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Alsibai KD, Daste G, Ferlicot S, Fabre M, Steenkeste K, Salleron J, Hammoudi Y, Fontaine-Aupart MP, Eschwege P. Fluorescence Emitted by Papanicolaou-Stained Urothelial Cells Improves Sensitivity of Urinary Conventional Cytology for Detection of Urothelial Tumors. World J Oncol 2020; 11:204-215. [PMID: 33117464 PMCID: PMC7575278 DOI: 10.14740/wjon1305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/12/2020] [Indexed: 01/17/2023] Open
Abstract
Background Urinary conventional cytology (UCCy) is easy to perform, but its low sensitivity, especially for low-grade urothelial neoplasms (LGUNs), limits its indications in the management of patients at risk of bladder cancer. The authors aim at obtaining a complementary test that would effectively increase the sensitivity of UCCy on voided urines by analyzing fluorescence of Papanicolaou-stained urothelial cells with no change of method in slide preparation. Methods In this retrospective study of 155 patients, 91 Papanicolaou-stained voided urines were considered satisfactory under fluorescence microscopy (FMi). The results of FMi were compared with UCCy (using transmission microscopy) and correlated to cystoscopy, histology and follow-up data. Results The results are given for all patients and for two groups of them according to the patients’ main complaints (group 1: 33 patients followed up for a previously treated bladder tumor; group 2: 58 patients with persistent urinary symptoms). Overall negative predictive value (NPV) and sensitivity of FMi were 100% vs. 73.7% and 64.3% respectively for UCCy (P = 0.0001). Sensitivity of FMi for LGUN was unexpectedly high with a value of 100% vs. 46.2% for UCCy (P = 0.0002). FMi was significantly superior to UCCy for detecting urothelial tumors in every group of patients and would allow a better characterization of atypical urothelial cells (AUCs) defined by the Paris System for Reporting Urine Cytology (TPS). Conclusions Because of its sensitivity and NPV of 100%, FMi could complement UCCy to screen voided urines allowing a better detection of primary urothelial tumors or early recurrences of previously treated urothelial carcinoma. Moreover, this “dual screening” would allow completing efficiently cystoscopy to detect flat dysplasia, carcinoma in situ (CIS) and extra bladder carcinoma.
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Affiliation(s)
- Kinan Drak Alsibai
- Service d'Anatomie Pathologique, Centre des Ressources Biologiques, Centre Hospitalier de Cayenne, 97306 Cayenne Cedex, France.,These authors should be considered joint first authors
| | - Ghislaine Daste
- Centre de Pathologie Cellulaire et Moleculaire (CPCM-Labs), 31750 Escalquens, France.,These authors should be considered joint first authors
| | - Sophie Ferlicot
- Service d'Anatomo-Pathologie, Universite Paris-Sud, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, 94276 Le Kremlin-Bicetre Cedex, France
| | - Monique Fabre
- Service d'Anatomie Pathologique, Universite Paris-Descartes, Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, 75743 Paris Cedex, France
| | - Karine Steenkeste
- Institut des Sciences Moleculaires d'Orsay (ISMO), CNRS, Universite et Paris-Saclay, 91405 Orsay Cedex, France
| | - Julia Salleron
- Service de Biostatistiques, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France
| | - Yacine Hammoudi
- Service d'Urologie, Universite Paris-Sud, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, 94276 Le Kremlin-Bicetre Cedex, France
| | | | - Pascal Eschwege
- Service d'Urologie, Universite de Lorraine, CNRS UMR 7039 CRAN, Centre Hospitalier Regional Universitaire, 54035 Nancy Cedex, France
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Dutheil F, Rouanet L, Mulliez A, Naughton G, Fontana L, Druet-Cabanac M, Moustafa F, Chamoux A. Urine cytology screening of French workers exposed to occupational urinary tract carcinogens: a prospective cohort study over a 20-year period. BMJ Open 2017; 7:e016238. [PMID: 28939575 PMCID: PMC5623560 DOI: 10.1136/bmjopen-2017-016238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To demonstrate that urine cytology screening can provide relevant epidemiological data for earlier detection of urothelial cancer caused by occupational exposure. DESIGN Prospective cohort study. SETTING Industries using urothelial carcinogens in France. Urine samples were collected on site, after a work week and were analysed at the University Hospital of Clermont-Ferrand, France. PARTICIPANTS Participants were workers exposed to urothelial carcinogens. Women and current smokers at time of study recruitment were exclusion criteria. OUTCOMES Urine cells atypia were ranged into three classes: negative/normal, atypical/suspicious/dysplasia or positive/malignant. RESULTS We included 2020 workers over a period of 20 years from 1993 to 2013: 606 worked in rubber manufacturing, 692 from metal processing, 245 in chemical industry and 477 in roadwork and building industry. Workers had a mean exposure of 15.2±10.4 years before their first urine cytology screening. There was a mean of 3.4±4.3 urine cytology screenings per worker between 1993 and 2013. 