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Farahani SJ, Li J, Minder B, Vielh P, Glisic M, Muka T. Impact of implementing the first edition of the Paris system for reporting: A systematic review and meta-analysis. Cytopathology 2024. [PMID: 38934101 DOI: 10.1111/cyt.13407] [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: 08/18/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Urine cytology is a noninvasive, widely used diagnostic tool for screening and surveillance of genitourinary tract neoplasms. However, the absence of unified terminology and clear objective morphological criteria limits the clinical benefit of urine cytology. The Paris System for Reporting Urine Cytology (TPS) was developed with the goal of standardizing reporting and improving urine cytology performance in detecting high-grade malignancy (HGM). We aimed to evaluate potential effects of TPS on improving urine cytology diagnostic performance and clinical utility by conducting a systematic review and meta-analysis. We searched six electronic databases to identify cross-sectional and cohort studies written in English assessing the accuracy of urine cytology in detecting genitourinary tract malignancies of patients under surveillance or with clinical suspicion of malignancy from January 2004 to December 2022. We extracted relevant data from eligible studies to calculate relative distribution of cytology diagnostic categories; ratio of atypical to HGM cytology diagnosis; and risk of HGM (ROHGM) and HGM likelihood ratio (HGM-LR) associated with cytology diagnostic categories. We used a generalized linear mixed model with logit transformation to combine proportions and multilevel mixed-effect logistic regression to pool diagnostic accuracy measurements. We performed meta-regression to evaluate any significant difference between TPS and non-TPS cohorts. We included 64 studies for 99,796 combined total cytology samples, across 31 TPS and 49 non-TPS cohorts. Pooled relative distribution [95% confidence interval (CI)] of negative for high-grade urothelial carcinoma (NHGUC)/negative for malignancy (NM); atypical urothelial cells (AUC); suspicious for high-grade urothelial carcinoma (SHGUC)/suspicious for malignancy (SM); low-grade urothelial neoplasm (LGUN); and HGM categories among satisfactory cytology cases were 83.8% (80.3%-86.9%), 8.0% (6.0%-10.6%), 2.2% (1.4%-3.3%), 0.01% (0.0%-0.1%), and 4.2% (3.2%-5.5%) in TPS versus 80.8% (76.8-2.7%), 11.3% (8.6%-14.7%), 1.8% (1.2%-2.7%), 0.01% (0.0%-0.1%), and 3.3% (2.5%-4.3%) in non-TPS cohorts. Adopting TPS classification resulted in a significant increase in the frequency of NHGUC and a reduction in AUC cytology diagnoses, respectively. The AUC/HGM ratio in TPS cohort was 2.0, which showed a statistically significant difference from the atypical/HGM ratio of 4.1 in non-TPS cohort (p-value: 0.01). Moreover, the summary rate (95% CI) of LGUN called AUC on cytology significantly decreased to 20.8% (14.9%-28.3%) in the TPS compared with 34.1% (26.4%-42.8%) in non-TPS cohorts. The pooled ROHGM (95% CI) was 20.4% (6.2%-50.0%) in nondiagnostic (NDX), 15.5% (9.6%-24.2%) in NHGUC, 40.2% (30.9%-50.2%) in AUC, 80.8% (72.9%-86.8%) in SHGUC, 15.1% (5.7%-34.3%) in LGUN, and 91.4% (87.3%-94.3%) in HGM categories in TPS studies. NHGUC, AUC, SHGUC, and HGM categories were associated with HGM-LR (95% CI) of 0.2 (0.1-0.3), 0.9 (0.6-1.3), 6.9 (2.4-19.9), and 16.8 (8.3-33.8). Our results suggest that TPS 1.0 has reduced the relative frequency of AUC diagnosis, AUC/HGM ratio, and the frequency of LGUNs diagnosed as AUC on cytology. Adopting this classification has improved the clinical utility of SHGUC and HGM cytology diagnoses in ruling in high-grade lesions. However, an NHGUC diagnosis does not reliably rule out the presence of a high-grade lesion.
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Affiliation(s)
- Sahar J Farahani
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Caner, New York, New York, USA
| | - Joshua Li
- Department of Pathology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland
- Epistudia, Bern, Switzerland
| | - Taulant Muka
- Epistudia, Bern, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
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Ciaparrone C, Maffei E, L'Imperio V, Pisapia P, Eloy C, Fraggetta F, Zeppa P, Caputo A. Computer-assisted urine cytology: Faster, cheaper, better? Cytopathology 2024. [PMID: 38894608 DOI: 10.1111/cyt.13412] [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: 04/11/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
Recent advancements in computer-assisted diagnosis (CAD) have catalysed significant progress in pathology, particularly in the realm of urine cytopathology. This review synthesizes the latest developments and challenges in CAD for diagnosing urothelial carcinomas, addressing the limitations of traditional urinary cytology. Through a literature review, we identify and analyse CAD models and algorithms developed for urine cytopathology, highlighting their methodologies and performance metrics. We discuss the potential of CAD to improve diagnostic accuracy, efficiency and patient outcomes, emphasizing its role in streamlining workflow and reducing errors. Furthermore, CAD tools have shown potential in exploring pathological conditions, uncovering novel biomarkers and prognostic/predictive features previously unknown or unseen. Finally, we examine the practical issues surrounding the integration of CAD into clinical practice, including regulatory approval, validation and training for pathologists. Despite the promising results, challenges remain, necessitating further research and validation efforts. Overall, CAD presents a transformative opportunity to revolutionize diagnostic practices in urine cytopathology, paving the way for enhanced patient care and outcomes.
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Affiliation(s)
- Chiara Ciaparrone
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Elisabetta Maffei
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, IRCCS Fondazione San Gerardo dei Tintori, University of Milano-Bicocca, Milan, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Catarina Eloy
- Pathology Laboratory, Institute of Molecular Pathology and Immunology of University of Porto (IPATIMUP), Porto, Portugal
| | | | - Pio Zeppa
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Alessandro Caputo
- Department of Pathology, University Hospital of Salerno, Salerno, Italy
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
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Abe H, Kawahara A, Akiba J, Yamaguchi R. Advances in diagnostic liquid-based cytology. Cytopathology 2024. [PMID: 38837293 DOI: 10.1111/cyt.13405] [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: 01/29/2024] [Revised: 05/09/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
Liquid-based cytology (LBC) has changed the landscape of gynaecological cytology. A growing demand exists for LBC in diagnostic cytology, particularly for ancillary testing, such as immunocytochemistry and molecular testing. Ancillary testing solely based on conventional preparation (CP) methods remains challenging. Recently, the increased demand for specialist testing and minimally invasive techniques, such as endoscopic ultrasonography fine-needle aspiration, to obtain cellular samples has led to an increasing demand for ancillary testing on cytology LBC supernatant, slides and cell block (CB). This facilitates the diagnosis and prognosis in cytology samples enabling personalized treatment. An understanding of the history and future prospects of LBC is crucial for its application in routine diagnostics by cytopathologists and cytotechnologists. In this review, we initiated an internet search using the keyword 'liquid-based cytology', and we conducted a literature review to discuss the usefulness of combined diagnosis of LBC and CP, immunocytochemistry and molecular testing and assessed the quality of nucleic acids in diagnostic LBC. High-quality and cell-rich diagnostic LBC surpassed the CP method alone in terms of reliability and versatility of ancillary testing in cytological diagnosis. Conclusively, diagnostic LBC lends itself to various new technologies and is expected to continue evolving with innovations in the future.
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Affiliation(s)
- Hideyuki Abe
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Rin Yamaguchi
- Department of Diagnostic Pathology, Nagasaki University Hospital, Nagasaki, Japan
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Arora S, Singh P, Kumar A, Srivastava N, Kolte S, Yadav A. Impact of Implementing Paris System on Diagnostic Precision and Management of Urinary Bladder Neoplasms. Indian J Surg Oncol 2024; 15:225-235. [PMID: 38741619 PMCID: PMC11088611 DOI: 10.1007/s13193-023-01864-z] [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: 07/04/2023] [Accepted: 12/09/2023] [Indexed: 05/16/2024] Open
Abstract
The diagnosis of atypia has always been under question both by the pathologist and the clinician. It was one of the main aims of the Paris system (TPS) to reduce the number of cases under the AUC (Atypical urothelial cells) category. With the strict criteria laid down by the Paris system, the rate of diagnosis of this category has reduced markedly. This study was done to test the impact of implementing TPS categories and criteria in comparison to our previously used system. TPS is one of the important deciding factors for the management of the patient. The management of patients with AUC diagnosis often varies depending on the treating physician (urologist/nonurologist). For further categorization of the diagnosis of AUC, markers like p53 and Ki67 can be used. One hundred urinary cytology specimens received for the period of 6 months were included in the study. The presentation of the categorical variables was done in the form of numbers and percentages (%). Interrater kappa agreement was used to find out the strength of the agreement between the Paris system and the traditional system. Using histopathological diagnosis as the gold standard, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic accuracy were calculated. Immunohistochemistry was performed on the cell block for Ki67 and p53, and their values were correlated with histopathological examination, using Spearman's rank correlation. The interrater kappa agreement analyzed between the traditional reporting system and the Paris system was 0.522. Around 32% (6/19) of cases that were reported as AUC by the traditional system were recategorized under negative for high-grade urothelial carcinoma (NHGUC) by the Paris system. Thus, obliviating the need for further management and decreasing the unnecessary cost of the health care system with a decrease in patient anxiety. Histopathology was available in 28 cases and diagnostic accuracy of urine cytology classified by TPS was 89.2% with a sensitivity of 94.4%, specificity of 80%, positive likelihood ratio of 89.4, and negative likelihood ratio of 88.6. The correlation coefficient of p53 with grading of carcinoma was found to be strong at 0.864. The correlation coefficient of Ki67 with grading of carcinoma was also as strong as 0.885. TPS along with immunohistochemistry improves the performance of urine cytology by reclassifying the AUC category into other groups and increases the sensitivity for detecting HGUC.
