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Giudici N, Schoch A, Genitsch V, Rodriguez-Calero A, Thalmann GN, Seiler R. A 2-center review of histopathology of variants of upper urinary tract urothelial carcinoma and their impact on clinical outcomes. Urol Oncol 2024:S1078-1439(24)00463-0. [PMID: 38942714 DOI: 10.1016/j.urolonc.2024.05.005] [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: 11/20/2023] [Revised: 04/11/2024] [Accepted: 05/10/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Similar to bladder cancer, about one third of upper tract urothelial carcinoma (UTUC) present variant histology (VH). We aim to evaluate the incidence, clinical characteristics and the impact on outcomes of VH in UTUC. METHODS We consecutively enrolled 77 patients treated between 2009 and 2022 by radical surgery for UTUC from a secondary and a tertiary referral center. A pathology review of all specimens was performed by 1 independent uropathologist for each center. We compared pure UTUC and UTUC with VH and the accuracy of endoscopic biopsy. Descriptive and comparative analysis was performed to assess the association with clinical characteristics and the Kaplan-Meier estimator to compare outcomes. RESULTS Median follow-up after surgery was 51 months. VH was present in 21/77 (28%) patients and 4/21 (19%) patients had multiple variants. The most frequent VH was squamous 12/21 (57%), followed by glandular 7/21 (33%) and micropapillary 3/21 variants (14%). Neuroendocrine carcinoma was present in 2 patients. Nested variant was found in 1 patient. Muscle invasive tumor (≥pT2) was present in 30/56 (54%) patients with pure UTUC and in 18/21 (86%) patients with VH (P < 0.05). Presence of carcinoma in situ was seen in 24/56 (43%) patients with pure UTUC and in 16/21 (76%) with VH (P < 0.05). Cumulative 8/56 (14%) with pure UTUC had a nonintravesical recurrence (6 patients with local and 2 distant recurrence) compared to 8/21 (38%) (3 local, 3 nodal, 2 distant) in the subgroup with VH (P < 0.05). Opposite effect was noted for bladder recurrence: 60% for pure UTUC vs. 29% for tumors with VH (P < 0.05). Review of preoperative endoscopic biopsy did not show the presence of VH in any patients. Differences in outcomes did not reach significance: 3yr-OS 63% vs. 42% (P 0.28) and 3yr-CSS 77% vs. 50% (P 0.7). CONCLUSION Almost a third of UTUC present VH. Presence of VH is related to more aggressive tumor characteristics and associated with unfavorable outcomes. Due to a higher rate of extravesical recurrences in UTUC with VH, Follow-up controls should include cross sectional imaging and cystoscopy.
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Affiliation(s)
- N Giudici
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Urology, Spitalzentrum Biel, Biel, Switzerland.
| | - A Schoch
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute for Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - V Genitsch
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Rodriguez-Calero
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Institute for Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - G N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - R Seiler
- Department of Urology, Spitalzentrum Biel, Biel, Switzerland
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Wolff I, Kravchuk AP, Wirtz RM, Schlomm T, Rabien A, Rong D, Hofbauer SL, Labonté FK, Barski D, Otto T, Gössl A, Brookman-May SD, Gilfrich CP, Ecke TH, May M. Real-world performance of Uromonitor® in urothelial bladder cancer detection: a multicentric trial. BJU Int 2024. [PMID: 38923777 DOI: 10.1111/bju.16450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To compare Uromonitor® (U-Monitor Lda, Porto, Portugal), a multitarget DNA assay that detects mutated proto-oncogenes (telomerase reverse transcriptase [TERT], fibroblast growth factor receptor 3 [FGFR-3], Kirsten rat sarcoma viral oncogene homologue [KRAS]), with urine cytology in the urine-based diagnosis of urothelial carcinoma of the bladder (UCB) within a multicentre real-world setting. PATIENTS AND METHODS This multicentre, prospective, double-blind study was conducted across four German urological centres from 2019 to 2024. We evaluated the diagnostic performance of Uromonitor compared to urine cytology in a cohort of patients with UCB and in healthy controls within a real-world setting. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and accuracy of the tests were measured, in addition to multivariate analyses to assess the ability of individual proto-oncogene mutations in detecting UCB. The biometric sample size was designed to achieve a 10% difference in sensitivity. RESULTS Patients with UCB comprised 63.7% (339/532) of the study group. Uromonitor showed a sensitivity, specificity, PPV, NPV, accuracy, and an area-under-the-curve of 49.3%, 93.3%, 92.8%, 51.1%, 65.2%, and 0.713%, respectively. These metrics did not demonstrate statistical superiority over urine cytology in terms of sensitivity (44.6%; P = 0.316). Moreover, the comparison of additional test parameters, as well as the comparison within various sensitivity analyses, yielded no significant disparity between the two urinary tests. Multivariate logistic regression underscored the significant predictive value of a positive Uromonitor for detecting UCB (odds ratio [OR] 9.03; P < 0.001). Furthermore, mutations in TERT and FGFR-3 were independently associated with high odds of UCB detection (OR 13.30 and 7.04, respectively), while KRAS mutations did not exhibit predictive capability. CONCLUSION Despite its innovative approach, Uromonitor fell short of confirming the superior results anticipated from previous studies in this real-world setting. The search for an optimal urine-based biomarker for detecting and monitoring UCB remains ongoing. Results from this study highlight the complexity of developing non-invasive diagnostic tools and emphasise the importance of continued research efforts to refine these technologies.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Anton P Kravchuk
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Rabien
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dezhi Rong
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian L Hofbauer
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora K Labonté
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dimitri Barski
- Department of Urology, Rheinland Clinic Neuss, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Clinic Neuss, Neuss, Germany
- Medical School, University of Duisburg-Essen, Essen, Germany
| | - Andreas Gössl
- Department of Urology, Rheinland Clinic Neuss, Neuss, Germany
| | - Sabine D Brookman-May
- Department of Urology, University of Munich, LMU, Munich, Germany
- Johnson and Johnson Innovative Medicine, Research & Development, Spring House, PA, USA
| | - Christian P Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Thorsten H Ecke
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
- Teaching Hospital of the University Clinic Regensburg, Chair of Urology at the Caritas St. Josef Medical Center, Regensburg, Germany
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Lacoste-Collin L. [What contribution can make artificial intelligence to urinary cytology?]. Ann Pathol 2024; 44:195-203. [PMID: 38614871 DOI: 10.1016/j.annpat.2024.03.003] [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: 12/11/2023] [Revised: 01/30/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
Urinary cytology using the Paris system is still the method of choice for screening high-grade urothelial carcinomas. However, the use of the objective criteria described in this terminology shows a lack of inter- and intra-observer reproducibility. Moreover, if its sensitivity is excellent on instrumented urine, it remains insufficient on voided urine samples. Urinary cytology appears to be an excellent model for the application of artificial intelligence to improve performance, since the objective criteria of the Paris system are defined at cellular level, and the resulting diagnostic approach is presented in a highly "algorithmic" way. Nevertheless, there is no commercially available morphological diagnostic aid, and very few predictive devices are still undergoing clinical validation. The analysis of different systems using artificial intelligence in urinary cytology rises clear prospects for mutual contributions.
