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Farahani SJ, Li J, Minder B, Vielh P, Glisic M, Muka T. Impact of implementing the first edition of the Paris system for reporting: A systematic review and meta-analysis. Cytopathology 2024; 35:616-633. [PMID: 38934101 DOI: 10.1111/cyt.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Urine cytology is a noninvasive, widely used diagnostic tool for screening and surveillance of genitourinary tract neoplasms. However, the absence of unified terminology and clear objective morphological criteria limits the clinical benefit of urine cytology. The Paris System for Reporting Urine Cytology (TPS) was developed with the goal of standardizing reporting and improving urine cytology performance in detecting high-grade malignancy (HGM). We aimed to evaluate potential effects of TPS on improving urine cytology diagnostic performance and clinical utility by conducting a systematic review and meta-analysis. We searched six electronic databases to identify cross-sectional and cohort studies written in English assessing the accuracy of urine cytology in detecting genitourinary tract malignancies of patients under surveillance or with clinical suspicion of malignancy from January 2004 to December 2022. We extracted relevant data from eligible studies to calculate relative distribution of cytology diagnostic categories; ratio of atypical to HGM cytology diagnosis; and risk of HGM (ROHGM) and HGM likelihood ratio (HGM-LR) associated with cytology diagnostic categories. We used a generalized linear mixed model with logit transformation to combine proportions and multilevel mixed-effect logistic regression to pool diagnostic accuracy measurements. We performed meta-regression to evaluate any significant difference between TPS and non-TPS cohorts. We included 64 studies for 99,796 combined total cytology samples, across 31 TPS and 49 non-TPS cohorts. Pooled relative distribution [95% confidence interval (CI)] of negative for high-grade urothelial carcinoma (NHGUC)/negative for malignancy (NM); atypical urothelial cells (AUC); suspicious for high-grade urothelial carcinoma (SHGUC)/suspicious for malignancy (SM); low-grade urothelial neoplasm (LGUN); and HGM categories among satisfactory cytology cases were 83.8% (80.3%-86.9%), 8.0% (6.0%-10.6%), 2.2% (1.4%-3.3%), 0.01% (0.0%-0.1%), and 4.2% (3.2%-5.5%) in TPS versus 80.8% (76.8-2.7%), 11.3% (8.6%-14.7%), 1.8% (1.2%-2.7%), 0.01% (0.0%-0.1%), and 3.3% (2.5%-4.3%) in non-TPS cohorts. Adopting TPS classification resulted in a significant increase in the frequency of NHGUC and a reduction in AUC cytology diagnoses, respectively. The AUC/HGM ratio in TPS cohort was 2.0, which showed a statistically significant difference from the atypical/HGM ratio of 4.1 in non-TPS cohort (p-value: 0.01). Moreover, the summary rate (95% CI) of LGUN called AUC on cytology significantly decreased to 20.8% (14.9%-28.3%) in the TPS compared with 34.1% (26.4%-42.8%) in non-TPS cohorts. The pooled ROHGM (95% CI) was 20.4% (6.2%-50.0%) in nondiagnostic (NDX), 15.5% (9.6%-24.2%) in NHGUC, 40.2% (30.9%-50.2%) in AUC, 80.8% (72.9%-86.8%) in SHGUC, 15.1% (5.7%-34.3%) in LGUN, and 91.4% (87.3%-94.3%) in HGM categories in TPS studies. NHGUC, AUC, SHGUC, and HGM categories were associated with HGM-LR (95% CI) of 0.2 (0.1-0.3), 0.9 (0.6-1.3), 6.9 (2.4-19.9), and 16.8 (8.3-33.8). Our results suggest that TPS 1.0 has reduced the relative frequency of AUC diagnosis, AUC/HGM ratio, and the frequency of LGUNs diagnosed as AUC on cytology. Adopting this classification has improved the clinical utility of SHGUC and HGM cytology diagnoses in ruling in high-grade lesions. However, an NHGUC diagnosis does not reliably rule out the presence of a high-grade lesion.