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Affiliation(s)
- Sheetal Arora
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Priyanka Singh
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Aman Kumar
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Namita Srivastava
- Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sachin Kolte
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Amit Yadav
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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VandenBussche CJ, Heaney CD, Kates M, Hooks JJ, Baloga K, Sokoll L, Rosenthal D, Detrick B. Urinary IL-6 and IL-8 as predictive markers in bladder urothelial carcinoma: A pilot study. Cancer Cytopathol 2024; 132:50-59. [PMID: 37812596 DOI: 10.1002/cncy.22767] [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: 05/12/2023] [Revised: 07/05/2023] [Accepted: 08/16/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Cytokines are known to be a key a factor in numerous malignancies and to exert an important regulatory role in the tumor microenvironment. Interest has grown in understanding how cytokines modulate the tumor microenvironment and which cytokines may serve as markers of the tumor process; however, a complete picture of the cytokine landscape in bladder cancer remains unclear. METHODS Fresh urine specimens with sufficient volume were collected at random intervals. The urine concentrations of IL-8 (CXCL8), CCL18, and CXCL9 were determined using the standard commercially available enzyme immunoassay. The urine concentrations of IL-6 were determined using the high sensitivity enzyme immunoassay kit. Urinary cytokine concentrations were normalized with urinary creatinine concentrations. RESULTS Significantly elevated concentrations of IL-6 and IL-8 were detected in the urine from patients with urothelial carcinoma on follow-up compared to patients with benign follow-up. The presence of both IL-6 and IL-8 in the urine samples from the high grade urothelial carcinoma (HGUC) cohort revealed a clear discrimination when compared to samples from patients with benign follow-up. The presence of the combination of both IL-6 and IL-8 had a sensitivity of 90.0% and a specificity of 81.25%. Similar data were obtained when receiver operating characteristic analysis was performed on both IL-6 and IL-8 concentrations in the urine from patients with HGUC vs. the hematuria cohort. CONCLUSIONS The presence of IL-6 and IL-8 in urine specimens may have predictive value for urothelial carcinoma. However, a large longitudinal study is required to statistically eliminate confounding factors and support this theory.
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Affiliation(s)
- Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Max Kates
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, Maryland, USA
| | - John J Hooks
- Laboratory of Immunology, Virology Section, NEI, NIH, Bethesda, Maryland, USA
| | - Kelly Baloga
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lori Sokoll
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorothy Rosenthal
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barbara Detrick
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Christofidis K, Moulavasilis N, Fragkiadis E, Goutas D, Lazaris AC, Mitropoulos D, Mikou P. Diagnosis of Low-Grade Urothelial Neoplasm in the Era of the Second Edition of the Paris System for Reporting Urinary Cytology. Diagnostics (Basel) 2023; 13:2625. [PMID: 37627884 PMCID: PMC10453841 DOI: 10.3390/diagnostics13162625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The Paris System for Reporting Urinary Cytology (TPS) is considered the gold standard when it comes to diagnostic classifications of urine specimens. Its second edition brought some important changes, including the abolition of the diagnostic category of "low-grade urothelial neoplasm (LGUN)", acknowledging the inability of cytology to reliably discern low-grade urothelial lesions. METHODS In this retrospective study, we assessed the validity of this change, studying the cytological diagnoses of histologically diagnosed low-grade urothelial carcinomas during a three-year period. Moreover, we correlated the sum of the urinary cytology diagnoses of this period with the histological diagnoses, whenever available. RESULTS Although all the cytological diagnoses of LGUN were concordant with the histological diagnoses, most low-grade urothelial carcinomas were misdiagnosed cytologically. Subsequently, the positive predictive value (PPV) of urinary cytology for the diagnosis of LGUN was 100%, while the sensitivity was only 21.7%. Following the cyto-histopathological correlation of the sum of the urinary cytology cases, the sensitivity of urinary cytology for the diagnosis of high-grade urothelial carcinoma (HGUC) was demonstrated to be 90.1%, the specificity 70.8%, the positive predictive value (PPV) 60.3%, the negative predictive value (NPV) 93.6% and the overall accuracy 77.2%, while for LGUN, the values were 21.7%, 97.2%, 87.5%, 58.6% and 61.9%, respectively. Risk of high-grade malignancy was 0% for the non-diagnostic (ND), 4.8% for the non-high-grade urothelial carcinoma (NHGUC), 33.3% for the atypical urothelial cells (AUCs), 65% for the suspicious for high-grade urothelial carcinoma (SHGUC), 100% for the HGUC and 12.5% for the LGUN diagnostic categories. CONCLUSIONS This study validates the incorporation of the LGUN in the NHGUC diagnostic category in the second edition of TPS. Moreover, it proves the ability of urinary cytology to safely diagnose HGUC and stresses the pivotal role of its diagnosis.
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Affiliation(s)
| | - Napoleon Moulavasilis
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Evangelos Fragkiadis
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Dimitrios Goutas
- 1st Laboratory of Pathology, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (D.G.); (A.C.L.)
| | - Andreas C. Lazaris
- 1st Laboratory of Pathology, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (D.G.); (A.C.L.)
| | - Dionisios Mitropoulos
- 1st Urology Department, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece; (N.M.); (E.F.); (D.M.)
| | - Panagiota Mikou
- Cytopathology Department, Laiko General Hospital, 11527 Athens, Greece;
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Liu CL, Tsai HW, Peng SL, Chang CP, Chang YH, Huang HS. CDCP1 (CUB domain containing protein 1) is a potential urine-based biomarker in the diagnosis of low-grade urothelial carcinoma. PLoS One 2023; 18:e0281873. [PMID: 36862682 PMCID: PMC9980759 DOI: 10.1371/journal.pone.0281873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/01/2023] [Indexed: 03/03/2023] Open
Abstract
Urine-based cytology is non-invasive and widely used for clinical diagnosis of urothelial carcinoma (UC), but its sensitivity is less than 40% for low-grade UC detection. As such, there is a need for new diagnostic and prognostic biomarkers of UC. CUB domain containing protein 1 (CDCP1) is a type I transmembrane glycoprotein highly expressed in various cancers. Using tissue array analysis, we demonstrated that CDCP1 expression in UC patients (n = 133), especially in those with low-grade UC, was significantly higher than in 16 normal persons. In addition, CDCP1 expression in urinary UC cells could also be detected by using immunocytochemistry method (n = 11). Furthermore, in 5637-CD cells, overexpression of CDCP1 affected the expression of epithelial mesenchymal transition-related markers and increased matrix metalloproteinase 2 expression and migration ability. Conversely, the knockdown of CDCP1 in T24 cells had the opposite effects. Using specific inhibitors, we demonstrated the involvement of c-Src/PKCδ signaling in the CDCP1-regulated migration of UC. In conclusion, our data suggest that CDCP1 contributes to the malignant progression of UC and may have the potential as a urine-based biomarker for detecting low-grade UC. However, a cohort study needs to be conducted.
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Affiliation(s)
- Chien-Liang Liu
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Ling Peng
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Hao Chang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huei-Sheng Huang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- * E-mail:
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Harvey SE, VandenBussche CJ. Nuclear membrane irregularity in high-grade urothelial carcinoma cells can be measured by using circularity and solidity as morphometric shape definitions in digital image analysis of urinary tract cytology specimens. Cancer Cytopathol 2023. [PMID: 36794999 DOI: 10.1002/cncy.22682] [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: 09/27/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND The Paris System for Reporting Urine Cytology defines objective (elevated nuclear/cytoplasmic ratio ≥0.7) and subjective (nuclear membrane irregularity, hyperchromicity, and coarse chromatin) cytomorphologic criteria to identify conventional high-grade urothelial carcinoma (HGUC) cells. Digital image analysis allows quantitative and objective measurement of these subjective criteria. In this study, digital image analysis was used to quantitate nuclear membrane irregularity in HGUC cells. METHODS Whole-slide images of HGUC urine specimens were acquired, and HGUC nuclei were manually annotated using the open-source bioimage analysis software QuPath. Custom scripts were used to calculate nuclear morphometrics and perform downstream analysis. RESULTS In total, 1395 HGUC cell nuclei were annotated across 24 HGUC specimens (48.1 ± 6.0 nuclei per case) using both pixel-level and smooth annotation approaches. Nuclear membrane irregularity was estimated by calculating nuclear circularity and solidity. Annotating at pixel-level resolution artifactually increases nuclear membrane perimeter, thus smoothing is necessary to better approximate a pathologist's assessment of nuclear membrane irregularity. After smoothing, nuclear circularity and solidity discriminate between HGUC cell nuclei with visually apparent differences in nuclear membrane irregularity. CONCLUSIONS Nuclear membrane irregularity defined by The Paris System for Reporting Urine Cytology is inherently subjective. This study identifies nuclear morphometrics that visually correlate with nuclear membrane irregularity. HGUC specimens show intercase variation in nuclear morphometrics, with some nuclei appearing remarkably regular while others show marked irregularity. A small population of irregular nuclei generates most of the intracase variation in nuclear morphometrics. These results highlight nuclear membrane irregularity as an important, but not definitive, cytomorphologic criterion in HGUC diagnosis.
