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Arshia A, Hassan FA, Hensley PJ, Allison DB. Urinary tract cytology showing variant morphology and divergent differentiation. Cytopathology 2024; 35:199-212. [PMID: 37919868 DOI: 10.1111/cyt.13322] [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: 07/31/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
Urothelial carcinoma represents a diverse group of tumours with distinct histologic subtypes, each exhibiting unique cytomorphologic features, architectural growth patterns, and/or well-developed aberrant differentiation. In fact, there are more than 13 subtypes of urothelial carcinoma recognized in the 2022 WHO classification of tumours in the urinary tract. The identification of these subtypes is crucial for an accurate diagnosis of urothelial carcinoma, and many have important clinical implications. Variant/divergent features may coexist with conventional high-grade urothelial carcinoma (HGUC) or present with 100% variant morphology. In urinary tract cytology (UTC), urothelial carcinoma can display divergent differentiation, such as squamous, glandular, or small cell carcinoma differentiation. The use of cell block preparations and immunohistochemistry with available residual urine can enhance diagnostic accuracy. On the other hand, identifying urothelial carcinoma variants, including nested, micropapillary, and plasmacytoid subtypes, poses significant challenges in UTC. Many cases of these variants are only detected retrospectively after variant histology has been established from resection specimens. Moreover, some variants exhibit features inconsistent with the diagnostic criteria for HGUC according to the Paris System for Reporting Urinary Tract Cytology. Nevertheless, the rarity of pure variant morphology and the occurrence of some false negatives for these variant cases are essential to maintain the specificity of UTC overall. This review covers the histology, cytomorphology, and important clinical aspects observed in urothelial carcinoma exhibiting divergent differentiation and various urothelial carcinoma variants detected in UTC.
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Affiliation(s)
- Asma Arshia
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Faisal A Hassan
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Patrick J Hensley
- Markey Cancer Center, Lexington, Kentucky, USA
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Derek B Allison
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Markey Cancer Center, Lexington, Kentucky, USA
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Pierconti F, Rossi ED, Fiorentino V, Bakacs A, Carlino A, Navarra E, Sacco E, Totaro A, Palermo G, Larocca LM, Martini M. Methylation Analysis of Urinary Sample in Non-Muscle-Invasive Bladder Carcinoma: Frequency and Management of Invalid Result. Biomedicines 2023; 11:3288. [PMID: 38137509 PMCID: PMC10741688 DOI: 10.3390/biomedicines11123288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Numerous studies showed that methylation analysis represents a newly developed urinary marker based on DNA methylation changes in a panel of genomic biomarkers and it could represent a valid tool in terms of the diagnosis and prediction of high-grade urothelial carcinoma recurrences. One of the limits of the use of this new molecular method during a follow-up is represented by the number of invalid tests in routine practice. METHOD A total of 782 patients with a diagnosis of non-muscle-invasive high-grade carcinoma (NMIBC) was studied. The Bladder EpiCheck test (BE) was performed together with cytology in all cases within 1 year after the end of treatment. In 402 patients, the urinary samples were voided urine (UV), while, in 380 cases, the samples were collected after bladder washing (IU). For all the patients with invalid BE results, a second BE test was performed following the instructions for use that indicated the test should be repeated with a new urinary sample in the case of an invalid result. RESULTS Analyzing the two different groups (UV and IU), we found the invalid BE results seemed to be not related to urinary samples (p = 0.13 Fisher's exact test), suggesting that the collection method was not relevant in order to reduce the number of invalid tests. CONCLUSIONS In the follow-up for NMIBC, for patients for whom a BE test is planned, a combined approach of cytology and a methylation test is recommended in order to repeat the BE test with an invalid result only in those cases with a cytological diagnosis of atypical urothelial cells (AUC) suspicious for high-grade urothelial carcinoma (SHGUC) and high-grade urothelial carcinoma (HGUC).
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Affiliation(s)
- Francesco Pierconti
- Institute of Pathology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00153 Rome, Italy; (E.D.R.); (A.B.); (E.N.)
| | - E. D. Rossi
- Institute of Pathology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00153 Rome, Italy; (E.D.R.); (A.B.); (E.N.)
| | - V. Fiorentino
- Institute of Pathology, University of Messina, 98125 Messina, Italy; (V.F.); (M.M.)
| | - A. Bakacs
- Institute of Pathology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00153 Rome, Italy; (E.D.R.); (A.B.); (E.N.)
| | - A. Carlino
- Institute of Pathology, UniCamillus Rome, 00131 Rome, Italy; (A.C.); (L.M.L.)
| | - E. Navarra
- Institute of Pathology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00153 Rome, Italy; (E.D.R.); (A.B.); (E.N.)
| | - E. Sacco
- Institute of Urology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00168 Rome, Italy; (E.S.); (A.T.); (G.P.)
| | - A. Totaro
- Institute of Urology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00168 Rome, Italy; (E.S.); (A.T.); (G.P.)
| | - G. Palermo
- Institute of Urology, Catholic University of Rome, Fondazione Policlinico Gemelli Roma, 00168 Rome, Italy; (E.S.); (A.T.); (G.P.)
| | - L. M. Larocca
- Institute of Pathology, UniCamillus Rome, 00131 Rome, Italy; (A.C.); (L.M.L.)
| | - M. Martini
- Institute of Pathology, University of Messina, 98125 Messina, Italy; (V.F.); (M.M.)