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Affiliation(s)
- Sahar J Farahani
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Caner, New York, New York, USA
| | - Joshua Li
- Department of Pathology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
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Zheng J, Lu S, Huang Y, Chen X, Zhang J, Yao Y, Cai J, Wu J, Kong J, Lin T. Preoperative fluorescence in situ hybridization analysis as a predictor of tumor recurrence in patients with non-muscle invasive bladder cancer: a bi-institutional study. J Transl Med 2023; 21:685. [PMID: 37784106 PMCID: PMC10546664 DOI: 10.1186/s12967-023-04528-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Non-muscle invasive bladder cancer (NMIBC) is known for its elevated recurrence rate, necessitating an enhancement in the current risk stratification for recurrence. The urine-based fluorescence in situ hybridization (FISH) assay has emerged as a noninvasive auxiliary tool for detecting bladder cancer. The aim of this study was to explore the potential relationship between the preoperative FISH assay and recurrence, and to develop a FISH-clinical nomogram for predicting the recurrence-free survival (RFS) in NMIBC patients. METHODS In total, 332 eligible patients were enrolled from two hospitals. The SYSMH cohort was randomly assigned to the training set (n = 168) and the validation set I (n = 72) at a ratio of 7:3, while the SYSUTH cohort was allocated to the validation set II (n = 92). The correlation between the preoperative FISH assay and recurrence was determined through the Cox regression analysis. The least absolute shrinkage and selection operator (LASSO) Cox regression algorithm was used for model construction. The performance of the model was assessed by its discrimination, calibration, and clinical usefulness. RESULTS We uncovered that chromosome 7 aneuploidy, p16 locus loss, number of the positive FISH sites, and the FISH test result were significantly associated with tumor recurrence. Then, a FISH-clinical nomogram incorporating the FISH test result, T stage, associated CIS, tumor grade, and tumor status was developed. It showed favorable calibration and discrimination with a C-index of 0.683 (95%CI, 0.611-0.756) in the training set, which was confirmed in the validation set I and validation set II with C-indexes of 0.665 (95%CI, 0.565-0.765) and 0.778 (95%CI, 0.665-0.891), respectively. Decision curve analysis revealed the clinical usefulness of the nomogram. Moreover, our proposed nomogram significantly outperformed the guideline-recommended EORTC and CUETO scoring models. CONCLUSION Our study confirmed the prognostic value of the preoperative FISH assay and proposed a FISH-clinical nomogram to predict RFS in NMIBC patients. Our nomogram can serve as a more precise tool for recurrence risk stratification, which may optimize disease management in bladder cancer and improve patient prognosis.
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Affiliation(s)
- Junjiong Zheng
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Sihong Lu
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Yi Huang
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Xu Chen
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Jie Zhang
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Yuhui Yao
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, People's Republic of China
| | - Jieying Wu
- Department of Urology, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China.
| | - Jianqiu Kong
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China.
| | - Tianxin Lin
- Department of Urology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangdong Provincial Clinical Research Center for Urological Diseases, 107 Yan Jiang West Road, Guangzhou, People's Republic of China.
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Renshaw AA, Gould EW. High-grade urothelial carcinoma with hypochromatic chromatin in urine cytology. J Am Soc Cytopathol 2020; 10:25-28. [PMID: 33132055 DOI: 10.1016/j.jasc.2020.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Some high-grade urothelial carcinomas (UCs) in urine cytology have hypochromatic chromatin, but the incidence and criteria for diagnosis are not well described. MATERIALS AND METHODS Urine cytology cases with biopsy follow up were reviewed. RESULTS Cytospin preparations from 331 cases with biopsy follow up (230 benign/low-grade UC, 101 malignant) were reviewed. There were no false-positive cases. Cases with malignant cells with hypochromatic chromatin were identified in a total of 17 cases (16.8% of all malignancies). These comprised 2 carcinoma in situ, 11 high-grade papillary UC, 3 invasive UC, and 1 adenocarcinoma. Sixteen of 93 high-grade UCs (17.2%) had cells with hypochromatic chromatin. These cells were the only type of malignant cell in 4 of 101 cases (4.0%). All cases had cells with high nuclear-to-cytoplasmic ratios and markedly indented and irregular nuclear membranes that could be identified on both cytology and subsequent histology. CONCLUSIONS Malignant urothelial cells in urine cytology with hypochromatic chromatin can be present in 17% of cases and can be diagnosed as "positive for malignancy" based on their high nuclear-to-cytoplasmic ratio, and markedly indented and irregular nuclear membranes.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida; Miami Cancer Institute, Miami, Florida.