6478 cytology were normal, 462 suspicious and 13 malignant. Suspicious and malignant cytology occurred in 4.8% of workers exposed for 1-10 years, 6.2% for 11-20 years of exposure, 7.6% for 21-30 years and 8.6% for >30 years (p<0.001). Using exposure for 1-10 years as reference, the adjusted OR of receiving a suspicious or malignant diagnosis increased with duration of exposure: OR=1.50 (95% CI 1.10 to 2.05, p=0.01) for 21-30 years and OR=1.78 (95% CI 1.23 to 2.56, p=0.002) for >30 years of exposure. Using metal processing as reference, the risk of pathological urine cytology results increased for rubber manufacturing (OR=1.32, 95% CI 1.05 to 1.65, p=0.02), with a trend for roadwork and building industry (OR=1.39, 95% CI 0.98 to 1.97, p=0.07) and for chemical industry (OR=1.34, 95% CI 0.94 to 1.93, p=0.11). CONCLUSIONS Urine cytology is a useful tool in occupational medicine. We promote new guidelines with an early screening of urothelial cancer by cytology, starting with beginning of exposure.
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Affiliation(s)
- Frederic Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, Clermont-Ferrand, France
- Faculty of Health, Australian Catholic University, Melbourne, Victoria, Australia
| | - Lucile Rouanet
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand, CHU-Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Clinical Research Direction, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | | | - Luc Fontana
- Faculty of Medicine Jacques-Lisfranc, University Jean-Monnet, Saint-Etienne, France
- Department of Preventive and Occupational Medicine, University Hospital of Saint-Etienne, CHU Saint-Etienne, Saint-Etienne, France
- UMR T9405, UMRESTTE (IFSTTAR-UCBL), University Lyon 1, Domaine Rockefeller, Lyon, France
| | - Michel Druet-Cabanac
- CNRS 3503 GEIST, INSERM UMR s1094, Tropical Neuroepidemiology, University Hospital of Limoges, CHU Limoges, Preventive and Occupational Medicine, Limoges, France
| | - Farès Moustafa
- Emergency Department, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
| | - Alain Chamoux
- Department of Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand, CHU-Clermont-Ferrand, Clermont-Ferrand, France
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Roy M, Kaushal S, Jain D, Seth A, Iyer VK, Mathur SR. An institutional experience with The Paris System: A paradigm shift from ambiguous terminology to more objective criteria for reporting urine cytology. Cytopathology 2017; 28:509-515. [DOI: 10.1111/cyt.12448] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 01/02/2023]
Affiliation(s)
- M. Roy
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. Kaushal
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - D. Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - A. Seth
- Department of Urology; All India Institute of Medical Sciences; New Delhi India
| | - V. K. Iyer
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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Hassan M, Solanki S, Kassouf W, Kanber Y, Caglar D, Auger M, Brimo F. Impact of Implementing the Paris System for Reporting Urine Cytology in the Performance of Urine Cytology: A Correlative Study of 124 Cases. Am J Clin Pathol 2016; 146:384-90. [PMID: 27543983 DOI: 10.1093/ajcp/aqw127] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We assessed the performance of urine cytology using the Paris System for Reporting Urine Cytology (PSRUC) in comparison to our current system. METHODS In total, 124 specimens with histologic correlation were reviewed and assigned to the PSRUC categories: benign, atypical urothelial cells (AUCs), suspicious for high-grade urothelial carcinoma (SHGUC), and high-grade urothelial carcinoma (HGUC). Original cytological diagnoses were recorded. RESULTS Fewer cases were given an AUC diagnosis using the PSRUC in comparison to the original diagnoses (26% vs 39%), while the association of AUCs with subsequent HGUC increased from 33% to 53% with the PSRUC. Using the PSRUC resulted in a higher number of low-grade carcinomas assigned to the benign (40%) rather than the AUC (22%) category. The performance of SHGUC/HGUC diagnoses was similar in both systems (predictive value = 94%). CONCLUSIONS The PSRUC seems to improve the performance of urine cytology by limiting the AUC category to cases that are more strongly associated with HGUC.