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Christofidis K, Theochari M, Mavropoulos Papoudas S, Kiohou L, Sousouris S, Dimitriadou A, Volakakis N, Maounis N, Mikou P. Optimal Volume Assessment for Serous Fluid Cytology. Biomedicines 2024; 12:899. [PMID: 38672252 PMCID: PMC11048718 DOI: 10.3390/biomedicines12040899] [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: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the optimal volume of serous fluid needed for accurate diagnosis using The International System for Reporting Serous Fluid Cytopathology (TIS), as well as to provide information on the distribution of serous effusion cases in the TIS categories (ND: non-diagnostic, NFM: negative for malignancy, AUS: atypia of undetermined significance, SFM: suspicious for malignancy, MAL: malignant) and relevant epidemiological data. METHODS A retrospective analysis of 2340 serous effusion cases (pleural, peritoneal, and pericardial) from two hospitals between 2018 and 2020 was conducted. TIS categories were assigned to each case, and for 1181 cases, these were correlated with the volume of the analyzed fluid. RESULTS Our study found statistically significant differences in volume distributions between certain TIS categories. Statistically lower volumes were observed in NFM compared to MAL, in UNCERTAIN (ND, AUS, SFM) compared to both MAL and NFM, and in NOT MAL (ND, NFM, AUS, SFM) compared to MAL. However, these differences were not substantial enough to hold any clinical relevance. CONCLUSIONS This study suggests that while fluid volume may slightly influence the TIS category, it does not impact the diagnostic accuracy of serous effusion cytology. Therefore, the ideal serous effusion specimen volume can be defined solely by practical parameters.
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Affiliation(s)
| | - Maria Theochari
- Oncology Unit, “Hippokration” General Hospital of Athens, 11527 Athens, Greece
| | | | - Lamprini Kiohou
- Cytopathology Laboratory, “Sismanoglio-Amalia Fleming” General Hospital of Athens, 15127 Athens, Greece
| | - Stylianos Sousouris
- Cytopathology Laboratory, “Laiko” General Hospital of Athens, 11527 Athens, Greece
| | - Areti Dimitriadou
- Oncology Unit, “Hippokration” General Hospital of Athens, 11527 Athens, Greece
| | - Nikolaos Volakakis
- Oncology Unit, “Hippokration” General Hospital of Athens, 11527 Athens, Greece
| | - Nicoletta Maounis
- Cytopathology Laboratory, “Sismanoglio-Amalia Fleming” General Hospital of Athens, 15127 Athens, Greece
| | - Panagiota Mikou
- Cytopathology Laboratory, “Laiko” General Hospital of Athens, 11527 Athens, Greece
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Tsuji K, Kaneko M, Harada Y, Fujihara A, Ueno K, Nakanishi M, Konishi E, Takamatsu T, Horiguchi G, Teramukai S, Ito-Ihara T, Ukimura O. A Fully Automated Artificial Intelligence System to Assist Pathologists' Diagnosis to Predict Histologically High-grade Urothelial Carcinoma from Digitized Urine Cytology Slides Using Deep Learning. Eur Urol Oncol 2024; 7:258-265. [PMID: 38065702 DOI: 10.1016/j.euo.2023.11.009] [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: 07/10/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Urine cytology, although a useful screening method for urothelial carcinoma, lacks sensitivity. As an emerging technology, artificial intelligence (AI) improved image analysis accuracy significantly. OBJECTIVE To develop a fully automated AI system to assist pathologists in the histological prediction of high-grade urothelial carcinoma (HGUC) from digitized urine cytology slides. DESIGN, SETTING, AND PARTICIPANTS We digitized 535 consecutive urine cytology slides for AI use. Among these slides, 181 were used for AI development, 39 were used as AI test data to identify HGUC by cell-level classification, and 315 were used as AI test data for slide-level classification. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Out of the 315 slides, 171 were collected immediately prior to bladder biopsy or transurethral resection of bladder tumor, and then outcomes were compared with the histological presence of HGUC in the surgical specimen. The primary aim was to compare AI prediction of the histological presence of HGUC with the pathologist's histological diagnosis of HGUC. Secondary aims were to compare the time required for AI evaluation and concordance between the AI's classification and pathologist's cytology diagnosis. RESULTS AND LIMITATIONS The AI capability for predicting the histological presence of HGUC was 0.78 for the area under the curve. Comparing the AI predictive performance with pathologists' diagnosis, the AI sensitivity of 63% for histological HGUC prediction was superior to a pathologists' cytology sensitivity of 46% (p = 0.0037). On the contrary, there was no significant difference between the AI specificity of 83% and pathologists' specificity of 89% (p = 0.13), and AI accuracy of 74% and pathologists' accuracy of 68% (p = 0.08). The time required for AI evaluation was 139 s. With respect to the concordance between the AI prediction and pathologist's cytology diagnosis, the accuracy was 86%. Agreements with positive and negative findings were 92% and 84%, respectively. CONCLUSIONS We developed a fully automated AI system to assist pathologists' histological diagnosis of HGUC using digitized slides. This AI system showed significantly higher sensitivity than a board-certified cytopathologist and may assist pathologists in making urine cytology diagnoses, reducing their workload. PATIENT SUMMARY In this study, we present a deep learning-based artificial intelligence (AI) system that classifies urine cytology slides according to the Paris system. An automated AI system was developed and validated with 535 consecutive urine cytology slides. The AI predicted histological high-grade urothelial carcinoma from digitized urine cytology slides with superior sensitivity than pathologists, while maintaining comparable specificity and accuracy.
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Affiliation(s)
- Keisuke Tsuji
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatomo Kaneko
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuki Harada
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kengo Ueno
- KYOCERA Communication Systems Co., Ltd, Kyoto, Japan
| | | | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuro Takamatsu
- Department of Medical Photonics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Go Horiguchi
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiko Ito-Ihara
- Department of Clinical and Translational Research Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Kannan N, Gochhait D, Ramanitharan M, Siddaraju N. A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update. Diagn Cytopathol 2024; 52:187-199. [PMID: 38164657 DOI: 10.1002/dc.25269] [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: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Owing to certain inherent limitations of earlier reporting systems, "The Paris System for Reporting Urinary Cytology (TPS)" was implemented in 2015 to standardize reporting urine cytology with more stringent cytomorphologic criteria. We share our post-TPS experience, comparing it with the conventional system (CS). AIM To assess and compare the cyto-histopathologic/cystoscopic agreement between the conventional and the Paris systems (CS and TPS) for reporting urine cytology. MATERIALS AND METHODS It is a cross-sectional study involving urine samples from 170 patients divided into two groups (CS and TPS). Of the 170 cases, 85 were reported according to the CS, and 85 were reported according to TPS with all the relevant clinical, radiologic, and cystoscopic findings. Using the kappa statistics, both groups were statistically analyzed for sensitivity, specificity, predictive values, and agreement. RESULTS The sensitivity and specificity for high-grade urothelial carcinoma (HGUC) as per TPS were 83.33% and 94.59%, respectively, while they were 73.47% and 80.56% for the conventional system. The agreement for HGUC with TPS was 87.06% with a kappa value of 0.7416, while it was 76.5% with a kappa value of 0.53 for the CS. Implementing the TPS minimized usage of the atypical urothelial cells (AUC) category, increasing the clarity in detecting HGUC. CONCLUSION TPS provides better agreement with histopathology than the CS for diagnosing HGUC, which is attributable to stringent TPS criteria that prompt cytopathologists to look more diligently for morphologic and numeric criteria.