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida; Miami Cancer Institute, Miami, Florida
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Diao X, Cai J, Zheng J, Kong J, Wu S, Yu H, Huang H, Xie W, Chen X, Huang C, Huang L, Qin H, Huang J, Lin T. Association of chromosome 7 aneuploidy measured by fluorescence in situ hybridization assay with muscular invasion in bladder cancer. Cancer Commun (Lond) 2020; 40:167-180. [PMID: 32279463 PMCID: PMC7170658 DOI: 10.1002/cac2.12017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background The preoperative prediction of muscular invasion status is important for adequately treating bladder cancer (BC) but nevertheless, there are some existing dilemmas in the current preoperative diagnostic accuracy of BC with muscular invasion. Here, we investigated the potential association between the fluorescence in situ hybridization (FISH) assay and muscular invasion among patients with BC. A cytogenetic‐clinical nomogram for the individualized preoperative differentiation of muscle‐invasive BC (MIBC) from non‐muscle‐invasive BC (NMIBC) is also proposed. Methods All eligible BC patients were preoperatively tested using a FISH assay, which included 4 sites (chromosome‐specific centromeric probe [CSP] 3, 7, and 17, and gene locus‐specific probe [GLP]‐p16 locus). The correlation between the FISH assay and BC muscular invasion was evaluated using the Chi‐square tests. In the training set, univariate and multivariate logistic regression analyses were used to develop a cytogenetic‐clinical nomogram for preoperative muscular invasion prediction. Then, we assessed the performance of the nomogram in the training set with respect to its discriminatory accuracy and calibration for predicting muscular invasion, and clinical usefulness, which were then validated in the validation set. Moreover, model comparison was set to evaluate the discrimination and clinical usefulness between the nomogram and the individual variables incorporated in the nomogram. Results Muscular invasion was more prevalent in BC patients with positive CSP3, CSP7 and CSP17 status (OR [95% CI], 2.724 [1.555 to 4.774], P < 0.001; 3.406 [1.912 to 6.068], P < 0.001 and 2.483 [1.436 to 4.292], P = 0.001, respectively). Radiology‐determined tumor size, radiology‐determined clinical tumor stage and CSP7 status were identified as independent risk factors of BC muscular invasion by the multivariate regression analysis in the training set. Then, a cytogenetic‐clinical nomogram incorporating these three independent risk factors was constructed and was observed to have satisfactory discrimination in the training (AUC 0.784; 95% CI: 0.715 to 0.853) and validation (AUC 0.743; 95% CI: 0.635 to 0.850) set. The decision curve analysis (DCA) indicated the clinical usefulness of our nomogram. In models comparison, using the receiver operator characteristic (ROC) analyses, the nomogram showed higher discriminatory accuracy than any variables incorporated in the nomogram alone and the DCAs also identified the nomogram as possessing the highest net benefits at wide range of threshold probabilities. Conclusion CSP7 status was identified as an independent factor for predicting muscular invasion in BC patients and was successfully incorporated in a clinical nomogram combining the results of the FISH assay with clinical risk factors.
