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Ose H, Nakamura A, Nukaya T, Sofue T, Haba R, Itoh T, Kamoshida S, Ohsaki H. p53 and Vimentin Double Immunostaining to Differentiate between High-Grade Urothelial Carcinoma Cells and Benign Atypical Cells. Acta Cytol 2024:1-9. [PMID: 38880083 DOI: 10.1159/000539417] [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: 04/02/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION Urine cytology is an indispensable test for detecting high-grade urothelial carcinoma (HGUC); however, the distinction between HGUC cells and morphologically similar benign atypical cells poses clinical challenges. In this study, we performed double immunostaining for p53 and vimentin to establish a diagnostic method to accurately distinguish HGUC cells from benign atypical cells. METHODS This study included 41 cases of HGUC, 11 of urolithiasis, and 22 of glomerular disease diagnosed histopathologically or clinically. After preparing urine cytology specimens from voided urine samples, p53 immunostaining was performed, and the p53-positive intensity and p53 positivity rate were calculated. Subsequently, vimentin immunostaining was performed on the same specimens to calculate the rate of vimentin positivity. RESULTS The HGUC cell group had a mean p53-positive intensity of 2.40, a mean p53 positivity rate of 73.2%, and a mean vimentin positivity rate of 5.1%. In contrast, the mean p53-positive intensity, p53 positivity rate, and vimentin positivity rate were 1.63, 36.7%, and 66.2%, respectively, in the benign atypical cell group. There were significant differences between the two groups for each parameter. Moreover, two multiple logistic regression models combining the results of these three parameters exhibited higher sensitivity and specificity than solely assessing the p53-positive intensity, positivity rate, and vimentin positivity rate. CONCLUSION Since double immunostaining with p53 and vimentin distinguishes HGUC cells from benign atypical cells, it could be to improve the diagnostic accuracy of urine cytology.
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Affiliation(s)
- Hiroko Ose
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri University, Tenri, Japan
| | - Takuhisa Nukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Kita-gun, 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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Saharti S, Aljhdali H, Ajabnoor R, Al Zahrani RA, Daous Y, Refai F, Badawi F, Mokhtar G, Alghamdi D. Cytospin performance when using Paris system for reporting urinary cytology. Cytojournal 2022; 19:47. [PMID: 36128466 PMCID: PMC9479516 DOI: 10.25259/cytojournal_48_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives:
The Paris System (TPS) for Reporting Urine Cytology has significantly improved the approach to evaluating urine cytology. TPS criteria were defined mainly according to ThinPrep and SurePath preparations, as they are widely utilized. The objective of this study is to validate urine cytology interpretation according to the TPS classification using cytospin technique in relation to the gold slandered histology.
Material and Methods:
This retrospective study examined and analyzed 316 urine specimens from King Abdulaziz University Hospital between 2015 and 2020. Cytospin technique is performed for all cases. Slides were recategorized using TPS criteria, then compared with the original histology diagnosis.
Results:
According to the TPS, 108 cases were classified as 101 AUC (32%), 95 NEG (30%), 59 HGUC (18.7%), 31 SHGUC (9.8%), and 30 (9.5%) others. The computed sensitivity of cytospin in urine cytology was 94.7%, with 73.9% specificity, a positive predictive value of 85.6%, a negative predictive value of 89.5%, and overall accuracy of 86.8%.
Conclusion:
Urine cytology testing is considered to be a non-invasive and sensitive method to screen for urothelial carcinoma. TPS defined standards are reliable on cytospin prepared slides for reporting urine cytology.
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Affiliation(s)
- Samah Saharti
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Hessa Aljhdali
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Rana Ajabnoor
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Reem A. Al Zahrani
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Yara Daous
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Fahd Refai
- Department of Pathology, Faculty of Medicine, King Abdulaziz University and King Abdulaziz University Hospital, Jeddah, Saudi Arabia,
| | - Fatima Badawi
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia,
| | - Ghadeer Mokhtar
- Department of Anatomic Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia,
| | - Doaa Alghamdi
- Department of Laboratory Medicine, Division of Anatomical Pathology, King Fahad Medical City, Riyadh, Saudi Arabia,
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Peña KB, Riu F, Hernandez A, Guilarte C, Badia J, Parada D. Usefulness of the Urine Methylation Test (Bladder EpiCheck®) in Follow-Up Patients with Non-Muscle Invasive Bladder Cancer and Cytological Diagnosis of Atypical Urothelial Cells—An Institutional Study. J Clin Med 2022; 11:jcm11133855. [PMID: 35807141 PMCID: PMC9267544 DOI: 10.3390/jcm11133855] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
Urothelial bladder cancer is a heterogeneous disease and one of the most common cancers worldwide. Bladder cancer ranges from low-grade tumors that recur and require long-term invasive surveillance to high-grade tumors with high mortality. After the initial contemporary treatment in non-muscle invasive bladder cancer, recurrence and progression rates remain high. Follow-up of these patients involves the use of cystoscopies, cytology, and imaging of the upper urinary tract in selected patients. However, in this context, both cystoscopy and cytology have limitations. In the follow-up of bladder cancer, the finding of urothelial cells with abnormal cytological characteristics is common. The main objective of our study was to evaluate the usefulness of a urine DNA methylation test in patients with urothelial bladder cancer under follow-up and a cytological finding of urothelial cell atypia. In addition, we analyzed the relationship between the urine DNA methylation test, urine cytology, and subsequent cystoscopy study. It was a prospective and descriptive cohort study conducted on patients presenting with non-muscle invasive urothelial carcinoma between 1 January 2018 and 31 May 2022. A voided urine sample and a DNA methylation test was extracted from each patient. A total of 70 patients, 58 male and 12 female, with a median age of 70.03 years were studied. High-grade urothelial carcinoma was the main histopathological diagnosis. Of the cytologies, 41.46% were cataloged as atypical urothelial cells. The DNA methylation test was positive in 17 urine samples, 51 were negative and 2 were invalid. We demonstrated the usefulness of a DNA methylation test in the follow-up of patients diagnosed with urothelial carcinoma. The methylation test also helps to diagnose urothelial cell atypia.