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Affiliation(s)
- Narasimhapriyan Kannan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Manikandan Ramanitharan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Khajir G, Sun T, Wang H, Sprenkle PC, Adeniran AJ, Cai G, Levi AW. Cytologic evaluation of upper urinary tract specimens: An institutional retrospective study using The Paris System for Reporting Urine Cytology second edition with histopathologic follow-up. Cytopathology 2024; 35:235-241. [PMID: 37916579 DOI: 10.1111/cyt.13328] [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: 07/07/2023] [Revised: 08/30/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Cytologic evaluation of the upper urinary tract (UUT) can be challenging due to instrumentation artefacts. This study retrospectively reviewed UUT specimens using The Paris System for Reporting Urinary Cytopathology, second edition (TPS 2.0), compared it with the original reporting system (ORS) and correlated it with histopathologic follow-up. METHODS An institutional database was reviewed for the UUT biopsy/resection histopathologic specimens, and we included 52 UUT cytology specimens pertinent to these cases in the study. These specimens were blindly reviewed and reclassified using TPS 2.0. The correlation between TPS 2.0, ORS and histopathologic follow-up was assessed. RESULTS The UUT cytology specimens corresponded to 21 (40.4%) high-grade urothelial carcinoma (HGUC), 27 (51.9%) low-grade urothelial carcinoma (LGUC) and 4 (7.7%) benign cases on follow-up. For HGGC cases, the associated TPS categories included unsatisfactory (n = 1, 4.8%), negative for HGUC (NHGUC; n = 3, 14.3%), atypical urothelial cells (AUC; n = 6, 28.6%), suspicious for HGUC (SHGUC; n = 3, 14.3%) and HGUC (n = 8, 38.1%), while ORS categorised the specimens as unsatisfactory (n = 1, 4.8%), negative for malignant cells (NFMC; n = 3, 14.3%), AUC (n = 5, 23.8%), low-grade urothelial carcinoma (LGUC; n = 0, 0%), SHGUC (n = 5, 23.8%) and HGUC (n = 7, 33.3%). The risks of high-grade malignancy among cytologic categories were similar between ORS and TPS (p > 0.05). The majority of LGUC were classified as AUC similarly by ORS and TPS (55.6% vs. 59.3%). CONCLUSIONS Our study demonstrated comparable performance between TPS 2.0 and ORS for UUT cytology specimens. Cytological diagnosis of UUT specimens remains challenging, especially for LGUC.
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Affiliation(s)
- Ghazal Khajir
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tong Sun
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - He Wang
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Preston C Sprenkle
- Department of Urology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Guoping Cai
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angelique W Levi
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Ecke TH, Lotan Y, Massfelder T. Editorial: Identifying novel biomarkers in bladder cancer. Front Oncol 2023; 13:1191736. [PMID: 37469396 PMCID: PMC10353301 DOI: 10.3389/fonc.2023.1191736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, Helios Hospital Bad, Saarow, Germany
- Deparment of Urology, Universitätsmedizin Berlin Charité, Berlin, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Thierry Massfelder
- INSERM (French National Institute of Health and Medical Research) UMR_S1260, Université de Strasbourg, Regenerative Nanomedicine, Centre de Recherche en Biomédecine de Strasbourg, Strasbourg, France
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Sakumo K, Morihashi K, Nakamura A, Nukaya T, Sumitomo M, Nakamura M, Sofue T, Haba R, Itoh T, Kamoshida S, Ohsaki H. The usefulness of nuclear area in the diagnosis of high-grade urothelial carcinoma cells in voided urine cytology. Cytopathology 2023; 34:295-301. [PMID: 36959684 DOI: 10.1111/cyt.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The Paris System for Reporting Urinary Cytology considered the nuclear-to-cytoplasmic (N:C) ratio as the most important cytomorphological feature for detecting high-grade urothelial carcinoma (HGUC) cells. Few quantitative studies have been conducted on other features although quantitative studies on the N:C ratio have been reported. Therefore, this study quantitatively analysed important cytomorphological features in distinguishing benign reactive cells from HGUC cells. METHODS We analysed 2866 cells from the urine of 52 patients. A digital image analyser was used to quantitatively measure the nuclear area, cell area, N:C ratio, and nuclear roundness for HGUC cells and benign reactive cells. Additionally, the diagnostic value of quantitative cytomorphological criteria in HGUC cells was evaluated by the receiver operating characteristic curve. RESULTS The area under the curve for the prediction of HGUC cells for all cells and the top five cells was in the following order: nuclear area (0.920 and 0.992, respectively), N:C ratio (0.849 and 0.977), cell area (0.781 and 0.920), and nuclear roundness (0.624 and 0.605). The best cutoff value of the N:C ratio to differentiate HGUC cells from benign reactive cells was 0.438, and using the N:C ratio of 0.702, the positive predictive value obtained was 100%. CONCLUSIONS Our study indicated that nuclear area is a more important cytomorphological criterion than the N:C ratio for HGUC cell detection. Moreover, extracted data of the top five cells were more valuable than the data of all cells, which can be helpful in the routine practice and future criteria definition in urine cytology.
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Affiliation(s)
- Kazuma Sakumo
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kenta Morihashi
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Takuhisa Nukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Muneo Nakamura
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Kita-gun, Kagawa, 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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Torous VF, Mito JK, VanderLaan PA. Leveraging thoughtful quality metric selection for individual and system improvements: the atypical category and use of dashboards. J Am Soc Cytopathol 2023; 12:3-9. [PMID: 36336566 DOI: 10.1016/j.jasc.2022.10.002] [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: 07/31/2022] [Revised: 08/31/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
Quality management is integral to the practice of cytopathology, especially given the heavily manual workflows and expanding ancillary testing requirements inherent to the cytopathology laboratory. Monitoring quality data like turnaround time, specimen unsatisfactory rates, and diagnostic category utilization rates allows for better understanding of performance with opportunities for targeted improvement if there are variations from that which is expected. However, there are costs to quality monitoring including the time and resources needed, and, in already taxed systems, quality management risks being viewed as just another box to check. While there are mandated quality metrics that must be collected by cytology laboratories, thoughtful selection of key performance indicators can be of tremendous benefit in helping to better understand complex laboratory processes and directing improvement endeavors where needed. The following short communication is a discussion on quality management in the cytopathology laboratory from 3 Cytopathology Quality Management Directors. The discussion focuses on monitoring the atypical reporting category with an emphasis on how trending and visualizing quality metrics can provide laboratories with key data.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Kurtycz DFI, Wojcik EM, Rosenthal DL. Perceptions of Paris: an international survey in preparation for The Paris System for Reporting Urinary Cytology 2.0 (TPS 2.0). J Am Soc Cytopathol 2023; 12:66-74. [PMID: 36274039 DOI: 10.1016/j.jasc.2022.09.002] [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: 07/13/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION An international panel of experts in the field of urinary cytopathology conducted a survey, supported by the American Society of Cytopathology, to seek opinions, gather evidence, and identify practice patterns regarding urinary cytology before and after the introduction of The Paris System for Reporting Urinary Cytopathology (TPS). Results from this survey were utilized in the development of the second edition of TPS (TPS-2.0). MATERIALS AND METHODS The study group, originally formed during the 2013 International Congress of Cytology, reconvened at the 2019 annual meeting of the American Society of Cytopathology. To prepare for the second edition of TPS, the group generated a survey that included 43 questions related to the taxonomy and practice of urinary cytology. RESULTS A total of 523 participant responses were collected, and 451 from 54 countries passed a qualifying screen. Three hundred ninety-four participants provided information about their work settings. Eighty-two percent (218/266) of responding participants use TPS. One hundred sixty-eight people who responded on their urinary cytology atypia rates reported an average decrease from 21.6% to 16%. Over three fourths of participants felt that the same criteria should be used for upper and lower tract interpretations and for instrumented and voided samples. There were varied opinions on addressing atypical squamous cells and suggestions for an expanded discussion of the issue to be included in TPS 2.0. CONCLUSIONS Results of the survey demonstrate strong support for TPS and show a decreased self-reported atypia rate in the laboratories using TPS. The majority of participants related that the criteria put forth for the reporting categories were user-friendly and applied with relative ease. The comment section of the survey included suggestions from the participants for further improvement of TPS. Results of this survey have been useful in fine-tuning and advancing TPS. They were considered along with recent literature to generate the second edition of TPS.