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Affiliation(s)
- Xiayao Diao
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Junjiong Zheng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Jianqiu Kong
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Shaoxu Wu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Hao Yu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Hao Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Weibin Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Xiong Chen
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Chengran Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China
| | - Lifang Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510120, P. R. China
| | - Haide Qin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510120, P. R. China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510120, P. R. China
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, P. R. China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, P. R. China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510120, P. R. China
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Vlajnic T, Gut A, Savic S, Bubendorf L. The Paris System for reporting urinary cytology in daily practice with emphasis on ancillary testing by multiprobe FISH. J Clin Pathol 2019; 73:90-95. [DOI: 10.1136/jclinpath-2019-206109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022]
Abstract
AimsThe Paris System (TPS) was introduced in the diagnostic routine with the goal to simplify and standardise diagnostic reporting of urinary cytology. The diagnostic categories of TPS are based on defined cytological criteria, with a focus on high-grade urothelial carcinoma (HGUC). While the categories ‘negative for HGUC (NHGUC)’ and ‘HGUC’ are straightforward, the categories ‘atypical urothelial cells (AUC)’ and ‘suspicious of HGUC (SHGUC)’ remain inconclusive. In this study, we evaluated the feasibility of TPS in daily practice with special emphasis on ancillary fluorescence in situ hybridisation (FISH) testing in the setting of TPS categories.MethodsIn a 19-month period, TPS was prospectively applied in the routine diagnostic setting on 3900 urinary cytology cases comprising bladder and upper urinary tract washings and voided urine specimens. Additionally, we analysed the results of the FISH assay UroVysion prospectively performed on a cohort of 128 cases enriched for AUC and SHGUC categories.ResultsThe most frequently reported category was NHGUC (n=3496, 89.7%), followed by AUC (n=178, 4.6%), HGUC (n=155, 4%), SHGUC (n=61, 1.6%), low-grade urothelial neoplasia (n=6, 0.1%) and other malignancies (n=4, 0.1%). In the FISH cohort, 40/90 (44%) cases within the AUC category were FISH positive, consistent with urothelial neoplasia. In the SHGUC category, 16/21 (76%) cases were FISH positive.ConclusionsWhen prospectively applying TPS in urinary cytology, inconclusive atypia accounts only for a small subset of cases. FISH additionally improves the stratification between reactive and malignant cells in the indeterminate AUC and SHGUC categories.
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Glass R, Rosca O, Raab S, Szabelska J, Chau K, Sheikh‐Fayyaz S, Cocker R. Applying the Paris system for reporting urine cytology to challenging cytology cases. Diagn Cytopathol 2019; 47:675-681. [DOI: 10.1002/dc.24166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Ryan Glass
- Department of PathologyStaten Island University Hospital Staten Island New York
| | - Oana Rosca
- Department of PathologyStaten Island University Hospital Staten Island New York
| | - Stephen Raab
- Department of PathologyUniversity of Mississippi Jackson Mississippi
| | | | - Karen Chau
- Department of PathologyNorthwell Health Lake Success New York
| | | | - Rubina Cocker
- Department of PathologyNorthwell Health Lake Success New York
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Sassa N, Iwata H, Kato M, Murase Y, Seko S, Nishikimi T, Hattori R, Gotoh M, Tsuzuki T. Diagnostic Utility of UroVysion Combined With Conventional Urinary Cytology for Urothelial Carcinoma of the Upper Urinary Tract. Am J Clin Pathol 2019; 151:469-478. [PMID: 30668617 DOI: 10.1093/ajcp/aqy170] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We prospectively evaluated the utility of UroVysion in urothelial carcinomas of the upper urinary tract (UCUUTs). METHODS Ninety patients who received nephroureterectomy for UCUUT were enrolled. We performed urinary cytology and UroVysion before nephroureterectomy. We also performed the assays on 23 volunteers without a history of urothelial carcinoma. RESULTS Seventy-five high-grade urothelial carcinomas (HGUCs), 10 low-grade urothelial carcinomas, and five other conditions were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value for HGUC detection by urinary cytology were 28.0%, 100.0%, 100.0%, and 31.6%, respectively; for detection by fluorescence in situ hybridization, these values were 60.0%, 84.0%, 93.8%, and 41.2%, respectively. UroVysion detected the only deletion of 9p21 in eight of 23 samples negative for HGUC by urinary cytology and in three of 23 volunteers. CONCLUSIONS Combining urinary cytology and UroVysion can improve the diagnostic accuracy of UCUUT. Caution is advised in diagnosing UCUUT based only on deletion of 9p21.