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Christofidis K, Moulavasilis N, Fragkiadis E, Goutas D, Lazaris AC, Mitropoulos D, Mikou P. Diagnosis of Low-Grade Urothelial Neoplasm in the Era of the Second Edition of the Paris System for Reporting Urinary Cytology. Diagnostics (Basel) 2023; 13:2625. [PMID: 37627884 PMCID: PMC10453841 DOI: 10.3390/diagnostics13162625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The Paris System for Reporting Urinary Cytology (TPS) is considered the gold standard when it comes to diagnostic classifications of urine specimens. Its second edition brought some important changes, including the abolition of the diagnostic category of "low-grade urothelial neoplasm (LGUN)", acknowledging the inability of cytology to reliably discern low-grade urothelial lesions. METHODS In this retrospective study, we assessed the validity of this change, studying the cytological diagnoses of histologically diagnosed low-grade urothelial carcinomas during a three-year period. Moreover, we correlated the sum of the urinary cytology diagnoses of this period with the histological diagnoses, whenever available. RESULTS Although all the cytological diagnoses of LGUN were concordant with the histological diagnoses, most low-grade urothelial carcinomas were misdiagnosed cytologically. Subsequently, the positive predictive value (PPV) of urinary cytology for the diagnosis of LGUN was 100%, while the sensitivity was only 21.7%. Following the cyto-histopathological correlation of the sum of the urinary cytology cases, the sensitivity of urinary cytology for the diagnosis of high-grade urothelial carcinoma (HGUC) was demonstrated to be 90.1%, the specificity 70.8%, the positive predictive value (PPV) 60.3%, the negative predictive value (NPV) 93.6% and the overall accuracy 77.2%, while for LGUN, the values were 21.7%, 97.2%, 87.5%, 58.6% and 61.9%, respectively. Risk of high-grade malignancy was 0% for the non-diagnostic (ND), 4.8% for the non-high-grade urothelial carcinoma (NHGUC), 33.3% for the atypical urothelial cells (AUCs), 65% for the suspicious for high-grade urothelial carcinoma (SHGUC), 100% for the HGUC and 12.5% for the LGUN diagnostic categories. CONCLUSIONS This study validates the incorporation of the LGUN in the NHGUC diagnostic category in the second edition of TPS. Moreover, it proves the ability of urinary cytology to safely diagnose HGUC and stresses the pivotal role of its diagnosis.
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Affiliation(s)
| | - Napoleon Moulavasilis
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Evangelos Fragkiadis
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Dimitrios Goutas
- 1st Laboratory of Pathology, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (D.G.); (A.C.L.)
| | - Andreas C. Lazaris
- 1st Laboratory of Pathology, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (D.G.); (A.C.L.)
| | - Dionisios Mitropoulos
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Panagiota Mikou
- Cytopathology Department, Laiko General Hospital, 11527 Athens, Greece;
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Saharti S, Aljhdali H, Ajabnoor R, Al Zahrani RA, Daous Y, Refai F, Badawi F, Mokhtar G, Alghamdi D. Cytospin performance when using Paris system for reporting urinary cytology. Cytojournal 2022; 19:47. [PMID: 36128466 PMCID: PMC9479516 DOI: 10.25259/cytojournal_48_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives:
The Paris System (TPS) for Reporting Urine Cytology has significantly improved the approach to evaluating urine cytology. TPS criteria were defined mainly according to ThinPrep and SurePath preparations, as they are widely utilized. The objective of this study is to validate urine cytology interpretation according to the TPS classification using cytospin technique in relation to the gold slandered histology.
Material and Methods:
This retrospective study examined and analyzed 316 urine specimens from King Abdulaziz University Hospital between 2015 and 2020. Cytospin technique is performed for all cases. Slides were recategorized using TPS criteria, then compared with the original histology diagnosis.
Results:
According to the TPS, 108 cases were classified as 101 AUC (32%), 95 NEG (30%), 59 HGUC (18.7%), 31 SHGUC (9.8%), and 30 (9.5%) others. The computed sensitivity of cytospin in urine cytology was 94.7%, with 73.9% specificity, a positive predictive value of 85.6%, a negative predictive value of 89.5%, and overall accuracy of 86.8%.
Conclusion:
Urine cytology testing is considered to be a non-invasive and sensitive method to screen for urothelial carcinoma. TPS defined standards are reliable on cytospin prepared slides for reporting urine cytology.
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Affiliation(s)
- Samah Saharti
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Hessa Aljhdali
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Rana Ajabnoor
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Reem A. Al Zahrani
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Yara Daous
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Fahd Refai
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Fatima Badawi
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia,
| | - Ghadeer Mokhtar
- Department of Anatomic Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia,
| | - Doaa Alghamdi
- Department of Laboratory Medicine, Division of Anatomical Pathology, King Fahad Medical City, Riyadh, Saudi Arabia,
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[Advances in Diagnosis and Treatment of Leptomeningeal Metastasis of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:517-523. [PMID: 35899451 PMCID: PMC9346159 DOI: 10.3779/j.issn.1009-3419.2022.102.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Leptomeningeal metastases (LM), a special type of metastasis in advanced lung cancer, is known for its severe clinical symptoms, rapid progression and poor prognosis. LM used to be featured with low clinical diagnosis rate, limited treatment options, poor treatment efficacy, and very short survival if treatment not given. Though cerebrospinal fluid (CSF) cytology remains to be the gold standard for the diagnosis of LM, the positive rate of the first CSF cytology even in patients with suggestive clinical symptoms and positive imaging generally does not exceed 50%, leading to a delay in the diagnosis and treatment of patients with LM. With the progress of targeted therapy for driver gene-positive lung cancer and immunotherapy for driver gene-negative lung cancer, the overall survival of patients with lung cancer has been prolonged, meanwhile incidence of LM has been increasing year by year. Current clinical research in this field center around how to improve diagnosis rate and to find effective treatment approaches. This paper reviews advances in diagnosis and treatment of LM of lung cancer..