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Affiliation(s)
- Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Wisconsin State Laboratory of Hygiene, Madison, Wisconsin.
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Dorothy L Rosenthal
- Department of Pathology and Laboratory Medicine, Johns Hopkins University, Baltimore, Maryland
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12
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Harris CK, Darrell CM, VanderLaan PA, Heher YK. Patient-facing communication for cytopathologists: A framework for disclosing diagnostic error. Cancer Cytopathol 2023; 131:10-18. [PMID: 35904882 DOI: 10.1002/cncy.22627] [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: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/04/2023]
Abstract
Medical errors are a major source of harm to patients. Regulatory bodies mandate and patient safety experts advocate the disclosure of medical errors to patients to promote transparency and to create accountability for improving health care processes. Although pathologists regularly report errors-either to pathology or clinical colleagues or via internal safety reporting systems-few pathologists directly disclose those errors to patients. Yet many pathologists are interested in participating in the direct disclosure of medical errors to patients and may even be mandated to do so. When surveyed on why they do not directly disclose errors to patients, pathologists commonly cite a lack of confidence and a lack of training. Another barrier cited is the lack of a preexisting relationship between the pathologist and the patient. With respect to this last barrier, cytopathologists have a distinct advantage over surgical or clinical pathologists, as many cytopathologists regularly interact with and develop a rapport with patients when they are performing fine-needle aspiration (FNA) procedures. To improve the safety culture in pathology, direct error disclosure practices must be developed, supported, and strengthened. It is critical for cytopathologists to be comfortable with disclosing errors to patients. Being comfortable with disclosing an error, however, requires training, practice, and advance reflection. Using a practical, case-based format centered around FNA examples, this article addresses how to disclose a medical error to a patient. It provides a framework, heuristic principles, and structured conversation systems and talking points to guide the inexperienced pathologist to find his or her voice in a challenging disclosure conversation.
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Affiliation(s)
- Cynthia K Harris
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Caitlin M Darrell
- Department of Pathology, Advocate Health Care, Oak Lawn, Illinois, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Yael K Heher
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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13
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Compérat E, Amin MB, Berney DM, Cree I, Menon S, Moch H, Netto GJ, Rao V, Raspollini MR, Rubin MA, Srigley JR, Tan PH, Tickoo SK, Turajlic S, Tsuzuki T. What's new in WHO fifth edition - urinary tract. Histopathology 2022; 81:439-446. [PMID: 35942645 DOI: 10.1111/his.14764] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
The fifth edition of the WHO Blue Book on urological tumours, specifically in the bladder chapter, represents a refinement and update in the classification of bladder tumours building on the aggregate major changes made in previous editions. Progress in the molecular underpinnings of urothelial tumours, particularly with promising stratifiers for more precision-based treatment approaches, have been made. Special attention has been paid to burning questions in bladder pathology, such as grading, heterogeneous lesions, inverted tumours and substaging. The concept of neuroendocrine tumours will be explained precisely.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, General Hospital, Medical University Vienna, Vienna, Austria
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Knoxville, TN, USA
- Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Dan M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Ian Cree
- International Agency for Research on Cancer (IARC), World Health Organisation, Lyon, France
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - George J Netto
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishal Rao
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mark A Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - John R Srigley
- Trillium Health Partners and University of Toronto, Mississauga, ON, Canada
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Satish Kumar Tickoo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London and Renal and Skin Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, School of Medicine, Aichi Medical University, Nagoya, Japan
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14
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Karashima T, Umemoto S, Kishida T, Osaka K, Nakagawa M, Yoshida E, Yoshimura T, Sakaguchi M, Nishimoto H, Tai M, Inoue K, Seiki M, Koshikawa N, Shuin T. Clinical evaluation of urine laminin-γ2 monomer as a potent biomarker for non-muscle invasive bladder cancer. Cancer Med 2022; 12:2453-2462. [PMID: 35924681 PMCID: PMC9939167 DOI: 10.1002/cam4.5087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND To evaluate whether urine laminin-γ2 monomer (Ln-γ2m) offers a useful biomarker for patients with non-muscle-invasive bladder cancer (NMIBC). METHODS Participants comprised 297 patients, including 111 patients with NMIBC, 136 patients with benign genitourinary disease (BD) and 50 healthy donors (HD). Urine Ln-γ2m was prospectively measured and accuracy was analyzed. Receiver operating characteristic (ROC) curves were determined and area under the ROC curve (AUC) was calculated for urine Ln-γ2m, and compared to those of traditional urine tumor markers such as nuclear matrix protein 22 (NMP22), bladder tumor antigen (BTA) and cytology. The net benefits of combining urine markers were analyzed by decision curve analysis. RESULTS Mean urine Ln-γ2m was significantly higher in NMIBC than in BD or HD. The AUC for urine Ln-γ2m was significantly higher than those for urine NMP22, BTA or cytology when comparing NMIBC with HD. In patients with low-grade NMIBC, the AUC for urine Ln-γ2m was higher than the AUCs for NMP22, BTA or cytology. A net benefit of combined examination using urine Ln-γ2m/uCRN with NMP22 was demonstrated. CONCLUSION These results suggest urine Ln-γ2m as a potentially useful biomarker for NMIBC, particularly in cases of low-grade cancer.
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Affiliation(s)
| | - Susumu Umemoto
- Department of UrologyKanagawa Cancer CenterYokohamaJapan
| | | | - Kimito Osaka
- Department of UrologyKanagawa Cancer CenterYokohamaJapan
| | | | | | | | - Masahiko Sakaguchi
- Integrated Center for Advanced Medical TechnologiesKochi Medical SchoolNankokuJapan,Division of Cancer Prevention and ControlKanagawa Cancer Center Research InstituteYokohamaJapan
| | - Hiroyuki Nishimoto
- Integrated Center for Advanced Medical TechnologiesKochi Medical SchoolNankokuJapan
| | - Mami Tai
- Integrated Center for Advanced Medical TechnologiesKochi Medical SchoolNankokuJapan
| | - Keiji Inoue
- Department of UrologyKochi Medical SchoolNankokuJapan
| | - Motoharu Seiki
- School of MedicineKanazawa UniversityKanazawaJapan,Institute of Medical ScienceUniversity of TokyoTokyoJapan
| | - Naohiko Koshikawa
- Institute of Medical ScienceUniversity of TokyoTokyoJapan,Division of Cancer Cell ResearchKanagawa Cancer Center Research InstituteYokohamaJapan
| | - Taro Shuin
- Department of UrologyKochi Medical SchoolNankokuJapan
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15
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Sbizzera M, Descotes F, Arber T, Neuville P, Ruffion A. Bladder cancer detection in patients with neurogenic bladder: are cystoscopy and cytology effective, and are biomarkers pertinent as future diagnostic tools? A scoping review. World J Urol 2022; 40:1897-1913. [PMID: 35119523 DOI: 10.1007/s00345-022-03943-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/16/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To summarize the current state of knowledge on bladder cancer diagnosis and screening in neurogenic bladder patients, and to explore the potential contribution of biomarkers in this context. METHODS A scoping review was performed to retrieve cystoscopy and urinary cytology performance for bladder cancer detection in neurogenic bladder patients. We also retrieved information of certified urinary biomarkers in bladder cancer detection and their potential application for this specific population. RESULTS A total of 1092 articles were identified; 19 of them were included in the scoping review regarding cytology and cystoscopy performance in patients with neurogenic bladder and 33 were included as related to biomarkers in bladder cancer. No significant study stood out to recommend bladder cancer screening in this specific population using cytology and cystoscopy because of the scarcity of results, low level-of-evidence studies, and lack of studies specifically designed to assess the test performance in this population. Two biomarkers were retained as potential future diagnostic tools: FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection. CONCLUSION There is no sufficient quality data to support cystoscopy and urinary cytology as effective tools for the diagnostic and surveillance of bladder cancer in neurogenic bladder patients. FISH analysis to detect chromosomal changes, and PCR for TERT and FGFR3 promoter mutation detection, associated or not with KRAS mutation detection, stand out as candidates of interest for bladder cancer detection in this specific population and should be prospectively tested.