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Affiliation(s)
| | - Sharaddha Solanki
- Department of Urology, McGill University and McGill University Health Center, Montreal, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University and McGill University Health Center, Montreal, Canada
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The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology. Adv Anat Pathol 2016; 23:193-201. [PMID: 27233050 DOI: 10.1097/pap.0000000000000118] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The main purpose of urine cytology is to detect high-grade urothelial carcinoma. With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of high-grade urothelial carcinoma. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. TPS Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.
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Barkan GA, Wojcik EM, Nayar R, Savic-Prince S, Quek ML, Kurtycz DFI, Rosenthal DL. The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology. Acta Cytol 2016; 60:185-97. [PMID: 27318895 DOI: 10.1159/000446270] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The main purpose of urine cytology is to detect high-grade urothelial carcinoma (HGUC). With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. The Paris System Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and the limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.
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Affiliation(s)
- Güliz A Barkan
- Department of Pathology, Loyola University Healthcare System, Maywood, Ill., USA
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Barkan GA, Wojcik EM, Nayar R, Savic-Prince S, Quek ML, Kurtycz DFI, Rosenthal DL. The Paris System for Reporting Urinary Cytology: the quest to develop a standardized terminology. J Am Soc Cytopathol 2016; 5:177-188. [PMID: 31042521 DOI: 10.1016/j.jasc.2016.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The main purpose of urine cytology is to detect high-grade urothelial carcinoma (HGUC). With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. The Paris System Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and the limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.
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Affiliation(s)
- Güliz A Barkan
- Department of Pathology, Loyola University Healthcare System, 2160 S. First Ave, Building 110, Room 2238, Maywood, Illinois, 60153.
| | - Eva M Wojcik
- Department of Pathology, Loyola University Healthcare System, 2160 S. First Ave, Building 110, Room 2238, Maywood, Illinois, 60153
| | - Ritu Nayar
- Department of Pathology, Northwestern Memorial Hospital, Chicago Illinois
| | | | - Marcus L Quek
- Department of Urology, Loyola University Health Systems, Maywood, Illinois
| | - Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Shimada K, Fujii T, Tatsumi Y, Anai S, Fujimoto K, Konishi N. Ubiquilin2 as a novel marker for detection of urothelial carcinoma cells in urine. Diagn Cytopathol 2015; 44:3-9. [PMID: 26303000 DOI: 10.1002/dc.23332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/23/2015] [Accepted: 08/05/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ubiquilin 2 (UBQLN2), an ubiquitin-related protein, is strongly expressed in urothelial carcinoma cells, in contrast to no or less expression in non-neoplastic cells; it protects cancer cells from reactive oxygen species (ROS)-induced cytotoxicity. In this study, we investigated whether UBQLN2 immunostaining, using liquid-based cytology sample could improve the accuracy of cytological urine diagnosis. METHODS Two-hundred and forty-five urinary samples, including 143 negative controls and 102 urothelial carcinomas, consisting of 42 low-grade and 60 high-grade urothelial carcinomas, were used for immunocytochemical analysis of UBQLN2. RESULTS Urothelial carcinoma cells were positive for UBQLN2-staining, while non-neoplastic cells, including renal tubular cells and degenerative atypical cells, were negative. Interestingly, percentage of nuclear stain immunopositive for UBQLN2 was significantly higher in carcinoma cells with high grade/invasive phenotype than in those with low grade/noninvasive phenotype. UBQLN2 immunostaining had an overall sensitivity of 87.6%, specificity of 98.6%, positive predictive value of 97.8% and negative predictive value of 92.8% for the detection of urothelial carcinoma. CONCLUSIONS UBQLN2 immunostaining is a practical test for urine cytology, even in samples with few cells, with slight atypia or severe degenerative changes. In addition, it allows prediction of tumor grade and stage by examining the cellular localization of UBQLN2.