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Affiliation(s)
- Samuel E Harvey
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Galceran J, Parada D, Eden M, Tumino R, Warren AY, Martos C, Neamtiu L, Visser O, Daubisse-Marliac L. The 2022 ENCR Recommendations on recording and reporting of urothelial tumours of the urinary tract. Front Oncol 2022; 12:1046239. [PMID: 36505871 PMCID: PMC9727225 DOI: 10.3389/fonc.2022.1046239] [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: 09/16/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
An updated European Network of Cancer registries (ENCR) Recommendations on Recording and Reporting of Urothelial Tumours of the Urinary Tract had been published in 2022. After the publication by the ENCR of the "Recommendations for coding bladder cancers" in 1995, knowledge about the biology and pathology of urinary tract tumors and their classification has varied and increased substantially. On the other hand, several studies have shown that cancer registries use different definitions, criteria for inclusion and coding of urothelial tumors. This great variability among registries affects not only the criteria for recording (registration, coding and classification) but also the criteria of reporting (counting in the statistics of incidence and survival) urinary tract tumors. This causes difficulties in the data comparability from different registries. Recording and reporting of urothelial tumors requires the application of standard criteria that must take into account the combination of the multiple aspects as the primary topography, the histological type, the grade, the extent of invasion, the multi-centricity, the progressions and the time interval between tumors. This led to the creation of a Working Group of the ENCR that developed these recommendations on the recording and reporting of urothelial tumors of the urinary tract. This article reports these recommendations and the rationale for each.
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Affiliation(s)
- Jaume Galceran
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Reus, Spain,Institut d’Investigacions Sanitàries Pere Virgili (IISPV), Reus, Spain,Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus-Tarragona, Spain,*Correspondence: Jaume Galceran, ; Carmen Martos,
| | - David Parada
- Institut d’Investigacions Sanitàries Pere Virgili (IISPV), Reus, Spain,Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus-Tarragona, Spain,Pathology Service, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Anne Yvonne Warren
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Carmen Martos
- European Commission, Joint Research Centre (JRC), Ispra, Italy,*Correspondence: Jaume Galceran, ; Carmen Martos,
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | - Otto Visser
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Laetitia Daubisse-Marliac
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France,CERPOP, Toulouse University, Inserm UMR 1295, UPS, Toulouse, France,FRANCIM, Network of French Cancer Registries, Toulouse, France,University Hospital Center, IUCT-O, Cancer Coordination Center, Toulouse, France
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10
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Yuan L, Gero M, Zia S, Aryal SC, Shetty S, Reynolds JP. Cyto-histo correlation and false-negative urine: Before and after the Paris system for reporting urinary cytology. Diagn Cytopathol 2022; 50:404-410. [PMID: 35652594 DOI: 10.1002/dc.24982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of implementing the Paris system (TPS) on the rate of discrepant cases in the negative for high-grade urothelial carcinoma (NHGUC) category that had a subsequent diagnosis of high-grade urothelial carcinoma (HGUC) on histology is not well studied. METHODS We adopted TPS in May 2019. We searched discrepant cases with negative urine cytology 2017-2019 in our cyto-histo correlation database. The urine cytology and follow-up biopsy/resection were reviewed by a cytopathologist who also did Genitourinary (GU) Pathology subspecialty sign-out. Voided urine and instrumented urine were included in this study. RESULTS There were total of 70 discrepant cases with negative cytology interpretation but HGUC on the subsequent biopsy or resected specimen. Following the TPS criteria, the rate of discrepant negative cytology cases increased from 6 cases between January 2017 and May 2019 to 64 cases after May 2019 when we adopted TPS. There were 2 discrepant negative cases in 2017, 3 cases in 2018, and 65 cases in 2019. Out of 65 cases in 2019, 64 cases were identified after May 2019. Additional 55 urine cytology slides were reviewed according to the TPS criteria, of which, the diagnoses remained unchanged in 45 (82%) cases and 10 (19%) cases were reassigned to either atypical or suspicious categories. The discrepancy was noted more on the instrumented urine and the upper tract urine. However, the false-negative rate rose faster in voided urine and lower tract urine. The risk of HGUC with the category of NHGUC was 0.03% in 2017, 0.05% in 2018, and 1.06% in 2019 at our institution. The increase in false-negative rate could not be attributed to a single cytopathologist. CONCLUSION After adopting TPS for reporting urine cytology, there was an increase in HGUC from negative urine cytology which was subsequently confirmed on histology as cases of HGUC. The quality control of negative urines could be important monitoring the process when implementing TPS.
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Affiliation(s)
- Lisi Yuan
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Margaret Gero
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shereen Zia
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameer Chhetri Aryal
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sindhu Shetty
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jordan P Reynolds
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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11
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Abd El-Salam MA, Smith CEP, Pan CX. Insights on recent innovations in bladder cancer immunotherapy. Cancer Cytopathol 2022; 130:667-683. [PMID: 35653623 DOI: 10.1002/cncy.22603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/12/2022]
Abstract
Bladder carcinoma is the most common genitourinary cancer, with a high prevalence and global incidence. In addition to early detection by cytology, the management of bladder cancer has recently advanced, not only by improvements in conventional treatments such as surgery and chemotherapy, but also through the introduction of immunotherapeutic strategies. The number of approved immunotherapeutic agents has dramatically increased, with various preclinical and clinical applications in cancer drug discovery. Some bladder cancer immunotherapies include immune checkpoint inhibitors, adoptive cell therapy, cytokine-based therapy, bispecific antibodies, and antibody-drug conjugates. This review provides an overview of some of the innovative immunotherapeutic agents approved and in development that can potentially be used in the treatment of bladder cancer.
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Affiliation(s)
- Mohamed A Abd El-Salam
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Institute for Research in Biomedicine (IRB) Barcelona, The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Department of Pharmacognosy, Faculty of Pharmacy, Delta University for Science and Technology International Coastal Road, Gamasa, Egypt
| | - Claire E P Smith
- Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Hematology and Medical Oncology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Chong-Xian Pan
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
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12
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Allison DB, Zhang ML, Vohra P, VandenBussche CJ. The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens. Diagnostics (Basel) 2022; 12:diagnostics12040931. [PMID: 35453979 PMCID: PMC9025489 DOI: 10.3390/diagnostics12040931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Since the release of The Paris System for Reporting Urinary Cytology (TPS), the assessment of urine cytology specimens has primarily focused on the detection of high-grade urothelial carcinoma (HGUC) and carcinoma in situ (CIS). Fortunately, the malignant cells in these lesions tend to be loosely cohesive, resulting in the natural exfoliation of individual malignant cells into the urine. However, HGUC/CIS lesions occasionally exfoliate larger fragments which can be difficult to assess due to cellular overlap and fragment three-dimensionality. Furthermore, reactive benign urothelial fragments and fragments from low-grade urothelial neoplasms (LGUN) may also be seen in urine specimens and contain atypical cytomorphologic features. As a result, the significance of urothelial tissue fragments (UTFs) is often unclear. Herein, we discuss the literature on UTFs before and after the implementation of TPS, as well as strategies to help overcome this diagnostic challenge.
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Affiliation(s)
- Derek B. Allison
- Department of Pathology and Laboratory Medicine, Lexington, KY 40536, USA;
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - M. Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Poonam Vohra
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Christopher J. VandenBussche
- Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-410-955-1180
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13
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Yamasaki M, Taoka R, Katakura K, Matsunaga T, Kani N, Honda T, Harada S, Tohi Y, Matsuoka Y, Kato T, Okazoe H, Tsunemori H, Ueda N, Haba R, Sugimoto M. The Paris System for reporting urinary cytology improves the negative predictive value of high-grade urothelial carcinoma. BMC Urol 2022; 22:51. [PMID: 35382830 PMCID: PMC8985280 DOI: 10.1186/s12894-022-01005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Paris System (TPS) for reporting urinary cytology differs from conventional systems (CS) in that it focuses on the diagnosis of high-grade urothelial carcinoma (HGUC). This study investigated the impact of TPS implementation on the diagnostic accuracy of HGUC by comparing it with our institutional CS. Methods A total of 649 patients who underwent transurethral resection of bladder tumor (TURBT) between January 2009 and December 2020 were included in this study. Our institution adopted TPS to report urinary cytology in February 2020. The diagnostic accuracy of HGUC in preoperative urinary cytology was compared with the presence or absence of HGUC in resected specimens of TURBT before and after TPS implementation. Results After implementing TPS in urinary cytology, 89 patients were reviewed and compared with 560 patients whose urinary cytology was diagnosed by CS. TPS and CS for detecting HGUC had 56.0% and 58.2% sensitivity, 97.8% and 91.2% specificity, and 93.3% and 87.9% positive predictive values, respectively. There were no significant differences between TPS and CS in terms of sensitivity, specificity, and positive predictive value for HGUC (P = 0.83, 0.21, 1.00). On the other hand, the negative predictive value for HGUC using TPS was 80.0%, which was significantly higher than that of CS (66.4%, P = 0.04) The multivariate logistic regression analysis indicated that not using TPS was one of the independent predictive factors associated with false-negative results for HGUC (odds ratio, 2.26; 95% confidence interval, 1.08–4.77; P = 0.03). Conclusion In instances where urinary cytology is reported as negative for HGUC by TPS, there is a low probability of HGUC, indicating that TPS has a potential diagnostic benefit.