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Affiliation(s)
- Karla B. Peña
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
- Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43007 Reus, Spain
| | - Francesc Riu
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
- Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43007 Reus, Spain
| | - Anna Hernandez
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
| | - Carmen Guilarte
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
| | - Joan Badia
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
| | - David Parada
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
- Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43007 Reus, Spain
- Correspondence:
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THE ROLE OF BLADDER EPICHECK TEST ™ IN FOLLOW-UP OF PATIENTS WITH NON MUSCLE INVASIVE BLADDER CANCER. Clin Genitourin Cancer 2022; 20:e271-e275. [DOI: 10.1016/j.clgc.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
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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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Singh I, Lele TP. Nuclear Morphological Abnormalities in Cancer: A Search for Unifying Mechanisms. Results Probl Cell Differ 2022; 70:443-467. [PMID: 36348118 PMCID: PMC9722227 DOI: 10.1007/978-3-031-06573-6_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Irregularities in nuclear shape and/or alterations to nuclear size are a hallmark of malignancy in a broad range of cancer types. Though these abnormalities are commonly used for diagnostic purposes and are often used to assess cancer progression in the clinic, the mechanisms through which they occur are not well understood. Nuclear size alterations in cancer could potentially arise from aneuploidy, changes in osmotic coupling with the cytoplasm, and perturbations to nucleocytoplasmic transport. Nuclear shape changes may occur due to alterations to cell-generated mechanical stresses and/or alterations to nuclear structural components, which balance those stresses, such as the nuclear lamina and chromatin. A better understanding of the mechanisms underlying abnormal nuclear morphology and size may allow the development of new therapeutics to target nuclear aberrations in cancer.
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Affiliation(s)
- Ishita Singh
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA
| | - Tanmay P. Lele
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, USA,Department of Chemical Engineering, University of Florida, Gainesville, FL, USA,Department of Translational Medical Sciences, Texas A&M University, Houston, TX, USA
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Onder S, Kurtulan O, Kavuncuoglu A, Akdogan B. Comparison of Diagnostic Performances of Urine Cytology Before and After the Use of The Paris System Criteria: An Institutional Experience from Turkey. J Cytol 2021; 38:133-139. [PMID: 34703089 PMCID: PMC8489696 DOI: 10.4103/joc.joc_38_21] [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: 02/25/2021] [Revised: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Urine cytology remains to be the test of choice in the detection of high-grade urothelial carcinomas (HGUC) due to its favorable sensitivity. However, a significant rate of cases is reported under atypical/indeterminate categories, which result in a decrease in its specificity. Providing standardized cytologic criteria, one of the aims of The Paris System (TPS) is to reduce the use of indeterminate diagnoses and provide a higher predictive value in these categories. Aims: We compared the diagnostic performances of TPS and our original reporting system, and also investigated the interobserver reproducibility of the cytologic criteria used. Materials and Methods: A total of 386 urine samples were reviewed retrospectively. Original cytologic diagnoses have been made using similar cytologic features proposed by TPS. All slides were recategorized after the use of the cytologic criteria as described by TPS guideline. Results: After TPS, specificity of the test increased from 39.6% to 63.5, sensitivity decreased from 92.5% to 88.8%, and diagnostic accuracy increased from 63.6% to 75%. The use of negative category increased threefold. Frequencies of indeterminate categories of atypical urothelial cells (AUC) and suspicious for HGUC (SHGUC) decreased by 36% and 56.5%, respectively. A subsequent detection of HGUC after AUC and SHGUC categories increased by 38% and 64%, respectively. Interobserver agreement for TPS categorization was 39%. Conclusions: TPS improved diagnostic accuracy of urine cytology by reducing the use of indeterminate categories, and resulted in increase in their predictive value for subsequent diagnosis of HGUC. However, reproducibility of diagnostic categories seemed to be imperfect.