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McIntire PJ, Aragao A, Burns BL, Pambuccian SE, Wojcik EM, Barkan GA. Digital image analysis of high-grade urothelial carcinoma in urine cytology confirms chromasia heterogeneity and reveals a subset with hypochromatic nuclei and another with extremely dark or "India ink" nuclei. Cancer Cytopathol 2022; 130:363-369. [PMID: 35104393 DOI: 10.1002/cncy.22554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Paris System for Reporting Urinary Cytology (TPS) uses hyperchromasia as major diagnostic criterion for high-grade urothelial carcinoma (HGUC). The purpose of the study was to evaluate cases that were diagnosed as HGUC by TPS and determine whether there are different chromatin distribution patterns (ie, subsets). METHODS Digital image annotations were performed on microscopic images of HGUC urine specimens with surgical biopsy/resection follow-up. Median gray values were generated for each cell. Neutrophils (polymorphonuclear leukocyte [PMN]) were also enumerated in each case to serve as an internal control. A HGUC/PMN ratio was generated for each case, and the cases were distributed. RESULTS Sixty-nine HGUC cases yielded 2660 cells, including 2078 HGUC (30.1 cells/case) and 582 PMNs (8.4 cells/case). The average median gray value of an HGUC was 50.6 and of a PMN was 36.8 (P < .0001). Eight of 69 cases (11.6%) contained nuclei that, on average, were darker than or as dark as a PMN (extremely dark, ie, "India ink"). Fifty-one of 69 cases (74.0%) contained nuclei that, on average, were slightly brighter than a PMN (hyperchromatic). Ten of 69 cases (14.5%) contained nuclei that, on average, were much brighter than a PMN (hypochromatic). Within a single case, all cases showed heterogeneity with the hypochromatic cases showing the most dramatic effect. CONCLUSIONS Digital image analysis reveals that there are large variations in chromasia between cases including a subset of cases with hypochromasia and another with extremely dark or "India ink" nuclei. There was much heterogeneity of chromasia seen within a single sample.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Alessa Aragao
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Bethany L Burns
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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Nikas IP, Seide S, Proctor T, Kleinaki Z, Kleinaki M, Reynolds JP. The Paris System for Reporting Urinary Cytology: A Meta-Analysis. J Pers Med 2022; 12:jpm12020170. [PMID: 35207658 PMCID: PMC8874476 DOI: 10.3390/jpm12020170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
The Paris System (TPS) for Reporting Urinary Cytology is a standardized, evidence-based reporting system, comprising seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other malignancies. This study aimed to calculate the pooled risk of high-grade malignancy (ROHM) of each category and demonstrate the diagnostic accuracy of urine cytology reported with TPS. Four databases (PubMed, Embase, Scopus, Web of Science) were searched. Specific inclusion and exclusion criteria were applied, while data were extracted and analyzed both qualitatively and quantitatively. The pooled ROHM was 17.70% for the nondiagnostic category (95% CI, 0.0650; 0.3997), 13.04% for the NHGUC (95% CI, 0.0932; 0.1796), 38.65% for the AUC (95% CI, 0.3042; 0.4759), 12.45% for the LGUN (95% CI, 0.0431; 0.3101), 76.89 for the SHGUC (95% CI, 0.7063; 0.8216), and 91.79% for the HGUC and other malignancies (95% CI, 0.8722; 0.9482). A summary ROC curve was created and the Area Under the Curve (AUC) was 0.849, while the pooled sensitivity was 0.669 (95% CI, 0.589; 0.741) and false-positive rate was 0.101 (95% CI, 0.063; 0.158). In addition, the pooled DOR of the included studies was 21.258 (95% CI, 14.336; 31.522). TPS assigns each sample into a diagnostic category linked with a specific ROHM, guiding clinical management.
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Affiliation(s)
- Ilias P. Nikas
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Correspondence:
| | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Zoi Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Internal Medicine Department, General Hospital of Nikea, 18454 Athens, Greece
| | - Maria Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
| | - Jordan P. Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32256, USA;
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Goutas D, Savvidou K, Vrettou K, Meletis E, Levis P, Constantinides C, Lazaris AC, Mikou P. Comparison of conventional and liquid-based cytology using The Paris System for Reporting Urinary Cytology. Cytopathology 2021; 32:795-801. [PMID: 34289188 DOI: 10.1111/cyt.13040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/23/2021] [Accepted: 07/18/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This retrospective study was conducted to compare the conventional cytospin method and ThinPrep liquid-based urinary cytology in diagnosing bladder cancer using The Paris System (TPS) of classification. METHODS We retrieved files for 2020, at the Cytopathology Department of Laiko Hospital, of urinary cases diagnosed according to TPS. Cytospin and ThinPrep slides were separately reviewed and new diagnoses were rendered, then compared with the original diagnosis and histology when available. Risk of high-grade malignancy (ROHM) for each TPS category was assessed, along with accuracy parameters of each method and their combination. RESULTS The study material comprised 100 cases of void urinary cytology classified as 20 high-grade urothelial carcinoma (HGUC = TPS5) cases, 20 of suspicion for HGUC (SHGUC = TPS4), 25 of atypical urothelial cells (AUC = TPS3), and 35 of negative for HGUC (NHGUC = TPS2). A single inadequate (TPS1) case and 4 of low-grade urothelial neoplasm (TPS6) were excluded as small in number. The ROHM was 95% for HGUC, 55% for SHGUC, 28% for AUC and 5.7% for NHGUC. Agreement with the original diagnosis was 86% for cytospin and 82% for ThinPrep. No significant differences were observed among the two techniques or their combination regarding sensitivity and specificity, with a mild advantage for cytospin. Interobserver reproducibility and repeatability were high. CONCLUSION No significant differences were found concerning sensitivity and specificity between cytospin and ThinPrep when applying TPS criteria. TPS is a reliable classification scheme for either conventional/cytospin or liquid-based cytology, or their combination.
