Malignant atypical cell in urine cytology: a diagnostic dilemma

The Significance of Atypical Urine Cytology in the Face of Normal Investigations—Is Extended Investigation and Follow-Up Required?

Objective:

To examine the natural history of patients identified with atypical urine cytology in the face of normal investigations, and thus provide guidance on the need for extended follow-up and investigation of such patients.

Patients and methods:

All patients identified over a 2-year period to have atypical urine cytology on Cytospin analysis and Papanicolaou staining were audited over a 5-year follow-up period. Clinical records, histopathology and radiology databases were independently searched. Patients were intensively investigated with cystoscopy and a range of upper tract imaging.

Results:

126 patients were identified to have atypical urine cytology, and 77 of these had no urothelial tumour found. In these normal patients, only 12/48 who had further samples taken showed persistent atypia. 11/77 normal patients had another urological pathology which may have explained their atypical urine cytology. No patient presenting for the first time later went on to develop urothelial malignancy in the face of negative initial investigations.

Conclusion:

In the group of patients in which cystoscopy and urography show no urothelial malignancy, the finding of atypical urinary cytology does not predict the development of later urothelial tumour, and does not require prolonged follow-up, repeat cytological testing or further imaging.

The Best in CytoJournal: 2006

This year CytoJournal celebrates the second full year of publication with its Best of CytoJournal: 2006. Like last year, it recognizes the work of the authors in thyroid FNAB. And, importantly, this years award, which was handed out at USCAP, was endowed by a gift from the Pathikonda family.

Noninvasive diagnosis of bladder cancer by detection of matrix metalloproteinases (MMP-2 and MMP-9) and their inhibitor (TIMP-2) in urine

OBJECTIVES

TIMPs control the activity of MMPs, one of the key molecules for tumor invasion and metastasis. The aim of this study was to assess the usefulness of MMP-2 and MMP-9 in relation to their inhibitor (TIMP2) as noninvasive diagnostic tests for bilharzial bladder cancer.

MATERIAL AND METHODS

Voided urine samples were provided from 244 subjects (154 bladder cancer [136 bilharzial]; 60 benign urologic disorders; 30 healthy volunteers). Urine sediment was used for cytology, and the supernatant for estimation of MMPs and TIMP-2 by ELISA and gelatin zymography.

RESULTS

The best cut-off values for the investigated markers were determined by ROC curve. Positivity rates and median levels for MMP-2, MMP-9, TIMP-2, MMP-2/TIMP-2, and MMP-9/TIMP-2 showed significant difference among the three investigated groups (p<0.001). MMP-9 and MMP-2/TIMP-2 were related to pathologic type, MMP-2/TIMP-2 was inversely related to the grade, and MMP-9/TIMP-2 was related to bilharziasis (p<0.05). MMP zymography results were comparable to those from ELISA.

CONCLUSION

The sensitivity and specificity of MMP zymography, MMP-9/TIMP-2 ratio, and MMP-2/TIMP2 ratio were superior among all investigated parameters; furthermore, combined testing of cytology with them improves the sensitivity even in superficial and low-grade tumors.

Thank you reviewers- CytoJournal 2007

Significant efforts, time, and resources are devoted for peer-reviewing numerous CytoJournal manuscripts. The Editorial Board of CytoJournal shares a significant proportion of this activity. Additional peers are requested to join periodically as 'academic editors' and reviewers to review CytoJournal manuscripts. We thank all the reviewers and academic editors for their time and efforts for completing the peer-review of CytoJournal manuscripts during 2006. The continued success of this important academic exercise depends on their continued enthusiasm to support with their highest standards. We also thank all the contributing authors for selecting CytoJournal and supporting open access initiative, which allows retention of the copyrights to their corresponding academic accomplishments.

Time for evidence-based cytology

Evidence-based medicine (EBM) is a fashionable and an extremely hot topic for clinicians, patients and the health service planners. Evidence-based cytology (EBC) is an offshoot of EBM. The EBC is concerned with generating a reproducible, high quality and clinically relevant test result in the field of cytology. This is a rapidly evolving area with high practical importance. EBC is based entirely on research data. The various professional bodies on cytology design and recommend guidelines on the basis of evidences. Once the guideline is implemented and practiced then the experiences of the practicing cytopathologists may be used as a feed back to alter the existing guideline. The various facets of EBC are sampling and specimen adequacy, morphological identification and computer based expert system, integrated reporting, identification of the controversial areas and high quality researches for evidences. It is the duty of the individuals and institutions to practice EBC for better diagnosis and management of the patients. In this present paper, the various aspects of EBC have been discussed.