression, the primary goal of surveillance is detection of recurrent disease. Although urine cytology seems to be limited to detection of few patients who would develop high-grade tumors, we conclude that the use of markers with high sensitivity for low-grade disease for patient follow-up has the potential to decrease the frequency of urethrocystoscopy without compromising patient prognosis. Because a single marker may not have sufficient sensitivity for detection of low-grade tumors, different scenarios, e.g., multitesting and reflex or sequential approaches, are discussed. CONCLUSIONS There is consensus that currently available markers have the potential to support clinical decision making in follow-up of patients with low-/intermediate-risk NMIBC. In light of our analysis, further additional randomized controlled studies to effectively assess the clinical usefulness of modern urine markers are required.
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Olson MT, Boonyaarunnate T, Altinboga AA, Ali SZ. 'Suspicious for papillary thyroid carcinoma' before and after The Bethesda System for Reporting Thyroid Cytopathology: impact of standardized terminology. Acta Cytol 2014; 58:15-22. [PMID: 24192286 DOI: 10.1159/000355696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/02/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND The high-risk 'suspicious for papillary thyroid carcinoma' (SPTC) is a clinically relevant diagnosis in the cytological interpretation of thyroid aspirates. While The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has provided invaluable terminology standardization, a performance comparison for this diagnostic category has not been performed. Therefore, this study evaluates the SPTC diagnosis before and after the introduction of TBSRTC in a large meta-analysis and at a single institution. MATERIALS AND METHODS The meta-analysis analyzed publications of SPTC or similar diagnoses before and after the introduction of TBSRTC. Similarly our own institutional experience was analyzed for the 8 years surrounding the introduction of TBSRTC. A correlation of the cytopathology and surgical pathology diagnoses was performed. RESULTS The introduction of TBSRTC coincided with a significant decrease in the fraction of cases called SPTC in the meta-analysis (4.5-3.1%, p < 0.00001) and in the institutional review (1.7-0.9%, p = 0.005). Meanwhile, the malignancy risk for those cases increased significantly in the meta-analysis from 62.5 to 80.5% (p < 0.00001) and trended upwards in the institutional review from 69 to 79% (p = 0.4). The follow-up rate was similar in both time periods in the meta-analysis and the institutional review. CONCLUSIONS The introduction of TBSRTC coincided with a decrease in the fraction of cases called SPTC and an increase in the malignancy risk associated with that diagnosis.
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Affiliation(s)
- Matthew T Olson
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA
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Dimashkieh H, Wolff DJ, Smith TM, Houser PM, Nietert PJ, Yang J. Evaluation of urovysion and cytology for bladder cancer detection: a study of 1835 paired urine samples with clinical and histologic correlation. Cancer Cytopathol 2013; 121:591-7. [PMID: 23801650 DOI: 10.1002/cncy.21327] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Urine cytology has been used for screening of bladder cancer but has been limited by its low sensitivity. UroVysion is a multiprobe fluorescence in situ hybridization (FISH) assay that detects common chromosome abnormalities in bladder cancers. For this study, the authors evaluated the effectiveness of multiprobe FISH and urine cytology in detecting urothelial cell carcinoma (UCC) in the same urine sample. METHODS In total, 1835 cases with the following criteria were selected: valid results from both the multiprobe FISH assay and urine cytology in the same urine sample, histologic and/or cystoscopic follow-up within 4 months of the original tests, or at least 3 years of clinical follow-up information. The results of FISH and cytology were correlated with clinical outcomes derived from a combination of histologic, cystoscopic, and clinical follow-up information. RESULTS Of 1835 cases, 1045 cases were from patients undergoing surveillance of recurrent UCC, and 790 were for hematuria. The overall sensitivity, specificity, positive predictive value, and negative predictive value in detecting UCC were 61.9%, 89.7%, 53.9%, and 92.4%, respectively, for FISH and 29.1%, 96.9%, 64.4%, and 87.5%, respectively, for cytology. The performance of both FISH and cytology generally was better in the surveillance population and in samples with high-grade UCC. In 95 of 296 cases with atypical cytology that were proven to have UCC, 61 cases, mostly high-grade UCC, were positive using the multiprobe FISH assay. CONCLUSIONS The UroVysion multiprobe FISH assay was more sensitive than urine cytology in detecting UCC, but it produced more false-positive results. The current data suggest that the use of FISH as a reflex test after an equivocal cytologic diagnosis may play an effective role in detecting UCC.
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Affiliation(s)
- Haythem Dimashkieh
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
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