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Affiliation(s)
- Mari Yamasaki
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan.
| | - Kazuya Katakura
- Department of Diagnostic Pathology, University Hospital, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Toru Matsunaga
- Department of Diagnostic Pathology, University Hospital, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Naoya Kani
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Tomoko Honda
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Satoshi Harada
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Homare Okazoe
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, University Hospital, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan
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14
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McIntire PJ, Aragao A, Burns BL, Pambuccian SE, Wojcik EM, Barkan GA. Digital image analysis of high-grade urothelial carcinoma in urine cytology confirms chromasia heterogeneity and reveals a subset with hypochromatic nuclei and another with extremely dark or "India ink" nuclei. Cancer Cytopathol 2022; 130:363-369. [PMID: 35104393 DOI: 10.1002/cncy.22554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Paris System for Reporting Urinary Cytology (TPS) uses hyperchromasia as major diagnostic criterion for high-grade urothelial carcinoma (HGUC). The purpose of the study was to evaluate cases that were diagnosed as HGUC by TPS and determine whether there are different chromatin distribution patterns (ie, subsets). METHODS Digital image annotations were performed on microscopic images of HGUC urine specimens with surgical biopsy/resection follow-up. Median gray values were generated for each cell. Neutrophils (polymorphonuclear leukocyte [PMN]) were also enumerated in each case to serve as an internal control. A HGUC/PMN ratio was generated for each case, and the cases were distributed. RESULTS Sixty-nine HGUC cases yielded 2660 cells, including 2078 HGUC (30.1 cells/case) and 582 PMNs (8.4 cells/case). The average median gray value of an HGUC was 50.6 and of a PMN was 36.8 (P < .0001). Eight of 69 cases (11.6%) contained nuclei that, on average, were darker than or as dark as a PMN (extremely dark, ie, "India ink"). Fifty-one of 69 cases (74.0%) contained nuclei that, on average, were slightly brighter than a PMN (hyperchromatic). Ten of 69 cases (14.5%) contained nuclei that, on average, were much brighter than a PMN (hypochromatic). Within a single case, all cases showed heterogeneity with the hypochromatic cases showing the most dramatic effect. CONCLUSIONS Digital image analysis reveals that there are large variations in chromasia between cases including a subset of cases with hypochromasia and another with extremely dark or "India ink" nuclei. There was much heterogeneity of chromasia seen within a single sample.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Alessa Aragao
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Bethany L Burns
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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15
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Nikas IP, Seide S, Proctor T, Kleinaki Z, Kleinaki M, Reynolds JP. The Paris System for Reporting Urinary Cytology: A Meta-Analysis. J Pers Med 2022; 12:jpm12020170. [PMID: 35207658 PMCID: PMC8874476 DOI: 10.3390/jpm12020170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
The Paris System (TPS) for Reporting Urinary Cytology is a standardized, evidence-based reporting system, comprising seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other malignancies. This study aimed to calculate the pooled risk of high-grade malignancy (ROHM) of each category and demonstrate the diagnostic accuracy of urine cytology reported with TPS. Four databases (PubMed, Embase, Scopus, Web of Science) were searched. Specific inclusion and exclusion criteria were applied, while data were extracted and analyzed both qualitatively and quantitatively. The pooled ROHM was 17.70% for the nondiagnostic category (95% CI, 0.0650; 0.3997), 13.04% for the NHGUC (95% CI, 0.0932; 0.1796), 38.65% for the AUC (95% CI, 0.3042; 0.4759), 12.45% for the LGUN (95% CI, 0.0431; 0.3101), 76.89 for the SHGUC (95% CI, 0.7063; 0.8216), and 91.79% for the HGUC and other malignancies (95% CI, 0.8722; 0.9482). A summary ROC curve was created and the Area Under the Curve (AUC) was 0.849, while the pooled sensitivity was 0.669 (95% CI, 0.589; 0.741) and false-positive rate was 0.101 (95% CI, 0.063; 0.158). In addition, the pooled DOR of the included studies was 21.258 (95% CI, 14.336; 31.522). TPS assigns each sample into a diagnostic category linked with a specific ROHM, guiding clinical management.
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Affiliation(s)
- Ilias P. Nikas
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Correspondence:
| | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Zoi Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Internal Medicine Department, General Hospital of Nikea, 18454 Athens, Greece
| | - Maria Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
| | - Jordan P. Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32256, USA;
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16
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Hermans J, Jokisch F, Volz Y, Eismann L, Pfitzinger P, Ebner B, Weinhold P, Schlenker B, Stief CG, Tritschler S, Schulz GB. Impact of bacillus Calmette‐Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high‐grade bladder cancer. Cancer Cytopathol 2021; 130:294-302. [DOI: 10.1002/cncy.22539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Julian Hermans
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | | | - Yannic Volz
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | - Lennert Eismann
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | - Paulo Pfitzinger
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | - Benedikt Ebner
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | - Philipp Weinhold
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | - Boris Schlenker
- Department of Urology Ludwig‐Maximilians University Munich Germany
| | | | - Stefan Tritschler
- Department of Urology and Urologic Oncology Loretto Hospital Freiburg Germany
| | - Gerald B. Schulz
- Department of Urology Ludwig‐Maximilians University Munich Germany
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17
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Allison DB, Kates M, VandenBussche CJ. Indeterminate atypia in urinary tract cytology: Does it really matter? Diagn Cytopathol 2021; 50:176-183. [PMID: 34870896 DOI: 10.1002/dc.24912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
The study of atypia in urinary cytology has been ongoing for decades but most studies have focused primarily on test performance in patients with concurrent biopsies and/or limited follow-up periods. While these data are useful, many studies fail to consider patient factors that may alter the pretest probability, which can subsequently affect test performance. An isolated diagnosis of malignancy in urinary cytology usually has a high positive predictive value and allows a urologist to conduct a rigorous workup of the patient to establish a tissue diagnosis. However, it is less certain how an atypical diagnosis impacts patient care, given that many patients have a history of bladder cancer and are already under surveillance with cystoscopy at regular screening intervals. Furthermore, a discrete negative urine cytology is unlikely to allow a patient to forego a cystoscopy procedure due to limitations in the sensitivity of urine cytology. Over the last several years, the introduction of The Paris System for Reporting Urinary Cytology (TPS) has improved the predictive value of atypical diagnoses, but additional studies are needed to evaluate the performance of these diagnoses in specific clinical situations. Such data could better inform urologists on how to manage patients with atypical diagnoses. This review discussed the diagnosis of atypia in urinary cytology and the impact of such a diagnosis in various clinical contexts.
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Affiliation(s)
- Derek B Allison
- Department of Pathology and Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Max Kates
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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18
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Varela Dos Santos M, Pacheco J, Barroca H. Guar cells in urine cytology: Two case reports and literature review. Cytopathology 2021; 32:671-673. [PMID: 34191380 DOI: 10.1111/cyt.13028] [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: 03/20/2021] [Revised: 06/04/2021] [Accepted: 06/26/2021] [Indexed: 12/01/2022]
Affiliation(s)
| | - João Pacheco
- Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Helena Barroca
- Centro Hospitalar Universitário de São João, Porto, Portugal
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19
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Lilli L, Giarnieri E, Scardapane S. A Calibrated Multiexit Neural Network for Detecting Urothelial Cancer Cells. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5569458. [PMID: 34234839 PMCID: PMC8216797 DOI: 10.1155/2021/5569458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
Deep convolutional networks have become a powerful tool for medical imaging diagnostic. In pathology, most efforts have been focused in the subfield of histology, while cytopathology (which studies diagnostic tools at the cellular level) remains underexplored. In this paper, we propose a novel deep learning model for cancer detection from urinary cytopathology screening images. We leverage recent ideas from the field of multioutput neural networks to provide a model that can efficiently train even on small-scale datasets, such as those typically found in real-world scenarios. Additionally, we argue that calibration (i.e., providing confidence levels that are aligned with the ground truth probability of an event) has been a major shortcoming of prior works, and we experiment a number of techniques to provide a well-calibrated model. We evaluate the proposed algorithm on a novel dataset, and we show that the combination of focal loss, multiple outputs, and temperature scaling provides a model that is significantly more accurate and calibrated than a baseline deep convolutional network.
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Affiliation(s)
- L. Lilli
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Italy
| | - E. Giarnieri
- Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - S. Scardapane
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome, Italy
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20
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Okuda C, Kyotake A, Nakamura A, Itoh T, Kamoshida S, Ohsaki H. Quantitative cytomorphological comparison of SurePath and ThinPrep liquid-based cytology using high-grade urothelial carcinoma cells. Cytopathology 2021; 32:654-659. [PMID: 34033150 DOI: 10.1111/cyt.12998] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In The Paris System for Reporting Urinary Cytology (TPS), the important cytomorphological features for diagnosing high-grade urothelial carcinoma (HGUC) are a nuclear-to-cytoplasmic (N:C) ratio exceeding 0.7, hyperchromasia, coarse chromatin, and irregular nuclear borders. However, quantitative cytomorphological assessments of HGUC cells using SurePath slides are rare. Therefore, we evaluated HGUC cells on SurePath slides quantitatively using a digital image analysis system and compared these data with ThinPrep data. METHODS The same urine samples were divided into two aliquots and used to prepare SurePath and ThinPrep slides. We used ImageJ to measure the N:C ratio, hyperchromasia, and irregular nuclear borders for HGUC cells on SurePath and ThinPrep slides. RESULTS The total number of analysed HGUC cells on SurePath slides was 981, versus 889 on ThinPrep slides. Hyperchromasia and irregular nuclear borders were significantly more severe on SurePath than on ThinPrep slides. Conversely, the N:C ratio did not differ between the methods. Additionally, HGUC cells with N:C ratios exceeding 0.7 were present on almost all slides for both methods. CONCLUSIONS Our data indicated the reasonableness of using the N:C ratio as the major criterion for TPS on both SurePath and ThinPrep slides, and an N:C ratio cut-off of 0.7 as suitable for identifying HGUC cells. However, the severity of hyperchromasia and irregular nuclear borders differed between the processing methods.