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Affiliation(s)
- Marc Sbizzera
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France.
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Françoise Descotes
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
| | - Théo Arber
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, 165 Chemin du Grand Revoyet, Pierre-Bénite, 69310, Lyon, France
- Equipe 2 - Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY) - Faculté de médecine Lyon Sud, Université Claude Bernard Lyon 1, Villeurbanne, France
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16
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Xu J, Zeng S, Li J, Gao L, Le W, Huang X, Wang G, Chen B, Zhang Z, Xu C. Novel Non-Invasive Diagnosis of Bladder Cancer in Urine Based on Multifunctional Nanoparticles. Front Cell Dev Biol 2022; 9:813420. [PMID: 35174172 PMCID: PMC8841412 DOI: 10.3389/fcell.2021.813420] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives: Tumor cells were reported to have perpetual negative surface charges due to elevated glycolysis, and multifunctional nanoprobes (Fe3O4@SiO2, mNPs) could attach onto tumor cells via opposite surface charges. We thus evaluated whether mixing mNPs with urine could improve the sensitivity of urine cytology test (UCT). Methods: We developed a novel UCT method by mixing urine with mNPs (Nano-cytology) to harvest more tumor cells during UCT procedures. The same voided urine sample was divided equally for the Nano-cytology and UCT assay, and evaluated by cytopathologists in a blinded way. The accuracy of UCT, Nano-cytology, and the combination of the two approaches (Nano-UCT) for detecting bladder cancer were determined. Results: Urine samples were prospectively collected from 102 bladder cancer patients and 49 non-cancer participants from June 2020 to February 2021 in Changhai Hospital. Overall sensitivity of the Nano-cytology assay was significantly higher than that of the UCT assay (82.4 vs. 59.8%, p < .01). Sensitivity for low- and high-grade tumors was 79.1% and 39.5% (p < .01) and 84.7% and 74.6% (p = .25) for Nano-cytology and UCT, respectively. Specificity of Nano-cytology was slightly lower than that of UCT (89.8% vs. 100%, p = .022), which is mainly caused by severe urinary tract infection. In addition, Nano-UCT showed increased sensitivity with 90.2% for overall patients, and 83.7% and 94.9% for low- and high-grade tumor, respectively. Conclusion: The Nano-cytology assay had a significantly improved sensitivity compared with UCT for detecting bladder cancer patients. It represents a promising tool for diagnosis of bladder cancer in clinical practice.
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Affiliation(s)
- Jinshan Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shuxiong Zeng
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jun Li
- Institute for Regenerative Medicine, Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Li Gao
- Department of Pathology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenjun Le
- Institute for Regenerative Medicine, Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Xin Huang
- Institute for Regenerative Medicine, Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
| | - Guandan Wang
- Department of Nutrition, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bingdi Chen
- Institute for Regenerative Medicine, Shanghai East Hospital, The Institute for Biomedical Engineering & Nano Science, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Bingdi Chen, ; Zhensheng Zhang, ; Chuanliang Xu,
| | - Zhensheng Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Bingdi Chen, ; Zhensheng Zhang, ; Chuanliang Xu,
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Bingdi Chen, ; Zhensheng Zhang, ; Chuanliang Xu,
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17
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Application of the International System for Reporting Serous Fluid Cytopathology with Cytohistological Correlation and Risk of Malignancy Assessment. Diagnostics (Basel) 2021; 11:diagnostics11122223. [PMID: 34943460 PMCID: PMC8700584 DOI: 10.3390/diagnostics11122223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/22/2022] Open
Abstract
The International System for Reporting Serous Fluid Cytopathology (TIS) classifies serous effusions into five categories: non-diagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM) and malignant (MAL). The main objectives of this classification comprise the establishment of a universal code of communication between cytopathologists and clinicians and histopathologists, as well as between different laboratories worldwide, paving the way for the setting of clinical management guidelines based on the risk of malignancy assessment for each diagnostic category. We retrieved the total number of pleural and peritoneal effusion cases of our department for the three-year time period between 2018 and 2020, yielding a total of 528 and 500 cases, respectively. We then proceeded to reclassify each specimen according to TIS guidelines and calculate the risk of malignancy (ROM) for each category by searching each patients’ histology records, medical history and clinical follow-up. For pleural effusions, 3 (0.57%) cases were classified as ND, 430 (81.44%) cases as NFM, 15 (2.84%) as AUS, 15 (2.84%) as SFM and 65 (12.31%) as MAL. ROM amounted to 0%, 5.3%, 33.33%, 93.33% and 100% for each category, respectively. As far as peritoneal effusions are concerned, 6 (1.2%) were categorized as ND with ROM estimated at 16.66%, 347 (69.4%) as NFM (ROM = 9%), 13 (2.6%) as AUS (ROM = 38.46%), 12 (2.4%) as SFM (ROM = 83.33%) and 122 (24.4%) as MAL (ROM = 100%). Our results underline the utility of the current classification, both as a means of communication between doctors of different specialties and as general guidelines for the further clinical management of patients.
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18
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Kurtycz DFI. International collaboration: Support for the Milan System from Japan. Cancer Cytopathol 2021; 130:16-17. [PMID: 34478239 DOI: 10.1002/cncy.22506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA.,State Laboratory of Hygiene, Madison, Wisconsin, USA
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19
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Nojima S, Terayama K, Shimoura S, Hijiki S, Nonomura N, Morii E, Okuno Y, Fujita K. A deep learning system to diagnose the malignant potential of urothelial carcinoma cells in cytology specimens. Cancer Cytopathol 2021; 129:984-995. [PMID: 33979039 DOI: 10.1002/cncy.22443] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although deep learning algorithms for clinical cytology have recently been developed, their application to practical assistance systems has not been achieved. In addition, whether deep learning systems (DLSs) can perform diagnoses that cannot be performed by pathologists has not been fully evaluated. METHODS The authors initially obtained low-power field cytology images from archived Papanicolaou-stained urinary cytology glass slides from 232 patients. To aid in the development of a diagnosis support system that could identify suspicious atypical cells, the images were divided into high-power field panel image sets for training and testing of the 16-layer Visual Geometry Group convolutional neural network. The DLS was trained using linked information pertaining to whether urothelial carcinoma (UC) in the corresponding histology specimen was invasive or noninvasive, or high-grade or low-grade, followed by an evaluation of whether the DLS could diagnose these characteristics. RESULTS The DLS achieved excellent performance (eg, an area under the curve [AUC] of 0.9890; F1 score, 0.9002) when trained on high-power field images of malignant and benign cases. The DLS could diagnose whether the lesions were invasive UC (AUC, 0.8628; F1 score, 0.8239) or high-grade UC (AUC, 0.8661; F1 score, 0.8218). Gradient-weighted class activation mapping of these images indicated that the diagnoses were based on the color of tumor cell nuclei. CONCLUSIONS The DLS could accurately screen UC cells and determine the malignant potential of tumors more accurately than classical cytology. The use of a DLS during cytopathology screening could help urologists plan therapeutic strategies, which, in turn, may be beneficial for patients.