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Affiliation(s)
- Dimitris Goutas
- First Department of Pathology, School of Medicine, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriaki Savvidou
- Department of Cytopathology, 401 General Military Hospital of Athens, Athens, Greece
| | - Klio Vrettou
- Department of Cytopathology, Laiko General Hospital of Athens, Athens, Greece
| | - Emmanouel Meletis
- Department of Cytopathology, Laiko General Hospital of Athens, Athens, Greece
| | - Panagiotis Levis
- First Urology Department, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Constantine Constantinides
- First Urology Department, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- First Department of Pathology, School of Medicine, Laiko General Hospital, The National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Mikou
- Department of Cytopathology, Laiko General Hospital of Athens, Athens, Greece
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Okuda C, Kyotake A, Nakamura A, Itoh T, Kamoshida S, Ohsaki H. Quantitative cytomorphological comparison of SurePath and ThinPrep liquid-based cytology using high-grade urothelial carcinoma cells. Cytopathology 2021; 32:654-659. [PMID: 34033150 DOI: 10.1111/cyt.12998] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In The Paris System for Reporting Urinary Cytology (TPS), the important cytomorphological features for diagnosing high-grade urothelial carcinoma (HGUC) are a nuclear-to-cytoplasmic (N:C) ratio exceeding 0.7, hyperchromasia, coarse chromatin, and irregular nuclear borders. However, quantitative cytomorphological assessments of HGUC cells using SurePath slides are rare. Therefore, we evaluated HGUC cells on SurePath slides quantitatively using a digital image analysis system and compared these data with ThinPrep data. METHODS The same urine samples were divided into two aliquots and used to prepare SurePath and ThinPrep slides. We used ImageJ to measure the N:C ratio, hyperchromasia, and irregular nuclear borders for HGUC cells on SurePath and ThinPrep slides. RESULTS The total number of analysed HGUC cells on SurePath slides was 981, versus 889 on ThinPrep slides. Hyperchromasia and irregular nuclear borders were significantly more severe on SurePath than on ThinPrep slides. Conversely, the N:C ratio did not differ between the methods. Additionally, HGUC cells with N:C ratios exceeding 0.7 were present on almost all slides for both methods. CONCLUSIONS Our data indicated the reasonableness of using the N:C ratio as the major criterion for TPS on both SurePath and ThinPrep slides, and an N:C ratio cut-off of 0.7 as suitable for identifying HGUC cells. However, the severity of hyperchromasia and irregular nuclear borders differed between the processing methods.
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Affiliation(s)
- Chihiro Okuda
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Aiko Kyotake
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kamoshida
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
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Lv S, Chu Y, Zhang P, Ma S, Zhao M, Wang Z, Gu Y, Sun X. Improved efficiency of urine cell image segmentation using droplet microfluidics technology. Cytometry A 2020; 99:722-731. [PMID: 33342063 DOI: 10.1002/cyto.a.24296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/25/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022]
Abstract
Recent advances in the recognition of biological samples using machine vision have made this technology increasingly important in research and detection. Image segmentation is an important step in this process. This study focuses on how to reduce the interference factors such as the overlap between different types (or within the same type) of urine cells according to microfluidics and improve the machine vision segmentation accuracy for cell images. In this study, we demonstrate that the platform can realize this hypothesis using urine cell image segmentation as an example application. We first discuss the reported urine cell droplet microfluidic chip system, which can realize the test conditions in which urine cells are encapsulated in the droplet and isolated from salt crystallization and/or bacteria and other urine-formed elements. Then, based on the analysis conditions set in the aforementioned experiment, the proportions of red blood cells, white blood cells, and squamous epithelial cells covered by various formed elements in the total urine cells in the same urine sample are measured. We simultaneously analyze the percentage of urine cells covered by salt crystallization and the incidence of overlapping between urine cells. Finally, the Otsu algorithm is used to segment the urine cell images encapsulated by the droplet and the urine cell images not encapsulated by the droplet, and the Dice, Jaccard, precision, and recall values are calculated. The results suggest that the method of encapsulating single cells based on droplets can improve the image segmentation effect without optimizing the algorithm.
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Affiliation(s)
- Shuxing Lv
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yuying Chu
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Panpan Zhang
- North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Sike Ma
- Engineering Research Center of Learning-Based Intelligent System, Ministry of Education of China, Tianjin University of Technology, Tianjin, China
| | - Meng Zhao
- Engineering Research Center of Learning-Based Intelligent System, Ministry of Education of China, Tianjin University of Technology, Tianjin, China
| | - Zhexiang Wang
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Yajun Gu
- School of Medical Laboratory, Tianjin Medical University, Tianjin, China
| | - Xuguo Sun
- School of Medical Laboratory, Tianjin Medical University, Tianjin, 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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McIntire PJ, Kilic I, Pambuccian SE, Wojcik EM, Barkan GA. The Paris System for Reporting Urinary Cytology reduces atypia rates and does not alter the negative predictive value of urine cytology. J Am Soc Cytopathol 2020; 10:14-19. [PMID: 33221245 DOI: 10.1016/j.jasc.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (TPS) was developed for standardization purposes and it placed an emphasis on screening for high-grade urothelial carcinoma (HGUC). Since then, it has shown to reduce atypia rates and better correlate with surgical specimens. The aim of this study was to calculate the negative predictive value (NPV) of urinary cytology for detecting HGUC using TPS and compare these data to our recently published pre-TPS cohort. As a screening test, it is imperative that TPS has a high NPV. MATERIAL AND METHODS A search of our institution's pathology database for the term "negative for HGUC" from January 1, 2016, to December 31, 2017, was conducted. A true negative was defined as a patient with at least 1 subsequent negative urine cytology/surgical biopsy specimen or the patient being clinically negative for 6 months. NPV rates were calculated based on the data obtained. RESULTS The cohort consisted of 2960 urine cytology specimens from 1894 patients. A total of 99 false negatives were identified, generating a NPV of 96.7% (2861/2960). This NPV is identical to our previously published pre-TPS cohort (years 2012-2013; NPV: 96.7%). The clinical indication most effected NPV, with a history of urothelial carcinoma with a NPV of 93.9% followed by hematuria at 98.9%. The atypia rate in years 2012-2013 was 8.2% and in 2016-2017 it was 5.7% (P < 0.001). CONCLUSIONS We demonstrate that TPS did not alter the NPV for detecting HGUC compared to our pre-TPS cohort. We believe that TPS is an effective reporting system for screening HGUC in urinary cytology.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois.