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Affiliation(s)
- Chihiro Okuda
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Aiko Kyotake
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kamoshida
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
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21
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Bladder cancer therapy using a conformationally fluid tumoricidal peptide complex. Nat Commun 2021; 12:3427. [PMID: 34103518 PMCID: PMC8187399 DOI: 10.1038/s41467-021-23748-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/15/2021] [Indexed: 02/05/2023] Open
Abstract
Partially unfolded alpha-lactalbumin forms the oleic acid complex HAMLET, with potent tumoricidal activity. Here we define a peptide-based molecular approach for targeting and killing tumor cells, and evidence of its clinical potential (ClinicalTrials.gov NCT03560479). A 39-residue alpha-helical peptide from alpha-lactalbumin is shown to gain lethality for tumor cells by forming oleic acid complexes (alpha1-oleate). Nuclear magnetic resonance measurements and computational simulations reveal a lipid core surrounded by conformationally fluid, alpha-helical peptide motifs. In a single center, placebo controlled, double blinded Phase I/II interventional clinical trial of non-muscle invasive bladder cancer, all primary end points of safety and efficacy of alpha1-oleate treatment are reached, as evaluated in an interim analysis. Intra-vesical instillations of alpha1-oleate triggers massive shedding of tumor cells and the tumor size is reduced but no drug-related side effects are detected (primary endpoints). Shed cells contain alpha1-oleate, treated tumors show evidence of apoptosis and the expression of cancer-related genes is inhibited (secondary endpoints). The results are especially encouraging for bladder cancer, where therapeutic failures and high recurrence rates create a great, unmet medical need.
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Henning GM, Barashi NS, Smith ZL. Advances in Biomarkers for Detection, Surveillance, and Prognosis of Bladder Cancer. Clin Genitourin Cancer 2021; 19:194-198. [PMID: 33781702 DOI: 10.1016/j.clgc.2020.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/24/2020] [Accepted: 12/26/2020] [Indexed: 02/07/2023]
Abstract
Bladder cancer may present management challenges, as it frequently recurs and can progress when not expeditiously diagnosed and carefully monitored following initial therapy for noninvasive disease. Cystoscopy and cytology have long been the primary tools for the urologist treating bladder cancer. However, as a host of potential biomarkers have been developed, new avenues for noninvasive testing have become available in the detection, surveillance, and prognostic setting. Analysis of urine for mutational signatures at the genetic and epigenetic levels appears promising, but such testing has yet to become widely adopted into clinical practice. Here, we review recent advances in bladder cancer biomarker assays, with particular attention to clinical relevance and potential application.
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Affiliation(s)
- Grant M Henning
- Division of Urology, Washington University School of Medicine, St Louis, MO
| | - Nimrod S Barashi
- Division of Urology, Washington University School of Medicine, St Louis, MO
| | - Zachary L Smith
- Division of Urology, Washington University School of Medicine, St Louis, MO.
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Rohra P, Ocampo Gonzalez FA, Yan L, Mir F, Furlan K, Basu S, Barua A, Cheng L, Park JW. Effect of the Paris system for reporting urinary cytology with histologic follow-up. Diagn Cytopathol 2021; 49:691-699. [PMID: 33600080 DOI: 10.1002/dc.24723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Paris system (TPS) for Reporting Urinary Cytology provides a standardized reporting system whose main focus is the diagnosis of high-grade urothelial carcinoma (HGUC). We conducted a study to see the impact of The Paris System on our cytologic diagnoses with associated histology. MATERIALS AND METHODS We reviewed our pathology database regarding urinary specimens in the year before implementation of The Paris System and the year after. We gathered the data regarding cytologic diagnosis and concurrent/subsequent histology. RESULTS Over a 1-year period from 2016-2017, 486 urine cytology specimens were identified before implementation of The Paris System and diagnosed as follows: 83% benign/negative, 10% atypical, 2% suspicious, 5% HGUC, 0.2% low grade urothelial neoplasm (LGUN), and 0.2% unsatisfactory. Over a next 1-year period from 2017 to 2018, 602 specimens used TPS and diagnosed as follows: 85% negative for HGUC, 6% atypical, 3% suspicious, 4% HGUC, 0.17% LGUN, and 2% unsatisfactory. Although, not listed as a standardized category in The Paris System, our institution used "Negative for high-grade, cannot rule out low-grade urothelial neoplasm (NHL)" as a subcategory of Negative for HGUC. 4% of the cases fell into this category. Focusing on the Atypical category before TPS, histology was available in 15/49 (31%) cases. Of these, 40% had HGUC. Regarding the Atypical category after TPS, histology was available in 21/36 (58%) cases. Of these, 52% were HGUC. For the NHL category, concurrent histology was available in 13/26 (50%) cases. Of these, 67% were low grade urothelial neoplasms. CONCLUSION Our study showed that TPS lowered the rate of Atypical from 10% to 6%. After the implementation of TPS, Atypical corresponded to a higher rate of high-grade urothelial carcinoma. Also, the NHL subcategory had a high positive predictive value for diagnosing low grade urothelial neoplasms.
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Affiliation(s)
- Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sanjib Basu
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Animesh Barua
- Departments of Cell and Molecular Medicine, Pathology and OB/GYN, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ji-Weon Park
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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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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McIntire PJ, Kilic I, Pambuccian SE, Wojcik EM, Barkan GA. The Paris System for Reporting Urinary Cytology reduces atypia rates and does not alter the negative predictive value of urine cytology. J Am Soc Cytopathol 2020; 10:14-19. [PMID: 33221245 DOI: 10.1016/j.jasc.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (TPS) was developed for standardization purposes and it placed an emphasis on screening for high-grade urothelial carcinoma (HGUC). Since then, it has shown to reduce atypia rates and better correlate with surgical specimens. The aim of this study was to calculate the negative predictive value (NPV) of urinary cytology for detecting HGUC using TPS and compare these data to our recently published pre-TPS cohort. As a screening test, it is imperative that TPS has a high NPV. MATERIAL AND METHODS A search of our institution's pathology database for the term "negative for HGUC" from January 1, 2016, to December 31, 2017, was conducted. A true negative was defined as a patient with at least 1 subsequent negative urine cytology/surgical biopsy specimen or the patient being clinically negative for 6 months. NPV rates were calculated based on the data obtained. RESULTS The cohort consisted of 2960 urine cytology specimens from 1894 patients. A total of 99 false negatives were identified, generating a NPV of 96.7% (2861/2960). This NPV is identical to our previously published pre-TPS cohort (years 2012-2013; NPV: 96.7%). The clinical indication most effected NPV, with a history of urothelial carcinoma with a NPV of 93.9% followed by hematuria at 98.9%. The atypia rate in years 2012-2013 was 8.2% and in 2016-2017 it was 5.7% (P < 0.001). CONCLUSIONS We demonstrate that TPS did not alter the NPV for detecting HGUC compared to our pre-TPS cohort. We believe that TPS is an effective reporting system for screening HGUC in urinary cytology.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois.
| | - Irem Kilic
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
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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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Moulavasilis N, Lazaris A, Katafigiotis I, Stravodimos K, Constantinides C, Mikou P. Risk of malignancy assessment for theParis Systemfor reporting urinary cytology. Diagn Cytopathol 2020; 48:1194-1198. [DOI: 10.1002/dc.24575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Napoleon Moulavasilis
- 1st Urology Department National and Kapodistrian University of Athens, Laiko Hospital Athens Greece
| | - Andreas Lazaris
- 1st Histopathology Department National and Kapodistrian University of Athens, Laiko Hospital Athens Greece
| | - Ioannis Katafigiotis
- 1st Urology Department National and Kapodistrian University of Athens, Laiko Hospital Athens Greece
| | - Konstantinos Stravodimos
- 1st Urology Department National and Kapodistrian University of Athens, Laiko Hospital Athens Greece
| | | | - Panagiota Mikou
- Head of Cytopathology Department Laiko Hospital Athens Greece
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Zhang ML, VandenBussche CJ, Hang JF, Miki Y, McIntire PJ, Peyton S, Vohra P. A review of urinary cytology in the setting of upper tract urothelial carcinoma. J Am Soc Cytopathol 2020; 10:29-35. [PMID: 32792229 DOI: 10.1016/j.jasc.2020.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
Abstract
Urothelial carcinomas of the upper urinary tract (UUT) are uncommon. Cytological examination of voided urine or washings from the UUT has been part of the standard workup for upper tract urothelial carcinoma (UTUC); however, its value remains controversial. The lack of uniform terminology and specific diagnostic criteria could also have contributed to the inferior performance of urinary cytology for detecting UTUC. The Paris System for Reporting Urinary Cytology (TPS) has provided a standardized reporting system for urinary cytology specimens with clearly defined cytomorphologic diagnostic criteria and found acceptance on an international level after its implementation in 2016. Recent studies have shown that TPS has led to improved diagnostic performance of urinary cytology; however, most of these studies had focused on the evaluation of lower urinary tract cytology specimens. Only a limited number of new research studies have analyzed the effect of TPS when applied to UUT cytology specimens. In the present report, we have summarized the current understanding and utility of UTUC, including its molecular biology, and reviewed the current literature.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yurina Miki
- Department of Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Stephen Peyton
- Department of Anatomical Pathology, QML Pathology, Brisbane, Queensland, Australia
| | - Poonam Vohra
- Department of Anatomic Pathology, University of California, San Francisco, San Francisco, California.