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Affiliation(s)
- Satoshi Nojima
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Terayama
- Graduate School of Medical Life Science, Yokohama City University, Kanagawa, Japan.,Graduate School of Medicine, Kyoto University, Kyoto, Japan.,RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.,Medical Sciences Innovation Hub Program, RIKEN Cluster for Science, Technology, and Innovation Hub, Kanagawa, Japan
| | - Saeko Shimoura
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Hijiki
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Okuno
- Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Medical Sciences Innovation Hub Program, RIKEN Cluster for Science, Technology, and Innovation Hub, Kanagawa, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Urology, Kindai University Faculty of Medicine, Osaka, Japan
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20
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Nichols MM, Reynolds JP, McKenney JK, Nicolas MM, McIntire PJ, Policarpio-Nicolas MLC. Urine cytology findings in patients with biopsy-confirmed urothelial carcinoma in situ with plasmacytoid features. Cancer Cytopathol 2021; 129:798-804. [PMID: 33900681 DOI: 10.1002/cncy.22445] [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: 03/06/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Urine cytology is an important screening tool in the diagnosis of high-grade urothelial carcinoma. Diagnosis in urine samples follows criteria outlined by The Paris System for Reporting Urinary Cytology (TPS). However, cytologic characteristics of the recently described urothelial carcinoma in situ with plasmacytoid features (P-CIS) have not been described, and it is unknown whether they conform to TPS criteria for high-grade urothelial carcinoma. This study was aimed at better characterizing possibly unique cytologic features of P-CIS. METHODS The authors collected urine cytology specimens from patients with subsequent bladder biopsy-proven P-CIS. Specimens were re-reviewed according to the TPS criteria. The proposed cytologic features of P-CIS (eccentric, enlarged, and hyperchromatic nuclei) were evaluated; this included the reproducibility of 3 cytopathologists for the proposed cytologic features. RESULTS Seventy-four urine specimens from 18 patients with P-CIS-diagnosed bladder biopsies were identified. The TPS diagnoses of the 74 urine cytology specimens were as follows: negative for high-grade urothelial carcinoma (n = 26), atypical urothelial cells (n = 26), suspicious for high-grade urothelial carcinoma (n = 12), and high-grade urothelial carcinoma (n = 10). Only 7 urine specimens met the proposed cytologic criteria for P-CIS, and they had TPS diagnoses of negative for high-grade urothelial carcinoma (n = 1), atypical urothelial cells (n = 3), and high-grade urothelial carcinoma (n = 3). The κ interobserver agreement ranged from poor to fair. CONCLUSION The features of P-CIS on urine cytology are subtle and infrequently reproducible and often do not meet the TPS criteria for diagnosis as high-grade urothelial carcinoma. In specimens that do not meet TPS criteria for high-grade urothelial carcinoma, P-CIS cytology in isolation would be best classified as atypical urothelial cells.
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Affiliation(s)
| | - Jordan P Reynolds
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jesse K McKenney
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Marlo M Nicolas
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
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21
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Allison DB. Challenges in recognizing urothelial carcinoma in situ with plasmacytoid features by urinary cytology. Cancer Cytopathol 2021; 129:772-773. [PMID: 33900683 DOI: 10.1002/cncy.22446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Derek B Allison
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky.,Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky
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22
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Sun T, Hutchinson L, Tomaszewicz K, Caporelli ML, Meng X, McCauley K, Fischer AH, Cosar EF, Cornejo KM. Diagnostic value of a comprehensive, urothelial carcinoma-specific next-generation sequencing panel in urine cytology and bladder tumor specimens. Cancer Cytopathol 2021; 129:537-547. [PMID: 33539671 DOI: 10.1002/cncy.22410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Urine cytology can reliably diagnose high-grade urothelial carcinoma (HGUC) but not low-grade urothelial carcinoma (LGUC), and a more sensitive test is needed. Previously, a pilot study highlighted the possible diagnostic utility of next-generation sequencing (NGS) in identifying both LGUC and HGUC in urine cytology specimens. METHODS Twenty-eight urine ThinPrep cytology specimens and preceding or subsequent bladder tumor biopsy/resection specimens obtained within 3 months were included in the study (LGUC, n = 15; HGUC, n = 13). A customized, bladder-specific NGS panel was performed; it covered 69 frequently mutated or altered genes in urothelial carcinoma (UC) that were reported by The Cancer Genome Atlas and the Catalogue of Somatic Mutations in Cancer. RESULTS The sequencing results were compared between the urine cytology specimens and the corresponding bladder tumor biopsies/resections. TP53 was the most frequently identified mutation in HGUC cases (11 of 13 [85%]). PIK3CA and KDM6A were the most frequently identified mutations in LGUC: they occurred in 7 of 15 cases (47%) and in 6 of 15 cases (40%), respectively. Additional frequent mutations identified in the panel included ARID1A (n = 5), EP300 (n = 4), LRP1B (n = 3), ERBB2 (n = 2), STAG2 (n = 2), FGFR3 (n = 3), MLL (n = 2), MLL3 (n = 2), CREBBP1 (n = 1), RB1 (n = 1), and FAT4 (n = 1). Overall, the concordance between the cytology and surgical specimens was 75%. The sensitivity and specificity for identifying mutations in urine cytology specimens were 84% and 100%, respectively. CONCLUSIONS A bladder-specific NGS panel increases the sensitivity and specificity of urine cytology's diagnostic utility in both low- and high-grade tumors and may serve as a noninvasive surveillance method in the follow-up of patients with UC harboring known mutations.
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Affiliation(s)
- Tong Sun
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lloyd Hutchinson
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Keith Tomaszewicz
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mandi-Lee Caporelli
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Xiuling Meng
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kathleen McCauley
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Andrew H Fischer
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ediz F Cosar
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kristine M Cornejo
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, Massachusetts.,Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ecke TH, Otto T, Le Calvez-Kelm F. Evaluating the Utility of Combined Bladder Cancer Biomarkers, the Molecular Prognostication of Tumor Subtypes, or What Else Is Needed to Illuminate Our Vision? Int J Mol Sci 2020; 21:E9657. [PMID: 33352845 PMCID: PMC7766346 DOI: 10.3390/ijms21249657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/24/2022] Open
Abstract
In the last few years, we published two special issues devoted to highlighting important scientific results in the field of bladder cancer research and clinical implications [...].
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Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, DE-15526 Bad Saarow, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Klinikum Neuss, DE-41464 Neuss, Germany;
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Pastorello RG, Barkan GA, Saieg M. Experience on the use of The Paris System for Reporting Urinary Cytopathology: review of the published literature. J Am Soc Cytopathol 2020; 10:79-87. [PMID: 33160893 DOI: 10.1016/j.jasc.2020.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (TPS) was first published in 2016 with clear objectives to standardize cytologic diagnostic criteria and provide uniform reporting, in order to improve patient stratification and associated clinical management. The aim of this paper is to evaluate the performance of TPS and review the literature published since TPS was introduced. MATERIALS AND METHODS Original articles focusing on the utilization and performance of TPS in urinary cytology specimens were identified using PubMed for publications from January 2016 to July 2020, using the keywords "Paris System", "urine cytology", and "urinary cytology". RESULTS Twenty-three relevant articles in the literature regarding the use of TPS were included in the review from a total of 30,802 urine cytology specimens, of which 21,485 (69.8%) had available diagnoses. Distribution of cases among categories ranged from 50.5% to 95.3% for negative for high-grade urothelial carcinoma (NHGUC), 1.2% to 23% for atypical urothelial cells (AUC), 0.2% to 6.6% for suspicious for high-grade urothelial carcinomas (SHGUC), and 2.2% to 14.1% for high-grade urothelial carcinomas (HGUC). The calculated risk of high-grade malignancy (ROHM) ranged from 8.7% to 36.8% for NHGUC, 12.3% to 60.9%% for AUC, 33.3% to 100% for SHGUC, and 58.8% to 100% for HGUC. Mean ROHM weighted by sample size was calculated at 15.7% (±7.8%), 38.5% (±14.3%), 76.2% (±17.2%), and 88.8% (±12.7%) for NHGUC, AUC, SHGUC, and HGUC, respectively. Reported sensitivity of TPS ranged from 40% to 84.7%, specificity from 73% to 100%, PPV from 62.3% to 100%, and NPV from 46% to 90%. CONCLUSIONS The application of TPS in the selected series has improved the screening and surveillance potential of urine cytology, while reducing high rates of indeterminate diagnoses, improving sensitivity and providing proper risk stratification for patients.