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Affiliation(s)
- Keiji Shimada
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara City, Nara, 634-8521, Japan
| | - Tomomi Fujii
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara City, Nara, 634-8521, Japan
| | - Yoshihiro Tatsumi
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara City, Nara, 634-8521, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara City, Nara, 634-8521, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara City, Nara, 634-8521, Japan
| | - Noboru Konishi
- Department of Pathology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara City, Nara, 634-8521, Japan
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Morency E, Antic T. Atypical urine cytology and the Johns Hopkins Hospital template: the University of Chicago experience. J Am Soc Cytopathol 2014; 3:295-302. [PMID: 31051719 DOI: 10.1016/j.jasc.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/24/2014] [Accepted: 06/27/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The rate of atypical diagnoses in urine cytology can be high depending on the screening population. Unlike thyroid and cervical cytology, there is a lack of standardized criteria to stratify them into more clinically meaningful categories. MATERIALS AND METHODS A set of diagnostic criteria described by Johns Hopkins Hospital (JHH) provided a tool to divide atypical urine specimens into those that were low risk and those likely to be predictive of high-grade urothelial carcinoma (HGUC). In this study, the JHH template was applied to a cohort of atypical urine cytology specimens from the University of Chicago (U of C) to compare it to existing U of C terminology and determine whether it should be formally adopted. RESULTS Sixty-eight percent of patients classified as atypical urothelial cells, favor high-grade lesion (AUC-H) were diagnosed with HGUC during the study. Correlation was noted between the JHH diagnostic categories and the U of C diagnostic categories, with 49% of patients reclassified as AUC-H being diagnosed with atypical urothelial cells, suspicious for neoplasia and 83% of cases of patients reclassified as atypical urothelial cells of unknown significance being diagnosed as atypical, urothelial cells. The JHH category of AUC-H had a higher positive predictive value for HGUC than the U of C category atypical urothelial cells, suspicious for neoplasm did (69% versus 58%, p = 0.0087). Unlike the JHH study, AUC-H showed higher correlation with HGUC in the hematuria group (90%) than in the surveillance group (66%). CONCLUSIONS JHH criteria demonstrated a higher rate of predicting HGUC than U of C diagnostic categories, supporting the adoption of these criteria at U of C.
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Affiliation(s)
- Elizabeth Morency
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois.
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois
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Ton Nu TN, Kassouf W, Ahmadi-Kaliji B, Charbonneau M, Auger M, Brimo F. The value of the “suspicious for urothelial carcinoma” cytology category: A correlative study of 4 years including 337 patients. Cancer Cytopathol 2014; 122:796-803. [DOI: 10.1002/cncy.21449] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Tuyet Nhung Ton Nu
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Wassim Kassouf
- Department of Urology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Babak Ahmadi-Kaliji
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Michele Charbonneau
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Manon Auger
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
| | - Fadi Brimo
- Department of Pathology; McGill University Health Center and McGill University; Montreal Quebec Canada
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Barasch S, Choi M, Stewart J, Das K. Significance of atypical category in voided urine specimens prepared by liquid-based technology: Experience of a single institution. J Am Soc Cytopathol 2014; 3:118-125. [PMID: 31051734 DOI: 10.1016/j.jasc.2013.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/16/2013] [Accepted: 10/07/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the clinical significance of atypical cytology in voided urine samples. We also studied any differences in outcome that may exist between the patients being surveyed versus high risk for urothelial carcinoma (UC). MATERIALS AND METHODS This was a retrospective study of all voided urine specimens with "atypical" cytology over a 10-year period. The patients were categorized into those with and without a prior diagnosis of UC as the "surveillance" and "de novo" (DG) groups. Follow-up was obtained. Clinical impact and outcomes of the 2 groups were compared. RESULTS In this study, 5.7% of voided urine specimens were atypical. Mean age of patients in years, male/female ratio, and time to diagnosis in days was 59 versus 71, 23:15 versus 22:1, and 95 versus 43 in the DG and surveillance group, respectively. Rate of progression to UC was similar in both groups. High-grade UC was significantly higher in the DG. CONCLUSIONS Approximately 20% of patients in the DG were subsequently diagnosed with UC. The common causes for the atypical diagnosis that did not progress to UC were stones and benign prostatic hyperplasia. In the absence of an etiology for the atypia, further investigations are warranted.