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Mezei T. Current classification systems and standardized terminology in cytopathology. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2020; 61:655-663. [PMID: 33817706 PMCID: PMC8112797 DOI: 10.47162/rjme.61.3.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/12/2021] [Indexed: 12/16/2022]
Abstract
The history of classification systems and the search for a unified nomenclature in cytopathology spans several decades and expresses the preoccupation of all those involved to make cytopathology a reliable diagnostic tool and a trusted screening method. Early classification schemes, applicable to exfoliative and aspiration cytology, attempted to set some basic standards for how non-gynecological cytopathology findings should be reported. While useful in establishing some basic guidelines, these were not specific to the various fields of non-gynecologic cytopathology, often burdened with specific problems. Cytopathology has evolved tremendously in the last couple of decades, undoubtedly boosted by the emergence of various classification schemes that, more than ever, are based on evidence gathered by professionals across the globe. The benefit of classification systems and standardized nomenclature in cytopathology is to provide useful, clear, and clinically relevant information for clinicians and ultimately to provide the best patient care. Standardized reporting systems make cytopathology reports more meaningful and robust. It now became standard that these include by default elements, such as adequacy criteria, diagnostic groups, risk of malignancy (ROM), and recommendations for patient management. In this brief review, we attempted to summarize how these classification schemes emerged and how they are reshaping the landscape of diagnostic cytopathology.
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Affiliation(s)
- Tibor Mezei
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Romania;
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Ren C, Wang X, Yang C, Li S, Liu S, Cao H. Investigation of Atyp.C using UF-5000 flow cytometer in patients with a suspected diagnosis of urothelial carcinoma: a single-center study. Diagn Pathol 2020; 15:77. [PMID: 32586345 PMCID: PMC7318455 DOI: 10.1186/s13000-020-00993-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study evaluated the predictive power of Atyp.C (a parameter of UF-5000 flow cytometer) for patients with a suspected diagnosis of urothelial carcinoma. METHODS We analyzed 163 urine specimens from 128 patients with suspected urothelial carcinoma using a fully automated fluorescence flow cytometry analyzer (UF-5000) and evaluated its performance on identifying atypical/malignant urothelial cells. From January 1, 2019 to April 4, 2019, all consecutive specimens for urinary cytopathology were enrolled. RESULTS Of the specimens with urinary cytopathology, 67 specimens (41.1%) revealed abnormal findings in cytology analysis. Among them, 20 specimens (12.3%) were diagnosed as atypical urothelial cells, 26 specimens (16.0%) as suspicious for malignancy (S-malignancy), and 21 specimens (12.9%) as confirmed malignancy. The UF-5000 findings were positive in 59 specimens (36.2%); therefore, the agreement with cytopathology was 73.0%. Using follow-up histologic diagnosis of urothelial carcinoma with or without urinary tract cytology (UTCy) as a reference standard (suspicious and confirmed malignancy were the positive criteria for UTCy), the sensitivity was 59.0%, specificity was 82.1%, positive predictive value was 75.0%, negative predictive value was 68.8%, and the agreement was 71.1%. CONCLUSIONS It is worth knowing and reporting that the Atyp.C assay may be used as an accessory test for patients with suspected urothelial carcinoma, based on its ability to identify high-risk patients who might need closer follow-up or additional medical treatment.
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Affiliation(s)
- Chunyun Ren
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Xing Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Chunwei Yang
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Shengchao Li
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Shuangchun Liu
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China
| | - Hongcui Cao
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China. .,State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China. .,Zhejiang Provincial Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases, 79 Qingchun Rd, Hangzhou City, 310003, China.
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Sajid MT, Zafar MR, Ahmad H, Ullah S, Mirza ZI, Shahzad K. Diagnostic accuracy of NMP 22 and urine cytology for detection of transitional cell carcinoma urinary bladder taking cystoscopy as gold standard. Pak J Med Sci 2020; 36:705-710. [PMID: 32494260 PMCID: PMC7260905 DOI: 10.12669/pjms.36.4.1638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine diagnostic accuracy of NMP 22 and urine cytology in the detection of transitional cell carcinoma (TCC) urinary bladder taking cystoscopy as a gold standard in patients having provisional diagnosis of bladder cancer (BC). Methods: This cross sectional validational study enrolled 380 patients fulfilling selection criteria and was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, Pakistan form July 2018 to July 2019. The urine sample collected underwent NMP22 and cytological analysis followed by rigid cystoscopy. Reports of all three tests divided patients into positive or negative for malignancy as per defined criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of NMP 22, urine cytology and their combination was determined. Receiver operating characteristic (ROC) curve analysis performed and area under the curve (AUC) compared among these tests. Results: The average age of patients was 53.08 ± 12.41 years having male to female ratio 3.75:1(300 males and 80 females). NMP 22 had better sensitivity and comparable specificity to cytology (81.9 & 81.2% vs 54 & 93.9%). Combination of NMP 22 / cytology outperformed both in terms of sensitivity (91.63 vs 81.83 vs 53.96), NPV (87.59 vs 77.46 vs 61.02) and diagnostic accuracy (85.26 vs 81.58 vs 71.32) but at the cost of specificity (76.97 vs 81.21 vs 93.94) and PPV (83.83 vs 85.02 vs 92.06). ROC curve revealed statistically significant higher AUC (0.843 vs .815 vs .73) for combination as compared to NMP 22 and Cytology (p < 0.001). Conclusion: NMP22 is a quick, point of care test having higher sensitivity, NPV and accuracy but similar specificity and PPV to urine cytology for detection of TCC urinary bladder. Combination outperformed both in terms of sensitivity while having modest specificity.
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Affiliation(s)
- Muhammad Tanveer Sajid
- Dr. Muhammad Tanveer Sajid, FCPS. Assistant Professor, Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan
| | - Muhammad Rafiq Zafar
- Prof. Muhammad Rafiq Zafar, FCPS. Associate Professor, Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan
| | - Hussain Ahmad
- Dr. Hussain Ahmad, FCPS. Associate Professor, Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan
| | - Saif Ullah
- Dr. Saif Ullah, Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan
| | - Zahoor Iqbal Mirza
- Prof. Zahoor Iqbal Mirza, FCPS. Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan
| | - Khubaib Shahzad
- Dr. Khubaib Shahzad, FCPS. Associate Professor, Armed Forces Institute of Urology (AFIU), Rawalpindi, Pakistan
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Sanghvi AB, Allen EZ, Callenberg KM, Pantanowitz L. Performance of an artificial intelligence algorithm for reporting urine cytopathology. Cancer Cytopathol 2019; 127:658-666. [PMID: 31412169 DOI: 10.1002/cncy.22176] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unlike Papanicolaou tests, there are no commercially available computer-assisted automated screening systems for urine specimens. Despite The Paris System for Reporting Urinary Cytology, there still is poor interobserver agreement with urine cytology and many cases in which a definitive diagnosis cannot be made. In the current study, the authors have reported on the development of an image algorithm that applies computational methods to digitized liquid-based urine cytology slides. METHODS A total of 2405 archival ThinPrep glass slides, including voided and instrumented urine cytology cases, were digitized. A deep learning computational pipeline with multiple tiers of convolutional neural network models was developed for processing whole slide images (WSIs) and predicting diagnoses. The algorithm was validated using a separate test data set comprised of consecutive cases encountered in routine clinical practice. RESULTS There were 1.9 million urothelial cells analyzed. An average of 5400 urothelial cells were identified in each WSI. The algorithm achieved an area under the curve of 0.88 (95% CI, 0.83-0.93). Using the optimal operating point, the algorithm's sensitivity was 79.5% (95% CI, 64.7%-90.2%) and the specificity was 84.5% (95% CI, 81.6%-87.1%) for high-grade urothelial carcinoma. CONCLUSIONS The authors successfully developed a computational algorithm capable of accurately analyzing WSIs of urine cytology cases. Compared with prior studies, this effort used a much larger data set, exploited whole slide-level and not just cell-level features, and used a cell gallery to display the algorithm's output for easy end-user review. This algorithm provides computer-assisted interpretation of urine cytology cases, akin to the machine learning technology currently used for automated Papanicolaou test screening.