| | - Irem Kilic
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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Predictive value of MCM5 (ADXBLADDER) analysis in urine of men evaluated for the initial diagnosis of bladder cancer: A comparative prospective study. Diagn Cytopathol 2020; 48:1034-1040. [DOI: 10.1002/dc.24530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/24/2020] [Accepted: 06/03/2020] [Indexed: 02/04/2023]
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Cyto-histo correlations of plasmacytoid and micropapillary variants of high-grade urothelial carcinoma: do they fit well in The Paris System for reporting urinary cytology? J Am Soc Cytopathol 2020; 10:20-24. [PMID: 32620533 DOI: 10.1016/j.jasc.2020.05.013] [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: 02/27/2020] [Revised: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Plasmacytoid and micropapillary variants of high-grade urothelial carcinoma (HGUC) exhibit unique histologic morphology and very aggressive clinical behavior. However, the morphology of these 2 variants in urinary cytology is not well studied and evaluated using The Paris System for reporting urinary cytology. MATERIALS AND METHODS A database search was performed in all patients with the diagnosis of plasmacytoid or micropapillary HGUC. A total of 5 patients with positive urinary cytology cases were identified. The cytomorphology of every urinary cytology case was correlated with the histologic features in the surgical specimens from the same patient. RESULTS One urine and 4 bladder washings were evaluated. Cytologically, plasmacytoid HGUCs are characterized by single, large tumor cells with hyperchromasia, irregular nuclear membranes, and vacuolated cytoplasm. The nuclear-to-cytoplasmic (N:C) ratio was less than 0.5 in many of the malignant cells due to the abundant cytoplasm. The cytology features of micropapillary HGUC include the presence of micropapillae of tumor cells with no fibrovascular core. Individual high-grade urothelial cells were also identified in all 4 cases, but 1 (25%) of these had only rare cells meeting The Paris System criteria for HGUC due to abundant cytoplasm and lack of hyperchromasia in most malignant cells. CONCLUSIONS Plasmacytoid and micropapillary variants of HGUC have unique cytomorphologic features in urinary cytology specimens, which are reflective of the corresponding histological findings. These 2 clinically aggressive variants of HGUC may not be as readily interpreted as malignant using The Paris System for reporting urinary cytology, creating potential diagnostic pitfalls.
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Ma C, Zhang L. Comparison of urine cytology diagnostic reports before and after the implementation of the Paris System classification system in China. Cytopathology 2020; 31:457-462. [PMID: 32246545 DOI: 10.1111/cyt.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 03/07/2020] [Accepted: 03/22/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In 2013, The Paris System for Reporting Urinary Cytology (TPS) was developed as a uniform practical urine cytology system that could be applied worldwide. Here, we investigated the effectiveness of TPS diagnostic approach compared with that of the traditional urine cytological diagnosis method used in China. METHODS Based on the diagnostic criteria of TPS, 412 urine samples from 143 patients with histological follow-up data were retrospectively analysed, and the diagnoses were compared with the original cytological diagnoses. RESULTS In total, 110 patients were histologically diagnosed with high-grade urothelial carcinoma (HGUC), and 33 patients were diagnosed with low-grade urothelial neoplasia. Based on the traditional urine cytological analysis method, 50 patients (34.9%) were diagnosed as negative, 48 patients (33.6%) were diagnosed as having atypical urothelial cells, and 45 patients (31.5%) were diagnosed as positive. After reclassification using TPS, urine samples from 11 cases (7.7%) were categorised as unsatisfactory, 34 cases (23.8%) were negative, 21 cases (14.7%) were categorised as having atypical urothelial cells, 12 cases (8.4%) were diagnosed as suspicious for HGUC, 59 cases (41.2%) were diagnosed with HGUC, and six cases (4.2%) were reclassified as having low-grade urothelial neoplasia. Thus, after implementing TPS criteria, the sensitivity for positive malignancy diagnoses (HGUC alone) increased from 38.2% to 50.9%, while the specificity of the diagnosis was barely changed. CONCLUSIONS The Paris System for Reporting Urinary Cytology greatly contributes to the standardisation of urine cytology reports and significantly improves the diagnostic sensitivity for HGUC.
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Affiliation(s)
- Cao Ma
- Department of Pathology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lihua Zhang
- Department of Pathology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
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Anbardar MH, Monjazeb R. Reclassification of urinary cytology regarding The Paris System for Reporting Urinary Cytology with cytohistological correlation demonstrates high sensitivity for high-grade urothelial carcinoma. Diagn Cytopathol 2020; 48:446-452. [PMID: 31976626 DOI: 10.1002/dc.24387] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently, The Paris System for Reporting Urinary Cytology (TPS) has led to major changes in the approach to evaluate urine cytology and pattern of reporting. The aim of this study was to reclassify urine cytology reports with TPS in order to determine the frequency of abnormal results compared with the previous system; also, we performed cytohistological correlation in abnormal cytological results. METHODS In this study, the voided urine specimens from the patients referred to Shiraz University of Medical Sciences affiliated laboratories were retrieved and analyzed using the laboratory's electronic records system; slides prepared from the samples were reviewed by single cytopathologist blindly according to the proposed criteria of TPS. RESULTS Totally, 1842 urine cytology slides from 828 patients were blindly evaluated by TPS criteria and compared with routine urine cytology classification. Then, available cytohistological correlation was done on 99 abnormal urine cytological results from 58 patients. Among the 26 cytology slides with atypical urothelial cell (AUC) in the previous classification, eight (30.70%) slides were downgraded to negative results, and four (15.30%) were upgraded to higher groups. Therefore, through the reclassification of the slides with TPS, 46% of the AUC changed to other groups. Diagnostic accuracy of the TPS classified urine cytology was 78%, including 87.88% sensitivity, 27.27% specificity, 64.44% positive predictive value, and 60% negative predictive value. CONCLUSION The findings of the present study confirmed the importance and utility of TPS regarding the reclassification of AUC to other groups and its high sensitivity for detecting high-grade urothelial carcinoma (HGUC).