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Affiliation(s)
- Samuel Barasch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Michael Choi
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jimmie Stewart
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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Piaton E, Carré C, Advenier AS, Decaussin-Petrucci M, Mège-Lechevallier F, Lantier P, Granier G, Ruffion A. p16 INK4a overexpression and p16/Ki-67 dual labeling versus conventional urinary cytology in the evaluation of urothelial carcinoma. Cancer Cytopathol 2013; 122:211-20. [PMID: 24302621 DOI: 10.1002/cncy.21376] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 10/18/2013] [Accepted: 10/23/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Taking into consideration the known overexpression of p16(INK4a) in histologically demonstrated high-grade urothelial malignancies, the objective of the current study was to examine the value of p16(INK4a) overexpression and of p16/Ki-67 dual labeling versus urinary cytology in the detection of urothelial lesions. METHODS Immunolabeling was performed on demounted and destained Papanicolaou slides after liquid-based ThinPrep processing. Actual diagnoses were ascertained by cystoscopy controls and histopathology. Negative cases, papillary urothelial neoplasia of low malignant potential/low-grade tumor, and high-grade lesions were considered separately. RESULTS A total of 216 urine samples were collected from new patients with symptoms who were referred for cystoscopy (92 cases) or patients who were being followed after conservative treatment for lesions involving the bladder (117 cases) or the upper urinary tract (7 cases). p16(INK4a) positivity was assessed in 171 of the 216 cases (79.2%) and in 93 of 99 high-grade cases with positive cytology (93.9%). Coexpression of p16/Ki-67 in the same cells was observed in 119 of 216 cases (55.1%) and was noted in 18 of 51 cases of negative or papillary urothelial neoplasia of low malignant potential/low-grade tumor (35.3%) and in 80 of 101 high-grade tumors (79.2%) (P < .0001). Thirteen of 14 high-grade intraurothelial lesions (92.8%) were dual labeled. When high-grade tumors, disease progression (increased grade, muscle infiltration, and extension into the upper urinary tract), and cancer-related death were grouped together as an endpoint, dual labeling demonstrated a sensitivity that was slightly higher than that of urinary cytology (82.5% vs 80.8%; P = .8), with 94.9% overall specificity. CONCLUSIONS When applied to the search for high-grade and aggressive disease, p16/Ki-67 dual labeling and urinary cytology appear to demonstrate comparable performance.
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Affiliation(s)
- Eric Piaton
- Hospices Civils de Lyon, Centre de Biologie et Pathologie Est, Hôpital Femme-Mère-Enfant, Lyon Bron, France; Université Claude Bernard Lyon 1, Lyon, France
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13
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Muus Ubago J, Mehta V, Wojcik EM, Barkan GA. Evaluation of atypical urine cytology progression to malignancy. Cancer Cytopathol 2013; 121:387-91. [PMID: 23536358 DOI: 10.1002/cncy.21278] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/12/2012] [Accepted: 12/07/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND In urine cytology, the diagnosis of atypia is subjective and clinical management based on these results can be difficult to determine. In this study, the authors determined the percentage of atypical urine diagnoses that progressed to positive cytology or surgical pathology results over an 11-year period. METHODS In a retrospective review of the authors' institution, 1320 atypical urine cytology diagnoses were identified in specimens from 851 patients obtained from January 2000 through December 2010. All subsequent pathology reports were reviewed to determine which patients developed positive cytology/surgical pathology diagnoses. In total, 4106 cytology and surgical pathology specimen reports were reviewed. RESULTS At the authors' institution, 1320 of 16,299 of urine cytology specimens (8.1%) were diagnosed as atypical during the 11-year period. Overall, 271 of 1320 initial atypical urine specimens (21%) progressed to positive cytology or surgical pathology results with a mean time to progression of 155 days. Of the cases that progressed to malignancy, 118 were high-grade urothelial carcinoma and 92 were low-grade urothelial carcinoma. CONCLUSIONS The rate of atypia in urine specimens at this institution was 8.1%. Of the specimen types, atypia was the most common in urinary diversion specimens (16%) and the least common in upper tract cytology (3.8%). When diagnosed as atypical, upper tract specimens had the highest percentage of progression to high-grade carcinoma. Therefore, the authors concluded that the diagnosis of atypia in this specimen group has higher clinical significance and should be managed more aggressively. Cancer (Cancer Cytopathol) 2013;121:387-391. © 2013 American Cancer Society.