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Affiliation(s)
- Naoto Sassa
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidehiro Iwata
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
- Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Masashi Kato
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yota Murase
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
- Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Shuko Seko
- Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Toshinori Nishikimi
- Department of Urology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Ryohei Hattori
- Department of Urology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
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Cowan ML, VandenBussche CJ. The Paris System for Reporting Urinary Cytology: early review of the literature reveals successes and rare shortcomings. J Am Soc Cytopathol 2018; 7:185-194. [PMID: 31043275 DOI: 10.1016/j.jasc.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 06/09/2023]
Abstract
The Paris System for Reporting Urinary Cytology (TPS) provides recommendations for the diagnosis of urinary tract cytology (UTC) specimens and has found acceptance on an international level. Since the official release of TPS in 2016, numerous research studies have been published analyzing its impact. This review summarizes the studies published since the release of TPS, highlighting areas in which TPS has performed well and other areas in which TPS may need improvement.
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Affiliation(s)
- Morgan L Cowan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Rosolen DCB, Faria DK, Faria CS, Antonangelo L. Performance of the UroVysion ® FISH assay for the diagnosis of malignant effusions using two cutoff strategies. Cancer Med 2018; 7:1967-1977. [PMID: 29577646 PMCID: PMC5943432 DOI: 10.1002/cam4.1442] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/09/2018] [Accepted: 02/17/2018] [Indexed: 12/27/2022] Open
Abstract
The cytological examination of cavity fluids has limited sensitivity in the diagnosis of malignancy. Aneuploidy, which is commonly observed in neoplastic cells, could potentially be used as an ancillary diagnostic tool. To evaluate the detection of aneuploid cells in cavitary effusion samples using the fluorescence in situ hybridization (FISH) assay UroVysion® with some adaptations and two different cutoff strategies. Seventy samples of pleural or peritoneal fluid with positive (n = 40), negative (n = 15), or suspicious (n = 15) oncotic cytology were subjected to FISH assay with the multitarget UroVysion® kit, which is composed of probes that hybridize to the centromeric region of chromosomes 3, 7, and 17 and to the locus 9p21. FISH performance was evaluated using two different cutoffs: (1) the manufacturer's cutoff (M‐FISH) and 2) a proposed cutoff (P‐FISH). Using M‐FISH, the diagnostic sensitivity was 57.1%, specificity 87.5%, and accuracy 60.0%; with P‐FISH, the sensitivity was 87.3%, specificity 71.4%, and accuracy 85.7%. When combined with cytology, the sensitivity, specificity, and accuracy were 88.0%, 83.3%, and 87.8%, respectively. Malignant cells presented a predominance of chromosomal gains. The UroVysion® test using the P‐FISH cutoff was effective in demonstrating aneuploid cells in all malignant effusions, confirming the diagnosis of malignancy even in cases with suspicious cytology.