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Affiliation(s)
| | | | | | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Allison DB, VandenBussche CJ. A Review of Urine Ancillary Tests in the Era of the Paris System. Acta Cytol 2019; 64:182-192. [PMID: 31060038 DOI: 10.1159/000499027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/19/2019] [Indexed: 12/15/2022]
Abstract
Aside from its diagnostic importance, urinary tract endoscopy is an uncomfortable, expensive, and time-consuming procedure. Patients with a history of urothelial carcinoma remain at an increased risk for recurrence and the development of de novo disease; most have had exposure to carcinogenic risk factors for decades prior to their first diagnosis that have bathed the entire urothelial tract. Consequently, monitoring these patients over their lifetime has made urothelial carcinoma one of the most expensive cancers for the US healthcare system. This expense has provided a financial incentive for academic and commercial groups to develop a test with a sufficient negative predictive value to reduce the frequency of surveillance procedures. Slide-based tests require a separate slide prepared from a split urine sample or from an additional urinary tract specimen. This process can place an additional burden on the laboratory due to changes in the workflow, especially if the split specimens need to be stored until a cytologic diagnosis is rendered (i.e., when used as a reflex test). Importantly, slide-based tests allow for the result to be directly correlated with cytomorphologic findings; however, these tests require the cells of interest to be present. Thus, slide-based tests suffer from the same sensitivity issues as urinary tract cytology. In contrast, slide-free tests do not require an additional slide to be prepared, and laboratory testing may be centralized to a core facility or performed on-site. Some tests detect the expression of altered or abnormally expressed subcellular material (proteins, DNA, etc.) in urothelial neoplasms, which are found in tumor cells and/or in the urine specimen when the proteins are either excreted or leaked from degenerating tumor cells. Slide-free tests may also be developed into point-of-care tests, meaning that the result may be available to the urologist but not to the cytopathologist. Since these proteins are often disassociated from the tumor cells that produce them, such tests may have a positive result even if tumor cells are absent in the tested specimen. Here we review critical concepts as well as several ancillary tests that have been developed for urinary tract specimens.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
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Impact of intravesical therapy for non-muscle invasive bladder cancer on the accuracy of urine cytology. World J Urol 2019; 37:2051-2058. [DOI: 10.1007/s00345-018-02624-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022] Open
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35
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McIntire PJ, Khan R, Hussain H, Pambuccian SE, Wojcik EM, Barkan GA. Negative predictive value and sensitivity of urine cytology prior to implementation of The Paris System for Reporting Urinary Cytology. Cancer Cytopathol 2019; 127:125-131. [DOI: 10.1002/cncy.22102] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Patrick J. McIntire
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Reema Khan
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Hamad Hussain
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Stefan E. Pambuccian
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Eva M. Wojcik
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
| | - Güliz A. Barkan
- Department of Pathology and Laboratory Medicine Loyola University Medical Center Maywood Illinois
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Gelwan E, Zhang ML, Allison DB, Cowan ML, DeLuca J, Fite JJ, Wangsiricharoen S, Williamson B, Zhou A, VandenBussche CJ. Variability among observers utilizing the CellSolutions BestCyte Cell Sorter imaging system for the assessment of urinary tract cytology specimens. J Am Soc Cytopathol 2019; 8:18-26. [PMID: 30929755 DOI: 10.1016/j.jasc.2018.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Image analysis systems are not currently commonly used for evaluating urinary cytology specimens. We evaluated whether the BestCyte Cell Sorter (CellSolutions, Greensboro, NC) imaging system can reliably identify atypical cells in urinary cytology specimens. METHODS Fifty-three consecutive urine cytology specimens underwent 2 preparations: one slide using SurePath (SP; BD Diagnostics, Sparks, MD)™ for routine clinical evaluation, and a second slide using the CellSolutions F50 system for analysis by the BestCyte Cell Sorter (BCCS) scanning system. Eight observers reviewed atypical cells flagged by BCCS and assigned a BCCS diagnosis to each of the 53 specimens. The observers also blindly reviewed the SP preparation (when available) and assigned an SP diagnosis. The SP diagnoses given by one "expert" observer was considered as a reference diagnosis. RESULTS There was fair-to-moderate agreement among observers for identifying any atypia and high-grade atypia (Fleiss kappa: 0.417 and 0.338, respectively) using BCCS. Review of SP preparations had slightly better agreement (Fleiss kappa: 0.558 and 0.564, respectively). Intraobserver agreement between the two methods varied greatly between individuals (Cohen's kappa range: 0.260 to 0.647). When a consensus diagnosis could be reached among the observers for cases with surgical follow-up, the consensus diagnosis was concordant in 11 of 12 instances, with one instance being a one-step discrepancy. CONCLUSIONS Specimen review by BCCS resulted in slightly greater interobserver variability than review of routine SP preparations. This may have been due to variations in observer experience and comfort with the use of a digital imaging system, which is further suggested by the wide range of intraobserver agreement among individuals.
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Affiliation(s)
- Elise Gelwan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Derek B Allison
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan L Cowan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Juliana DeLuca
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Judd Fite
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Bonnie Williamson
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Zhou
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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McIntire PJ, Snow JT, Elsoukkary SS, Soong L, Sweeney J, Robinson BD, Siddiqui MT. Digital image analysis supports a nuclear‐to‐cytoplasmic ratio cutoff value below 0.7 for positive for high‐grade urothelial carcinoma and suspicious for high‐grade urothelial carcinoma in urine cytology specimens. Cancer Cytopathol 2018; 127:120-124. [DOI: 10.1002/cncy.22061] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/18/2018] [Accepted: 08/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Patrick J. McIntire
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
| | - Justin T. Snow
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
| | - Sarah S. Elsoukkary
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
| | - Lauren Soong
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
| | - Jacob Sweeney
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
| | - Brian D. Robinson
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
| | - Momin T. Siddiqui
- New York‐Presbyterian Hospital/Weill Cornell Medicine Department of Pathology and Laboratory Medicine New York New York
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The Paris System: achievement of a standardized diagnostic reporting system for urine cytology. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mpdhp.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mikou P, Lenos M, Papaioannou D, Vrettou K, Trigka EA, Sousouris S, Constantinides C. Evaluation of the Paris System in atypical urinary cytology. Cytopathology 2018; 29:545-549. [DOI: 10.1111/cyt.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 01/21/2023]
Affiliation(s)
- P. Mikou
- Department of Cytopathology; Laiko Hospital; Athens Greece
| | - M. Lenos
- Department of Cytopathology; Laiko Hospital; Athens Greece
| | - D. Papaioannou
- Department of Histopathology; Diagnostic and Therapeutic Centre of Athens - Hygeia; Athens Greece
| | - K. Vrettou
- Department of Cytopathology; Laiko Hospital; Athens Greece
| | - E-A. Trigka
- First Histopathology Department; Athens Medical School; Laiko General Hospital; Athens Greece
| | - S. Sousouris
- Department of Cytopathology; Laiko Hospital; Athens Greece
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Zare S, Mirsadraei L, Reisian N, Liao X, Roma A, Shabaik A, Hasteh F. A Single Institutional Experience With the Paris System for Reporting Urinary Cytology: Correlation of Cytology and Histology in 194 Cases. Am J Clin Pathol 2018; 150:162-167. [PMID: 29878037 DOI: 10.1093/ajcp/aqy043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The Paris System for Reporting Urinary Cytology (TPS) is designed to standardize the criteria and terminology used in urinary tract cytology reporting. The aim of this study was to evaluate the impact of implementing TPS and to analyze the correlation with follow-up biopsies in order to assess its reproducibility. METHODS Urinary tract cytology specimens with follow-up biopsies over a 2-year period were reviewed and reclassified according to TPS criteria. Surgical follow-up diagnoses were correlated with the initial cytology diagnoses and TPS interpretations, and the results were compared. RESULTS Applying TPS in comparison to our previous reporting system resulted in fewer cases in the atypia category (11.8% vs 24.2%) and higher specificity, accuracy, and predictive value. We observed acceptable interobserver agreement in diagnostic categories of this reporting system. CONCLUSIONS TPS improves the overall performance of urinary tract cytology by standardizing the criteria and terminology.
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Affiliation(s)
- Somaye Zare
- Department of Pathology, University of California San Diego, La Jolla
| | - Leili Mirsadraei
- Department of Pathology, University of California San Diego, La Jolla
| | - Niloufar Reisian
- Department of Pathology, University of California San Diego, La Jolla
| | - Xiaoyan Liao
- Department of Pathology, University of California San Diego, La Jolla
| | - Andres Roma
- Department of Pathology, University of California San Diego, La Jolla
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego, La Jolla
| | - Farnaz Hasteh
- Department of Pathology, University of California San Diego, La Jolla
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Cowan ML, VandenBussche CJ. The Paris System for Reporting Urinary Cytology: early review of the literature reveals successes and rare shortcomings. J Am Soc Cytopathol 2018; 7:185-194. [PMID: 31043275 DOI: 10.1016/j.jasc.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 06/09/2023]
Abstract
The Paris System for Reporting Urinary Cytology (TPS) provides recommendations for the diagnosis of urinary tract cytology (UTC) specimens and has found acceptance on an international level. Since the official release of TPS in 2016, numerous research studies have been published analyzing its impact. This review summarizes the studies published since the release of TPS, highlighting areas in which TPS has performed well and other areas in which TPS may need improvement.