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Affiliation(s)
- Mohammad Hossein Anbardar
- Department of Pathology, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Raha Monjazeb
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Paula R, Oliveira A, Nunes W, Bovolim G, Domingos T, De Brot L, Bezerra S, Cunha I, Morini M, Saieg M. Two‐year study on the application of the Paris system for urinary cytology in a cancer centre. Cytopathology 2019; 31:41-46. [DOI: 10.1111/cyt.12780] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/26/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Rafaela Paula
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Andrea Oliveira
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Warley Nunes
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Graziele Bovolim
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Tabata Domingos
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Louise De Brot
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | | | - Isabela Cunha
- Department of PathologyRede D'OR‐ São Luiz São Paulo Brazil
| | - Mariane Morini
- Department of PathologyRede D'OR‐ São Luiz São Paulo Brazil
| | - Mauro Saieg
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
- Department of PathologySanta Casa Medical School São Paulo Brazil
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Stanzione N, Ahmed T, Fung PC, Cai D, Lu DY, Sumida LC, Moatamed NA. The continual impact of the Paris System on urine cytology, a 3‐year experience. Cytopathology 2019; 31:35-40. [DOI: 10.1111/cyt.12777] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/29/2019] [Accepted: 10/02/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Nicholas Stanzione
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Tagreed Ahmed
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Po Chu Fung
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Diancai Cai
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - David Y. Lu
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Lauren C. Sumida
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Neda A. Moatamed
- Department of Pathology & Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
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Richardson CJ, Pambuccian SE, Barkan GA. Split‐sample comparison of urothelial cells in ThinPrep and cytospin preparations in urinary cytology: Do we need to adjust The Paris System for Reporting Urinary Cytology criteria? Cancer Cytopathol 2019; 128:119-125. [DOI: 10.1002/cncy.22218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/19/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Güliz A. Barkan
- Department of Pathology Loyola University Medical Center Maywood Illinois
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20
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Straccia P, Martini M, Sacco E, Bassi PF, Pierconti F. Cytological features of micropapillary and plasmacytoid variants of urothelial carcinoma. Diagn Cytopathol 2019; 48:111-117. [DOI: 10.1002/dc.24331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and HistologyUniversità Cattolica del Sacro Cuore, Foundation “A. Gemelli” University Hospital Largo Francesco Vito Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and HistologyUniversità Cattolica del Sacro Cuore, Foundation “A. Gemelli” University Hospital Largo Francesco Vito Rome Italy
| | - Emilio Sacco
- Urologic Clinic, Department of Surgical SciencesUniversità Cattolica del Sacro Cuore, Foundation “A. Gemelli” University Hospital Largo Francesco Vito Rome Italy
| | - Pier F. Bassi
- Urologic Clinic, Department of Surgical SciencesUniversità Cattolica del Sacro Cuore, Foundation “A. Gemelli” University Hospital Largo Francesco Vito Rome Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and HistologyUniversità Cattolica del Sacro Cuore, Foundation “A. Gemelli” University Hospital Largo Francesco Vito Rome Italy
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21
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Barkan GA, Tabatabai ZL, Kurtycz DFI, Padmanabhan V, Souers RJ, Nayar R, Sturgis CD. Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology. Arch Pathol Lab Med 2019; 144:172-176. [PMID: 31295017 DOI: 10.5858/arpa.2019-0045-cp] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known. OBJECTIVE.— To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. DESIGN.— A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. RESULTS.— Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. CONCLUSIONS.— Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.
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Affiliation(s)
- Güliz A Barkan
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
| | - Z Laura Tabatabai
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
| | - Daniel F I Kurtycz
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
| | - Vijayalakshmi Padmanabhan
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
| | - Rhona J Souers
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
| | - Ritu Nayar
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
| | - Charles D Sturgis
- From the Department of Pathology, Loyola University Medical Center, Maywood, Illinois (Dr Barkan); the Department of Pathology, University of California in San Francisco, and Veterans Affairs Medical Center, San Francisco (Dr Tabatabai); the Department of Pathology, University of Wisconsin, and the Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Padmanabhan); the Department of Biostatistics, College of American Pathologists, Northfield, Illinois (Ms Souers); the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Nayar); and the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Sturgis)
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Rai S, Lali BS, Venkataramana CG, Philipose CS, Rao R, Prabhu GGL. A Quest for Accuracy: Evaluation of The Paris System in Diagnosis of Urothelial Carcinomas. J Cytol 2019; 36:169-173. [PMID: 31359918 PMCID: PMC6592122 DOI: 10.4103/joc.joc_67_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Urine cytology is an important screening tool of patients for urothelial carcinoma (UC) and follow-up of patients with treated disease. Ease of procurement, cost-effectiveness, and lower turnaround time are the major advantages. OBJECTIVE To compare current system of reporting (CSR) at our institute with The Paris System (TPS) and analyze utility of urine cytology based on TPS reporting in correlation with urine culture and histopathology. MATERIALS AND METHODS One-year retrospective study of 90 cases was undertaken wherein cases presenting with painless hematuria and clinically suspicious of UC were included. Urine cytology slides were reviewed and reported with TPS guidelines. These findings were correlated with histopathological diagnosis and urine culture as indicated. Statistical analysis was done using SPSS 17 software. RESULTS With TPS guidelines, 11.1% and 5.6% cases were reported as high-grade UC (HGUC) and low-grade urothelial neoplasm (LGUN), respectively. Suspicious for HGUC category included 17.8% of cases. The rate of reporting "atypical urothelial cells (AUC)" was significantly lower (11.1%) with TPS on comparison with CSR (16.7%). Histopathological correlation of positive predictive value for HGUC was better (100%) on using TPS when compared with CSR (64.3%). Among 11 cases with microbial growth on urine culture, 9.1% were reported as atypical. Sensitivity and accuracy of TPS in detecting UC were 83.3% and 86.52%, respectively. Both were higher when compared with CSR. CONCLUSION In comparison to CSR, criteria of TPS limit the AUC category and enhance the sensitivity and accuracy of detecting HGUC. Adopting TPS for urinary cytology will ensure uniformity and accuracy of HGUC diagnosis.