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Affiliation(s)
- Débora C B Rosolen
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel K Faria
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caroline S Faria
- Faculdade de Medicina, Medical Investigation Laboratory (LIM03), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Leila Antonangelo
- Division of Clinical Pathology, Department of Pathology, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Faculdade de Medicina, Medical Investigation Laboratory (LIM03), Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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10
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Detection of Bladder Cancer in Urine Sediments by a Novel Multicolor Fluorescence In Situ Hybridization (Quartet) Test. Eur Urol Focus 2018; 5:664-675. [PMID: 29428551 DOI: 10.1016/j.euf.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/12/2018] [Accepted: 01/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bladder cancer is among the common human malignancies that show a heavy mutational load and copy number variations of numerous chromosomes, which makes them a target for diagnostic explorations. OBJECTIVE We aimed to design a multicolor fluorescence in situ hybridization (FISH) test referred to as the quartet test for the detection of bladder cancer in urine. DESIGN, SETTING, AND PARTICIPANTS We performed genome-wide copy number variation analysis on cohorts from the University of Texas MD Anderson Cancer Center (n=40) and The Cancer Genome Atlas (n=129), and identified the most frequently amplified chromosomal regions. These data were used to select four of the amplified regions to design a multicolor FISH test, referred to as the quartet test. Assay validation was performed on urine samples from 98 patients with bladder cancer: 56 with low-grade papillary, 42 with high-grade invasive disease, and 48 benign controls. INTERVENTION The quartet test can be used in clinical practice for noninvasive detection of bladder cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We initially analyzed samples using a fraction of abnormal cell scores and then by the quantitative score, which included not only the proportion of cells with abnormal copy numbers, but also the proportion of cells with numbers of altered copies and degree of amplification. We used receiver operator characteristic (ROC) curves to identify cutoff values for the scores at which performances of sensitivity and specificity were maximized. RESULTS AND LIMITATIONS The copy number status assessed by probes detected in voided urine reflected the amplification status of the primary tumor. An ROC curve summarizing the proportion of assayed cells with any abnormal copy numbers gave specificity of 93.8% and sensitivity of 78.6% using the proportion of cells with abnormal copy numbers. The quantitative score giving extra weight to cells with multiple simultaneous amplifications provided 95.8% specificity and 76.8% sensitivity. Both percentage of abnormal cells and quantitative scores were highly effective for assessing the grade of the tumor. The full spectrum of potential clinical applications was not explored in the current study, and further validation studies are needed. CONCLUSIONS The quartet test shows promising specificity and sensitivity results, but it requires validation on a larger multi-institutional cohort of samples. PATIENT SUMMARY The quartet test can be used for noninvasive detection of bladder cancer in voided urine. It can also be used to assess the grade of the tumor and tumor recurrence as well as post-treatment effects.
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11
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Renshaw AA, Gould EW. High-grade urothelial carcinoma in urine cytology with jet black and smooth or glassy chromatin. Cancer Cytopathol 2017; 126:64-68. [PMID: 29072816 DOI: 10.1002/cncy.21947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some high-grade urothelial carcinomas (UCs) in urine cytology can have jet black, smooth, or glassy chromatin, but to the authors' knowledge, the incidence and criteria for diagnosis are not well described. The current study was performed to define the incidence and appearance of high-grade UC in urine cytology in cytospin preparations with jet black and smooth or glassy chromatin. METHODS Cytospin preparations from 331 cases with biopsy follow-up (230 benign/low-grade UCs and 101 malignant UCs) were reviewed. RESULTS Cases with malignant cells with jet black and smooth or glassy chromatin were identified in a total of 60 cases (59.4% of all malignancies). These comprised 18 carcinoma in situ cases, 28 high-grade papillary UCs, 8 invasive UCs, 3 squamous cell carcinomas, 2 adenocarcinomas, and 1 melanoma. Of the 93 high-grade UCs, 51 (54.8%) had cells with either jet black and smooth or glassy chromatin. These cells were the only type of malignant cell in 6 of 101 cases (5.9%). All cases had at least 50 cells with jet black nuclei. Nuclei with jet black and smooth chromatin often were smaller than normal urothelial cells, often but not always elongate, had irregular nuclear outlines including pointed areas, and usually were accompanied by necrosis. Cells with glassy chromatin often were larger than normal urothelial cells, had rounder but still irregular nuclei, and also had frequent necrosis. CONCLUSIONS Malignant urothelial cells in urine cytology with jet black chromatin are common and can be diagnosed as "positive for malignancy" based on their irregular nuclear outline, increased cellularity (≥50 abnormal cells), and frequent necrosis. Cancer Cytopathol 2018;126:64-8. © 2017 American Cancer Society.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