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Affiliation(s)
- Ricardo G Pastorello
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Healthcare System, Maywood, Illinois; Department of Urology, Loyola University Healthcare System, Maywood, Illinois
| | - Mauro Saieg
- Department of Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Pathology, Santa Casa Medical School, São Paulo, Brazil.
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Willner J, Matloob A, Colanta A, Khader SN. Educational Case: Urothelial Carcinoma: An Overview of Pathologic Diagnosis. Acad Pathol 2020; 7:2374289520958172. [PMID: 33088909 PMCID: PMC7545510 DOI: 10.1177/2374289520958172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 05/27/2020] [Accepted: 08/05/2020] [Indexed: 12/02/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Jonathan Willner
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Khader is now with UPMC Department of Pathology, Pittsburg, PA, USA
| | - Ammar Matloob
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Khader is now with UPMC Department of Pathology, Pittsburg, PA, USA
| | - Anges Colanta
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Khader is now with UPMC Department of Pathology, Pittsburg, PA, USA
| | - Samer N Khader
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. Khader is now with UPMC Department of Pathology, Pittsburg, PA, USA
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Zhang ML, Miki Y, Hang JF, Vohra M, Peyton S, McIntire PJ, VandenBussche CJ, Vohra P. A review of upper urinary tract cytology performance before and after the implementation of The Paris System. Cancer Cytopathol 2020; 129:264-274. [PMID: 32897658 DOI: 10.1002/cncy.22343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022]
Abstract
Urinary cytology (UC) is one of the primary diagnostic modalities used for the screening and surveillance of urothelial carcinoma. Despite its widespread use, UC has suffered from a lack of standardized or reproducible criteria and wide interobserver variability, particularly of the designation of atypical urothelial cells. The Paris System for Reporting Urinary Cytology (TPS), published in 2016, aimed to provide a standardized approach for evaluating UC by creating diagnostic categories with specific cytomorphologic criteria. Recent studies have primarily investigated the application of TPS on lower urinary tract specimens and have mostly shown that TPS implementation has improved the performance of UC specimens. Only a few studies have reported the impact of TPS on upper urinary tract (UUT) cytology. Additionally, there is uncertainty as to which cytological features are most predictive of high-grade urothelial carcinoma (HGUC) in the UUT. This review summarizes the literature regarding the utility and performance of UUT cytology and highlights findings before and after the implementation of TPS.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yurina Miki
- Department of Cellular Pathology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Manjiv Vohra
- Environmental Chemical Corp, Burlingame, California
| | - Stephen Peyton
- QML Pathology, Anatomical Pathology, Brisbane, Queensland, Australia
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | | | - Poonam Vohra
- Department of Anatomic Pathology, University of California, San Francisco, California
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Fiaz S, Ali A, Adnan S, Khalil MAI, Rasheed Y, Abu Bakar M, Ahmad Cheema Z, Mir K. Comparison of Outcomes Between Radical Radiotherapy and Radical Cystectomy in Muscle Invasive Bladder Cancer in a Cancer Specialized Unit of a Developing Country. Cureus 2020; 12:e10057. [PMID: 32999780 PMCID: PMC7520399 DOI: 10.7759/cureus.10057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Radical cystectomy (RC) is the current standard of care for treating muscle-invasive bladder cancer (MIBC), however bladder preservation by offering radical radiotherapy (RT) is gaining interest for improving the quality of life while maintaining a reasonable oncological outcome. In this study, we have compared outcomes of the two treatment options. Materials and methods This is a 10-year retrospective cohort study that included all patients who were treated for histologically proven muscle-invasive bladder cancer in the department of uro-oncology at Shaukat Khanum Memorial Cancer Hospital and Research Centre from January 2005 to January 2015. Data was analysed using Statistical Product and Service Solutions (SPSS), version 21 (IBM Corp., Armonk, NY). The primary end point of our study was to calculate the three- and five-year disease-free survival (DFS) and overall survival (OS). Results A total of 230 patients were included in the study with male gender predominating (88%). The mean and standard deviation for age was 58.32+11.128. Radical cystectomy was performed in 119 patients while 111 received RT. Clinically, 34% had stage 2 disease, while 66 % had stage 3 cancer. The median follow-up duration was 41 months (range: 2-155). During follow-up 57.4% of patients showed no recurrence. Local recurrence was found in 9.6% patients and distant metastasis in 32.2%. The three-year DFS of RC was 63% and that of RT was 57% while the five-year DFS for RC and RT were 60% and 49%, respectively (p=0.196). The three-year OS of RC was 64% and that for RT was 58%. On further analysis the five-year OS of RC was 53% and that for RT was 50% (p=0.98). Upon stage-based comparisons, we found no statistically significant difference between the three- and five-year DFS and OS of stage 2 and stage 3 when treated with either modality. Conclusion Most studies favor RC and consider it as the gold standard treatment for muscle-invasive bladder tumor treatment. The current study reveals that bladder preservation approach by chemo radiotherapy is a viable treatment option, having comparable oncological outcomes with patients receiving radical cystectomy, and can be offered to patients having muscle-invasive urothelial bladder cancer.
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Affiliation(s)
- Shaukat Fiaz
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Azfar Ali
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Siddique Adnan
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK.,Urology, Instutute of Kidney Diseases Hayat Abad Medical Complex, Peshawar, PAK
| | | | | | - Muhammad Abu Bakar
- Cancer Epidemiology and Biostatistics, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Zubair Ahmad Cheema
- Urology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Khurram Mir
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Kurtycz DFI, Sundling KE, Barkan GA. The Paris system of Reporting Urinary Cytology: Strengths and opportunities. Diagn Cytopathol 2020; 48:890-895. [PMID: 32780564 DOI: 10.1002/dc.24561] [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: 04/20/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
The Paris system for reporting urinary cytopathology (TPS) was created to address inherent weaknesses inherent in the practice of urinary cytopathology. While urothelial cytology has always performed well at finding high grade, genetically unstable urothelial carcinoma, it performs poorly when it comes to detecting low-grade urothelial neoplasia. TPS intends to improve the utility of urothelial cytology by focusing on what is important, high-grade urothelial carcinoma. This article is a snapshot of the current state of TPS as it heads into its second edition. Successes are described and further developments are considered.