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Affiliation(s)
- Sharada Rai
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Bhagat S. Lali
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Chaithra G. Venkataramana
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Cheryl S. Philipose
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Ranjitha Rao
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - GG Laxman Prabhu
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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Allison DB, VandenBussche CJ. A Review of Urine Ancillary Tests in the Era of the Paris System. Acta Cytol 2019; 64:182-192. [PMID: 31060038 DOI: 10.1159/000499027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 12/15/2022]
Abstract
Aside from its diagnostic importance, urinary tract endoscopy is an uncomfortable, expensive, and time-consuming procedure. Patients with a history of urothelial carcinoma remain at an increased risk for recurrence and the development of de novo disease; most have had exposure to carcinogenic risk factors for decades prior to their first diagnosis that have bathed the entire urothelial tract. Consequently, monitoring these patients over their lifetime has made urothelial carcinoma one of the most expensive cancers for the US healthcare system. This expense has provided a financial incentive for academic and commercial groups to develop a test with a sufficient negative predictive value to reduce the frequency of surveillance procedures. Slide-based tests require a separate slide prepared from a split urine sample or from an additional urinary tract specimen. This process can place an additional burden on the laboratory due to changes in the workflow, especially if the split specimens need to be stored until a cytologic diagnosis is rendered (i.e., when used as a reflex test). Importantly, slide-based tests allow for the result to be directly correlated with cytomorphologic findings; however, these tests require the cells of interest to be present. Thus, slide-based tests suffer from the same sensitivity issues as urinary tract cytology. In contrast, slide-free tests do not require an additional slide to be prepared, and laboratory testing may be centralized to a core facility or performed on-site. Some tests detect the expression of altered or abnormally expressed subcellular material (proteins, DNA, etc.) in urothelial neoplasms, which are found in tumor cells and/or in the urine specimen when the proteins are either excreted or leaked from degenerating tumor cells. Slide-free tests may also be developed into point-of-care tests, meaning that the result may be available to the urologist but not to the cytopathologist. Since these proteins are often disassociated from the tumor cells that produce them, such tests may have a positive result even if tumor cells are absent in the tested specimen. Here we review critical concepts as well as several ancillary tests that have been developed for urinary tract specimens.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
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McIntire PJ, Khan R, Hussain H, Pambuccian SE, Wojcik EM, Barkan GA. Negative predictive value and sensitivity of urine cytology prior to implementation of The Paris System for Reporting Urinary Cytology. Cancer Cytopathol 2019; 127:125-131. [DOI: 10.1002/cncy.22102] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Patrick J. McIntire
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Reema Khan
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Hamad Hussain
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Stefan E. Pambuccian
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Eva M. Wojcik
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Güliz A. Barkan
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
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Straccia P, Fadda G, Pierconti F. Comparison between cytospin and liquid-based cytology in cerebrospinal fluid diagnosis of neoplastic diseases: A single institution experience. Cytopathology 2018; 30:236-240. [PMID: 30468697 DOI: 10.1111/cyt.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/15/2018] [Accepted: 11/14/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The current tools available for detecting malignant neoplasms in the cerebrospinal fluid (CSF) are neurological examination, followed by neuroimaging, cytology and molecular techniques. To highlight the role of cytology the diagnosis of metastatic tumours in CSF samples, we present our experience using cytospin and ThinPrep liquid-based cytology. METHODS A retrospective analysis was conducted using the pathological records of 8181 cytological specimens of CSF, which were diagnosed over a 17-year period. Between 2000 and 2014, a total of 6994 CSF samples were processed using cytospin method and 1187 specimens were examined using ThinPrep method in the period between 2015 and 2017. RESULTS The most frequent metastatic neoplasm of the first period was non-Hodgkin lymphoma; in the second period the commonest malignancy found was brain tumour (glioblastoma and medulloblastoma). The samples processed by cytospin revealed cytolysis and haemorrhage, while the cases processed by ThinPrep had a clear background. Ten false-positive cases belonging to the suspicious category were processed by cytospin, while there was only one false positive case in the group processed by ThinPrep. The positive predictive value was 95% in cytospin and 100% in Thin Prep with comparable sensitivity, specificity, diagnostic accuracy and negative predictive values. CONCLUSIONS CSF cytology is a reliable technique for identifying malignancy in CSF. ThinPrep technology can be applied with good results in terms of clear background, cell enrichment, better nuclear details and high cellularity per slide.