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Affiliation(s)
- Morgan L Cowan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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McIntire PJ, Snow JT, Robinson BD, Rao RA, Goyal A, Heymann JJ, Siddiqui MT. Improved correlation of urinary cytology specimens using The Paris System in biopsy-proven upper tract urothelial carcinomas. Cancer Cytopathol 2018; 126:498-504. [PMID: 29927548 DOI: 10.1002/cncy.22005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Urine cytology specimens are essential for screening and monitoring high-grade urothelial carcinomas. However, inconsistent reporting and equivocal diagnostic categories have remained a challenge. The Paris System for Reporting Urinary Cytology (TPS) was developed to provide clear cytomorphologic criteria for urine cytology specimens. Significant correlation between the surgical biopsy diagnosis (SD) and TPS diagnosis (PD) has been established in lower urothelial tract carcinomas, but to the authors' knowledge limited information is available regarding upper urinary tract carcinomas. METHODS A total of 56 cytology specimens from 35 patients within 90 days of an SD of upper urinary tract carcinoma were included. Cytology was re-reviewed and assigned a PD. The original diagnosis (OD) and PD were compared with the corresponding SD to determine which correlated best. RESULTS The PD corresponded to the SD in 35 of 56 cases (63%), which was greater than that for the OD and SD, which were concordant in 19 of 56 cases (34%). Both the OD and PD were concordant in 18 of 56 cases (32%), and neither corresponded in 20 of 56 cases (36%). A total of 27 of 33 cases of high-grade urothelial carcinoma/carcinoma in situ on SD (82%) were identified using the PD whereas only 15 cases (45%) were identified with the OD. The number of "atypical" diagnoses in the OD was reduced from 16 of 56 cases (29%) to 7 of 56 cases (13%) using the PD. Of the 14 of 56 "negative" OD (25%), only 4 remained after implementation of the PD. A diagnosis of low-grade urothelial neoplasm was established in 6 of 20 cases (30%) with the PD compared with 3 of 20 cases with the OD (15%). CONCLUSIONS The authors found that reclassification with TPS improved correlation with the SD compared with previous methodologies. Specifically, TPS increased the number of high-grade urothelial carcinoma diagnoses and decreased the number of equivocal or "atypical" diagnoses. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Justin T Snow
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Allison DB, Sharma R, Cowan ML, VandenBussche CJ. Evaluation of Sienna Cancer Diagnostics hTERT Antibody on 500 Consecutive Urinary Tract Specimens. Acta Cytol 2018; 62:302-310. [PMID: 29874657 DOI: 10.1159/000489181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Telomerase activity can be detected in up to 90% of urothelial carcinomas (UC). Telomerase activity can also be detected in urinary tract cytology (UTC) specimens and indicate an increased risk of UC. We evaluated the performance of a commercially available antibody that putatively binds the telomerase reverse transcriptase (hTERT) subunit on 500 UTC specimens. STUDY DESIGN Unstained CytospinTM preparations were created from residual urine specimens and were stained using the anti-hTERT antibody (SCD-A7). Two algorithms were developed for concatenating the hTERT result and cytologic diagnosis: a "no indeterminates algorithm," in which a negative cytology and positive hTERT result are considered positive, and a "high-specificity algorithm," in which a negative cytology and positive hTERT result are considered indeterminate (and thus negative for comparison to the gold standard). RESULTS The "no indeterminates algorithm" and "high-specificity algorithm" yielded a sensitivity of 60.6 and 52.1%, a specificity of 70.4 and 90.7%, a positive predictive value of 39.1 and 63.8%, and a negative predictive value of 85.0 and 85.8%, respectively. CONCLUSIONS A positive hTERT result may identify a subset of patients with an increased risk of high-grade UC (HGUC) who may otherwise not be closely followed, while a negative hTERT immunocytochemistry result is associated with a reduction in risk for HGUC.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajni Sharma
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Morgan L Cowan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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VandenBussche CJ, Allison DB, Gupta M, Ali SZ, Rosenthal DL. A 20-year and 46,000-specimen journey to Paris reveals the influence of reporting systems and passive peer feedback on pathologist practice patterns. Cancer Cytopathol 2018; 126:381-389. [DOI: 10.1002/cncy.22006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher J. VandenBussche
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Derek B. Allison
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Mohit Gupta
- Department of Urology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Syed Z. Ali
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Radiology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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Gupta M, VandenBussche CJ, Bivalacqua TJ. Urinary cytology and the Paris system for reporting urinary cytology: Implications for urological management. Cytopathology 2018; 29:368-370. [DOI: 10.1111/cyt.12538] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 01/25/2023]
Affiliation(s)
- M. Gupta
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - C. J. VandenBussche
- Departments of Pathology and Oncology; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - T. J. Bivalacqua
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
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Fite JJ, Rosenthal DL, VandenBussche CJ. When words matter: A “suspicious” urinary tract cytology diagnosis improves patient follow-up among nonurologists. Cancer Cytopathol 2018; 126:282-288. [DOI: 10.1002/cncy.21971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
- J. Judd Fite
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Gynecology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Christopher J. VandenBussche
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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Roy M, Kaushal S, Jain D, Seth A, Iyer VK, Mathur SR. An institutional experience with The Paris System: A paradigm shift from ambiguous terminology to more objective criteria for reporting urine cytology. Cytopathology 2017; 28:509-515. [DOI: 10.1111/cyt.12448] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 01/02/2023]
Affiliation(s)
- M. Roy
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. Kaushal
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - D. Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - A. Seth
- Department of Urology; All India Institute of Medical Sciences; New Delhi India
| | - V. K. Iyer
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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Sun X, Liu X, Xia M, Yang S, Fei L, Zhang M, Ma H, Wang L, Chen S, Yu L. The combined application of urinary liquid-based cytology with fluorescence in situ hybridization and p16/Ki-67 dual immunostaining is valuable for improving the early diagnosis of upper tract urothelial carcinomas. Diagn Cytopathol 2017; 45:895-902. [PMID: 28799728 DOI: 10.1002/dc.23796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/10/2017] [Accepted: 08/03/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the diagnostic values of urine liquid-based cytology (LBC), fluorescence in situ hybridization (FISH), and p16/Ki-67 dual immunostaining in the detection of upper tract urothelial carcinomas (UTUCs). METHODS Sixty-one patients with UTUCs were retrospectively analyzed. All patients were diagnosed both by urine cytology and by FISH, and histologically confirmed as UTUCs. Thirty-two patients had been stained with p16/Ki-67 dual labeling. RESULTS The sensitivities for low-grade UTUCs (LGUTUCs) and high-grade UTUCs (HGUTUCs) were 33.3% and 67.4% by LBC, 60% and 69.6% by FISH, and 12.5% and 66.7% by p16/Ki-67 dual labeling, respectively. CONCLUSIONS Our results indicated that LBC was more suitable to identify HGUTUCs, FISH was highly valuable for predicting LGUTUCs, and p16/Ki-67 dual labeling was useful for distinguishing HGUTUCs from LGUTUCs. The combined application of these methods may improve the sensitivity or accuracy in the detection or diagnosis of UTUCs.
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Affiliation(s)
- Xueqi Sun
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Xubin Liu
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Meng Xia
- Department of Gynecology and Obstetrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shicong Yang
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Lingyan Fei
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Mengqi Zhang
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Hanyu Ma
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Liantang Wang
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Shangwu Chen
- State Key Laboratory for Biocontrol, Guangdong Key Laboratory of Pharmaceutical Functional Genes, Key Laboratory of Gene Engineering of the Ministry of Education, Department of Biochemistry, School of Life Sciences, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li Yu
- Department of Pathology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
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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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Pichler R, Tulchiner G, Fritz J, Schaefer G, Horninger W, Heidegger I. Urinary UBC Rapid and NMP22 Test for Bladder Cancer Surveillance in Comparison to Urinary Cytology: Results from a Prospective Single-Center Study. Int J Med Sci 2017; 14:811-819. [PMID: 28824318 PMCID: PMC5562188 DOI: 10.7150/ijms.19929] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 05/17/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Non-muscle invasive bladder cancer (NMIBC) is associated with high rates of recurrence, resulting in frequent follow-up cystoscopies. We evaluated the use of two point-of-care tests - the nuclear matrix protein 22 (NMP22) and urinary bladder cancer antigen (UBC) Rapid - compared to routine follow-up in patients with a previous history of NMIBC. Methods: 31 patients with cystoscopy-verified active bladder cancer, and 44 follow-up patients without disease as confirmed by cystoscopy were prospectively enrolled. All urine samples were analyzed by voided urine and bladder washing cytology, NMP22 and UBC rapid test (qualitatively and quantitatively). The best cutoff (highest Youden index; ≥6.7 ng/ml) for the quantitative UBC was determined by receiver operating characteristic curves. Results: Voided urine and barbotage cytology resulted in a sensitivity of 25.8% and 32.3%, and a specificity of 100% and 100%, while the NMP22 showed a sensitivity and specificity of 12.9% and 100%, respectively. The qualitative and quantitative UBC Rapid revealed a sensitivity of 61.3% and 64.5%, with a specificity of 77.3% and 81.8%. Barbotage cytology and qualitative UBC test proved to be the best dual combination with the highest overall sensitivity (77.4%). In contrast to barbotage cytology alone, sensitivity increased from 21.4% to 50% for detecting low-grade tumors, and from 43.8% to 100% for high-grade cancers, but reducing specificity from 100% to 77.3%. Conclusion: Compared to urinary cytology, UBC tests alone as well as UBC tests in combination with bladder washing cytology revealed higher sensitivities in detecting low- and high-grade tumors, but at the expense of a lower specificity. Thus, currently cystoscopy cannot be replaced by any of the evaluated methods.
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Affiliation(s)
- Renate Pichler
- Department of Urology, Medical University of Innsbruck, Austria
| | | | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Austria
| | - Georg Schaefer
- Department of Pathology, Division of General Pathology, Medical University of Innsbruck, Austria
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