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Affiliation(s)
- Julianne Muus Ubago
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
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Piaton E, Decaussin-Petrucci M, Mege-Lechevallier F, Advenier AS, Devonec M, Ruffion A. Diagnostic terminology for urinary cytology reports including the new subcategories ‘atypical urothelial cells of undetermined significance’ (AUC-US) and ‘cannot exclude high grade’ (AUC-H). Cytopathology 2013; 25:27-38. [DOI: 10.1111/cyt.12050] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 12/31/2022]
Affiliation(s)
- E. Piaton
- Hospices Civils de Lyon; Centre de Pathologie Est; Hôpital Femme-Mère-Enfant; Bron France
- Université Claude Bernard Lyon 1; Lyon France
| | - M. Decaussin-Petrucci
- Université Claude Bernard Lyon 1; Lyon France
- Centre de Pathologie Sud; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - F. Mege-Lechevallier
- Université Claude Bernard Lyon 1; Lyon France
- Service d'Anatomie et Cytologie Pathologiques; Hôpital Edouard Herriot; Lyon France
| | - A.-S. Advenier
- Hospices Civils de Lyon; Centre de Pathologie Est; Hôpital Femme-Mère-Enfant; Bron France
| | - M. Devonec
- Université Claude Bernard Lyon 1; Lyon France
- Service d'Urologie; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - A. Ruffion
- Université Claude Bernard Lyon 1; Lyon France
- Service d'Urologie; Centre Hospitalier Lyon Sud; Pierre Bénite France
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Piaton E, Bubendorf L. L’hybridation in situ en fluorescence (FISH) utilisant le kit multisonde UroVysion® dans les cytologies urinaires atypiques. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bubendorf L, Piaton E. UroVysion® multiprobe FISH in the triage of equivocal urinary cytology cases. Ann Pathol 2012; 32:e52-6, 438-43. [PMID: 23244486 DOI: 10.1016/j.annpat.2012.09.207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/13/2012] [Indexed: 11/15/2022]
Abstract
The search for biological and clinical significance of equivocal urinary cytology has emerged as the most promising application of fluorescence in situ hybridization (FISH). Using the multiprobe UroVysion(®) assay, a negative FISH result in the presence of atypical urothelial cells favors the presence of reactive, benign alterations and helps to avoid unnecessary invasive procedures. However, a negative FISH result in case of a negative or equivocal cytology does not exclude low-grade urothelial neoplasia. Equivocal findings are a notorious problem after conservative treatment, particularly after BCG immunotherapy of carcinoma in situ, where even benign reactive changes can appear worrisome. In this situation, a positive FISH result in spite of non-high grade cytology independently indicates persistent or recurrent urothelial carcinoma. However, chromosomal abnormalities are not restricted to malignancy but may also occur in benign cells. Tetraploidy with a balanced duplication of the whole genome, or polyploidy can occur in non-neoplastic conditions of the bladder such as Decoy cells, radiotherapy-induced changes and urolithiasis. Thus, a positive FISH result in a patient with a history of pelvic irradiation does not prove cancer unless there is unequivocal 9p21 deletion. Recent studies show that an aggressive workup of patients with a suspicious cytology+positive UroVysion(®) result and negative cystoscopy is not currently justified. However, multi-target UroVysion(®) FISH remains an excellent tool to improve diagnosis in urinary cytopathology, provided that FISH results are interpreted in the light of the clinical situation, and that one reminds that FISH adds no diagnostic value in case of clearly positive, high-grade cytology.
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Affiliation(s)
- Lukas Bubendorf
- Institute for Pathology, University Hospital Basel/University of Basel, Schönbeinstrasse 40, 4031 Basel, Switzerland.
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Piaton E, Advenier AS, Carré C, Decaussin-Petrucci M, Mege-Lechevallier F, Ruffion A. p16INK4a/Ki-67 dual labelling as a marker for the presence of high-grade cancer cells or disease progression in urinary cytopathology. Cytopathology 2012; 24:327-34. [DOI: 10.1111/j.1365-2303.2012.01008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Options for histological study of the structure and ultrastructure of human urinary bladder epithelium. Biologia (Bratisl) 2012. [DOI: 10.2478/s11756-012-0090-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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