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Affiliation(s)
- Patrizia Straccia
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Pierconti
- Division of Anatomic Pathology and Histology, Foundation "A. Gemelli" University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
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The Paris System: achievement of a standardized diagnostic reporting system for urine cytology. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mpdhp.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Pierconti F, Martini M, Straccia P, Fiorentino V, Musarra T, Larocca LM, Lopez-Beltran A. Hypochromatic large urothelial cells in urine cytology are indicative of high grade urothelial carcinoma. APMIS 2018; 126:705-709. [DOI: 10.1111/apm.12877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/20/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Francesco Pierconti
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Antonio Lopez-Beltran
- Faculty of Medicine; Unit of Anatomical Pathology; Cordoba University; Cordoba Spain
- The Champalimaud Clinical Center; Lisbon Portugal
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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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McIntire PJ, Snow JT, Robinson BD, Rao RA, Goyal A, Heymann JJ, Siddiqui MT. Improved correlation of urinary cytology specimens using The Paris System in biopsy-proven upper tract urothelial carcinomas. Cancer Cytopathol 2018; 126:498-504. [PMID: 29927548 DOI: 10.1002/cncy.22005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Urine cytology specimens are essential for screening and monitoring high-grade urothelial carcinomas. However, inconsistent reporting and equivocal diagnostic categories have remained a challenge. The Paris System for Reporting Urinary Cytology (TPS) was developed to provide clear cytomorphologic criteria for urine cytology specimens. Significant correlation between the surgical biopsy diagnosis (SD) and TPS diagnosis (PD) has been established in lower urothelial tract carcinomas, but to the authors' knowledge limited information is available regarding upper urinary tract carcinomas. METHODS A total of 56 cytology specimens from 35 patients within 90 days of an SD of upper urinary tract carcinoma were included. Cytology was re-reviewed and assigned a PD. The original diagnosis (OD) and PD were compared with the corresponding SD to determine which correlated best. RESULTS The PD corresponded to the SD in 35 of 56 cases (63%), which was greater than that for the OD and SD, which were concordant in 19 of 56 cases (34%). Both the OD and PD were concordant in 18 of 56 cases (32%), and neither corresponded in 20 of 56 cases (36%). A total of 27 of 33 cases of high-grade urothelial carcinoma/carcinoma in situ on SD (82%) were identified using the PD whereas only 15 cases (45%) were identified with the OD. The number of "atypical" diagnoses in the OD was reduced from 16 of 56 cases (29%) to 7 of 56 cases (13%) using the PD. Of the 14 of 56 "negative" OD (25%), only 4 remained after implementation of the PD. A diagnosis of low-grade urothelial neoplasm was established in 6 of 20 cases (30%) with the PD compared with 3 of 20 cases with the OD (15%). CONCLUSIONS The authors found that reclassification with TPS improved correlation with the SD compared with previous methodologies. Specifically, TPS increased the number of high-grade urothelial carcinoma diagnoses and decreased the number of equivocal or "atypical" diagnoses. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Justin T Snow
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Pierconti F, Rossi ED, Straccia P, Fadda G, Larocca LM, Bassi PF, Sacco E, Schinzari G. The risk of malignancy of atypical urothelial cells of undetermined significance in patients treated with chemohyperthermia or electromotive drug administration. Cancer Cytopathol 2018; 126:200-206. [DOI: 10.1002/cncy.21957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023]
Affiliation(s)
| | - Esther Diana Rossi
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | - Patrizia Straccia
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | - Guido Fadda
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | | | | | - Emilio Sacco
- Institute of Urology; Catholic University of the Sacred Heart; Rome Italy
| | - Giovanni Schinzari
- Institute of Oncology; Catholic University of the Sacred Heart; Rome Italy
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Lee OJ, Kang HW, Yun SJ. Urine Cytology and Urinary Biomarkers. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zheng X, Si Q, Du D, Harshan M, Zhang Z, Haines K, Shi W, Chhieng DC. The Paris System for urine cytology in upper tract urothelial specimens: A comparative analysis with biopsy and surgical resection. Cytopathology 2017; 29:184-188. [DOI: 10.1111/cyt.12505] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 01/08/2023]
Affiliation(s)
- X. Zheng
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Q. Si
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - D. Du
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Harshan
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Z. Zhang
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - K. Haines
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - W. Shi
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - D. C. Chhieng
- Department of Pathology; University of Washington; Seattle WA USA
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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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Toyonaga Y, Yamazaki K, Koyama Y, Yamada M, Ishida Y. A Modified Direct-Smear Processing Technique Employing Two-Step Centrifugation/Fixation Is Useful for Detecting High-Grade Urothelial Carcinoma. Acta Cytol 2017; 61:447-454. [PMID: 28954257 DOI: 10.1159/000480062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 08/08/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To demonstrate the usefulness of a direct-smear processing technique employing two-step centrifugation/fixation processing (TSCFP) in the cytoscreening of high-grade urothelial carcinoma (HGUC). STUDY DESIGN Using the T24 HGUC cell line, we compared the cell yield and the morphological preservation of preparations concurrently processed by direct-smear, SurePath, ThinPrep, and TSCFP techniques. A total of 287 urine cytology cases subjected to TSCFP over a period of 6 years were reviewed and reclassified according to the Paris System for Reporting Urinary Cytology (PSRUC) and correlated with histology results. RESULTS TSCFP of T24 cells demonstrated good cell yield with a recovery rate of about 70%. Diagnostic features of HGUC, such as a high nuclear/cytoplasmic ratio and irregular/hyperchromatic chromatin, were better discovered in TSCFP smears than in smears prepared with the other methods. Cytological evaluation of 287 voided urine specimens revealed that the rate of unsatisfactory preparations was quite low (0.30%) and the overall sensitivity, specificity, and positive and negative predictive values for urothelial carcinoma were 0.719, 0.923, 0.973, and 0.462, respectively. CONCLUSION TSCFP was able to provide adequate preparations for detecting HGUC in urine cytology and could be considered as a promising processing method according to the principal purpose of PSRUC.
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Affiliation(s)
- Yasuhiro Toyonaga
- Department of Surgical Pathology, Teikyo University, Chiba Medical Center, Ichihara, Japan
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Pierconti F, Straccia P, Emilio S, Bassi PF, De Pascalis I, Marques RC, Volavsek M, Larocca LM, Lopez-Beltran A. Cytological and histological changes in the urothelium produced by electromotive drug administration (EMDA) and by the combination of intravescical hyperthermia and chemotherapy (thermochemotherapy). Pathol Res Pract 2017; 213:1078-1081. [DOI: 10.1016/j.prp.2017.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/10/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
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