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Affiliation(s)
- Daniel F I Kurtycz
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Kaitlin E Sundling
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Chicago, Illinois, USA
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29
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Thrall MJ, Vrbin C, Barkan GA, Monaco SE, Pambuccian SE, Pantanowitz L, Pitman MB, Kurtycz DFI. Small core needle biopsies in cytology practice: a survey of members of the American Society of Cytopathology. J Am Soc Cytopathol 2020; 9:310-321. [PMID: 32653451 DOI: 10.1016/j.jasc.2020.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The introduction of a new generation of core needle biopsies (CNBs) for endoscopic procedures has prompted reconsideration of the role of cytopathologists in the handling of small biopsies. The American Society of Cytopathology (ASC) has therefore conducted a survey with the intention of elucidating current practices regarding the handling of small CNBs. MATERIALS AND METHODS The membership of the ASC was invited by email to participate in an online survey over a 2-month period. The survey consisted of 20 multiple choice questions with 2-8 possible responses per question. RESULTS Of 2651 members contacted by e-mail, 282 (10.6%) responded to the survey questions, including 196 pathologists (69.5%) and 86 cytotechnologists (30.5%). Of these, 265 respondents were from the US/Canada (94.0%), with 156 from academic institutions (58.9%) and 109 from non-academic practices (41.1%); 17 were from other countries (6.0%). In 18.8% of all practices, cytopathologists sign out >90% of small CNBs from endoscopic and radiologically guided procedures; in 36.5% of practices >90% are signed out by surgical pathologists; the remainder have such cases divided more evenly between cytopathologists and surgical pathologists. Responses show that 78.0% of all respondents are interested in signing out more small biopsies in the future, and 80.5% desire increased small biopsy-related resources from the ASC. CONCLUSIONS The survey responses indicate that practices currently vary widely across institutions. Most indicated an interest in greater incorporation of small biopsies into the practice of cytopathology.
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Affiliation(s)
- Michael J Thrall
- Houston Methodist Hospital, Department of Pathology and Genomic Medicine, Houston, Texas.
| | | | - Güliz A Barkan
- Loyola University Chicago Health Sciences Campus, Department of Pathology and Laboratory Medicine, Chicago, Illinois
| | - Sara E Monaco
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, Pennsylvania
| | - Stefan E Pambuccian
- Loyola University Chicago Health Sciences Campus, Department of Pathology and Laboratory Medicine, Chicago, Illinois
| | - Liron Pantanowitz
- University of Michigan Medical Center, Department of Pathology, Ann Arbor, Michigan
| | - Martha B Pitman
- Massachusetts General Hospital, Harvard Medical School, Department of Pathology, Boston, Massachusetts
| | - Daniel F I Kurtycz
- Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Department of Pathology and Laboratory Medicine, Madison, Wisconsin
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30
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Heher YK. Reduction of diagnostic error: Following cytopathology's lead. Cancer Cytopathol 2020; 128:914-916. [PMID: 32543776 DOI: 10.1002/cncy.22308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Yael K Heher
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Siddiqui MT. Serous cavity fluids: Momentum, molecules, markers… and more! Cancer Cytopathol 2020; 128:381-383. [PMID: 32163232 DOI: 10.1002/cncy.22255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/04/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill-Cornell Medicine, New York Presbyterian Hospital, New York, New York
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32
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Ecke TH, Otto T. Illumination of a Vision 2020-Urinary Based Biomarkers for Bladder Cancer on the Way to Clinical Decisions-Dream or Nightmare? Int J Mol Sci 2020; 21:ijms21051694. [PMID: 32121621 PMCID: PMC7084301 DOI: 10.3390/ijms21051694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Thorsten H. Ecke
- Department of Urology, HELIOS Hospital Bad Saarow, D-15526 Bad Saarow, Germany
- Correspondence: (T.H.E.); (T.O.)
| | - Thomas Otto
- Department of Urology, Lukaskrankenhaus Neuss, D-41464 Neuss, Germany
- University Hospital Essen, D-45147 Essen, Germany
- Correspondence: (T.H.E.); (T.O.)
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Montalbo R, Izquierdo L, Ingelmo-Torres M, Galve P, Solé M, Franco A, Ribal MJ, Alcaraz A, Mengual L. Urine cytology suspicious for urothelial carcinoma: Prospective follow-up of cases using cytology and urine biomarker-based ancillary techniques. Cancer Cytopathol 2020; 128:460-469. [PMID: 32083810 DOI: 10.1002/cncy.22252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Urine cytology results that are suspicious for urothelial carcinoma (UC) are challenging. The objective of this study was to elucidate the clinical significance of such results in patients who have a negative cystoscopy. METHODS In this prospective study, 83 patients who had urine cytology that was suspicious of UC and a negative cystoscopy underwent a second cystoscopy and urine evaluation by cytology, UroVysion fluorescence in situ hybridization (FISH) assay, FGFR3 (fibroblast growth factor receptor 3) and TERT (telomerase reverse transcriptase) mutations and an 8-gene expression classifier (GEC). Results from all techniques were compared with patients' clinical outcomes. RESULTS The presence of tumor was identified in 41% of patients; of these, 82% had tumors identified at their second evaluation (76% high-grade [HG] tumors), and 18% had tumors identified at a later follow-up (50% were HG tumors). After The Paris System for Reporting urinary Cytology (TPS) reclassification, 53 cytology results still had an indeterminate diagnosis (13 were suspicious for HGUC, and 40 had atypical urothelial cells (AUCs)]. Complete results from second evaluations using urine cytology, cytology-TPS, FISH, and GEC were available for 6 cases that were suspicious for HGUC and 34 cases that had AUCs. The sensitivity of these techniques to detect HG tumors in cases that were suspicious for HGUC was 100%, except for cytology-TPS, for which the sensitivity was 50%. The sensitivity of cytology and cytology-TPS to detect HG tumors in cases with AUCs was 33%, whereas the sensitivity of fluorescence in situ hybridization and GEC in these cases was 83% and 75%, respectively, to detect HG tumors at the second evaluation. CONCLUSIONS The current results indicate the relevant clinical significance of indeterminate urine cytology findings and strongly suggest the use of complementary evaluations by urine biomarker-based, ancillary techniques to elucidate their significance.
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Affiliation(s)
- Ruth Montalbo
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Laura Izquierdo
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mercedes Ingelmo-Torres
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Pilar Galve
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Manel Solé
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Agustín Franco
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - María José Ribal
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Lourdes Mengual
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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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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35
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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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Northrup V, Acar BC, Hossain M, Acker MR, Manuel E, Rahmeh T. Clinical follow up and the impact of the Paris system in the assessment of patients with atypical urine cytology. Diagn Cytopathol 2018; 46:1022-1030. [DOI: 10.1002/dc.24095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Victoria Northrup
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Deparment of Research Services; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
| | - Behram Cenk Acar
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Department of Pathology; Dalhousie University; Halifax Nova Scotia Canada
| | - Mohammad Hossain
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Department of Pathology; Dalhousie University; Halifax Nova Scotia Canada
| | - Matthew R. Acker
- Deparment of Urology; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Deparment of Urology; Dalhousie University; Halifax Nova Scotia Canada
| | - Eric Manuel
- Department of Medicine; Dalhousie Medicine New Brunswick; Saint John Canada
| | - Tarek Rahmeh
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Department of Pathology; Dalhousie University; Halifax Nova Scotia Canada
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Barkan GA, Wojcik EM, Pambuccian SE. A tale of atypia: What can we learn from this? Cancer Cytopathol 2018; 126:376-380. [DOI: 10.1002/cncy.22007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Güliz A. Barkan
- Department of Pathology; Loyola University Medical Center; Maywood Illinois
| | - Eva M. Wojcik
- Department of Pathology; Loyola University Medical Center; Maywood Illinois
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Virk RK, Abro S, de Ubago JMM, Pambuccian SE, Quek ML, Wojcik EM, Mehrotra S, Chatt GU, Barkan GA. The value of the UroVysion® FISH assay in the risk-stratification of patients with “atypical urothelial cells” in urinary cytology specimens. Diagn Cytopathol 2017; 45:481-500. [DOI: 10.1002/dc.23686] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Renu K. Virk
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Schuharazad Abro
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | | | | | - Marcus L. Quek
- Department of Urology; Loyola University Medical Center; Maywood IL 60153
| | - Eva M. Wojcik
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Swati Mehrotra
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Grazina U. Chatt
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
| | - Güliz A. Barkan
- Department of Pathology; Loyola University Medical Center; Maywood IL 60153
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