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12
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Chen Y, Tao B, Peng Y, Yang W, Wang C, Xiang X, Zhang T, Gao L, Yi J, Zhou X, Huang J. Utility of Fluorescence In Situ Hybridization (FISH) to Sub-Classify Low-Grade Urothelial Carcinoma for Prognostication. Med Sci Monit 2017; 23:3161-3167. [PMID: 28655867 PMCID: PMC5499627 DOI: 10.12659/msm.902481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Fluorescence in situ hybridization (FISH) is used widely to detect cancer levels, but its value in urothelial carcinoma remains unclear. The aim of this study was to use FISH to examine the urine specimens of low-grade urothelial carcinoma (UC) patients to determine the possibility of sub-classifying the prognosis of UC. Material/Methods We diagnosed 107 patients with low-grade UC using a UroVysion kit to detect chromosomes 3, 7, 17, and P16 in the urine. An average 46.6-month follow-up completed in January 2016 combined with the clinical follow-up data were evaluated with Spearman’s correlation analysis to analyze the aberration of chromosomes in relation to the prognostication. Univariate and multivariate analysis using the Mantel-Cox log-rank test for overall, cancer-specific, and disease-free survival were used to determine the prognostic significance of CSP7/CSP17 and CSP3/GLPp16. Results In the 107 samples, 84 showed positive reaction in the FISH test. Furthermore, CSP7/CSP17 was found to be significantly related with age, tumor size, T stage, and tumor numbers, but not in CSP3/GLPp16. In addition, Kaplan-Meier analysis and Cox proportional hazards regression revealed a significant negative correlation between CSP7/CSP17 and survival, while CSP3/GLPp16 showed no significantly differences. Conclusions CSP7/CSP17 positivity on FISH test appears to play a critical role in low-grade UC and may be considered as a high-risk and prognosis factor.
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Affiliation(s)
- Yi Chen
- Department of Urology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Bo Tao
- Department of Orthopaedics, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Ya Peng
- Center Laboratory of Basic Medical Science, Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Weijiao Yang
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Chuang Wang
- Department of Urology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Xuebao Xiang
- Department of Urology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Tianyu Zhang
- Department of Urology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Li Gao
- Department of Urology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
| | - Jiaoyu Yi
- Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Xiangfu Zhou
- Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jiefu Huang
- Department of Urology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China (mainland)
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13
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Virk RK, Abro S, de Ubago JMM, Pambuccian SE, Quek ML, Wojcik EM, Mehrotra S, Chatt GU, Barkan GA. The value of the UroVysion® FISH assay in the risk-stratification of patients with “atypical urothelial cells” in urinary cytology specimens. Diagn Cytopathol 2017; 45:481-500. [DOI: 10.1002/dc.23686] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Renu K. Virk
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Schuharazad Abro
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | | | | | - Marcus L. Quek
- Department of Urology; Loyola University Medical Center; Maywood IL 60153
| | - Eva M. Wojcik
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Swati Mehrotra
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Grazina U. Chatt
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Güliz A. Barkan
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
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14
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Knüchel-Clarke R, Gaisa NT. [Preneoplastic lesions and precursors of urothelial cancer]. DER PATHOLOGE 2016; 37:33-9. [PMID: 26811248 DOI: 10.1007/s00292-015-0130-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As even a mere thickening of the urothelium can harbor genetic changes identical to that of low grade papillary urothelial tumors, it is not always possible to clearly recognize a precursor lesion of urothelial carcinoma by routine histological diagnostics. Complementary immunohistochemical and molecular diagnostic methods assist the recognition of these entities. These methods especially help to identify clinically important genetically unstable cells as the hallmark of carcinoma in situ (CIS). Little is known about the clinical significance of the morphological subtypes of CIS, which range from large cell to micropapillary variants. For a better understanding of special types of bladder cancer (e.g. adenocarcinoma and squamous cell carcinoma), it seems to be important to define the phenotype and the molecular pattern of non-urothelial lesions, such as intestinal metaplasia and squamous metaplasia, better and more precisely.
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Affiliation(s)
- R Knüchel-Clarke
- Institut für Pathologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - N T Gaisa
- Institut für Pathologie, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
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