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Affiliation(s)
- Sevgen Onder
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Olcay Kurtulan
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Altan Kavuncuoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Pierconti F, Martini M, Fiorentino V, Cenci T, Capodimonti S, Straccia P, Sacco E, Pugliese D, Cindolo L, Larocca LM, Bassi PF. The combination cytology/epichek test in non muscle invasive bladder carcinoma follow-up: Effective tool or useless expence? Urol Oncol 2021; 39:131.e17-131.e21. [DOI: 10.1016/j.urolonc.2020.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
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Renshaw AA, Gould EW. High-grade urothelial carcinoma with hypochromatic chromatin in urine cytology. J Am Soc Cytopathol 2020; 10:25-28. [PMID: 33132055 DOI: 10.1016/j.jasc.2020.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Some high-grade urothelial carcinomas (UCs) in urine cytology have hypochromatic chromatin, but the incidence and criteria for diagnosis are not well described. MATERIALS AND METHODS Urine cytology cases with biopsy follow up were reviewed. RESULTS Cytospin preparations from 331 cases with biopsy follow up (230 benign/low-grade UC, 101 malignant) were reviewed. There were no false-positive cases. Cases with malignant cells with hypochromatic chromatin were identified in a total of 17 cases (16.8% of all malignancies). These comprised 2 carcinoma in situ, 11 high-grade papillary UC, 3 invasive UC, and 1 adenocarcinoma. Sixteen of 93 high-grade UCs (17.2%) had cells with hypochromatic chromatin. These cells were the only type of malignant cell in 4 of 101 cases (4.0%). All cases had cells with high nuclear-to-cytoplasmic ratios and markedly indented and irregular nuclear membranes that could be identified on both cytology and subsequent histology. CONCLUSIONS Malignant urothelial cells in urine cytology with hypochromatic chromatin can be present in 17% of cases and can be diagnosed as "positive for malignancy" based on their high nuclear-to-cytoplasmic ratio, and markedly indented and irregular nuclear membranes.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida; Miami Cancer Institute, Miami, Florida.
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida; Miami Cancer Institute, Miami, Florida
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Carvalho S, Abreu CM, Ferreira D, Lima L, Ferreira JA, Santos LL, Ribeiro R, Grenha V, Martínez-Fernández M, Duenas M, Suárez-Cabrera C, Paramio JM, Diéguez L, Freitas PP, Oliveira MI. Phenotypic Analysis of Urothelial Exfoliated Cells in Bladder Cancer via Microfluidic Immunoassays: Sialyl-Tn as a Novel Biomarker in Liquid Biopsies. Front Oncol 2020; 10:1774. [PMID: 33042825 PMCID: PMC7526084 DOI: 10.3389/fonc.2020.01774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 08/10/2020] [Indexed: 12/29/2022] Open
Abstract
Bladder cancer is the most common malignancy of the urinary tract, having one of the highest recurrence rates and progression from non-muscle to muscle invasive bladder cancer that commonly leads to metastasis. Cystoscopy and urine cytology are the standard procedures for its detection but have limited clinical sensitivity and specificity. Herein, a microfluidic device, the UriChip, was developed for the enrichment of urothelial exfoliated cells from fresh and frozen urine, based on deformability and size, and the cancer-associated glycan Sialyl-Tn explored as a putative bladder cancer urinary biomarker. Spiking experiments with bladder cancer cell lines showed an isolation efficiency of 53%, while clinical sample analyses revealed retention of cells with various morphologies and sizes. in situ immunoassays demonstrated significantly higher number of Sialyl-Tn-positive cells in fresh and frozen voided urine from bladder cancer patients, compared to healthy individuals. Of note, urothelial exfoliated cells from cryopreserved urine sediments were also successfully isolated by the UriChip, and found to express significantly high levels of Sialyl-Tn. Remarkably, Sialyl-Tn expression is correlated with tumor stage and grade. Overall, our findings demonstrate the potential of UriChip and Sialyl-Tn to detect urothelial bladder cancer cells in follow-up and long-term retrospective studies.
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Affiliation(s)
- Sandra Carvalho
- International Iberian Nanotechnology Laboratory, Department of Life Sciences, Braga, Portugal
| | - Catarina M. Abreu
- International Iberian Nanotechnology Laboratory, Department of Life Sciences, Braga, Portugal
| | - Dylan Ferreira
- Experimental Pathology and Therapeutics Group, Research Center of the Portuguese Institute of Oncology (CI-IPOP), Porto, Portugal
- Porto Comprehensive Cancer Center (P.ccc), Porto, Portugal
| | - Luís Lima
- Experimental Pathology and Therapeutics Group, Research Center of the Portuguese Institute of Oncology (CI-IPOP), Porto, Portugal
- Porto Comprehensive Cancer Center (P.ccc), Porto, Portugal
- School of Health, Polytechnic Institute of Porto, Porto, Portugal
| | - José A. Ferreira
- Experimental Pathology and Therapeutics Group, Research Center of the Portuguese Institute of Oncology (CI-IPOP), Porto, Portugal
- Porto Comprehensive Cancer Center (P.ccc), Porto, Portugal
| | - Lúcio L. Santos
- Experimental Pathology and Therapeutics Group, Research Center of the Portuguese Institute of Oncology (CI-IPOP), Porto, Portugal
- Porto Comprehensive Cancer Center (P.ccc), Porto, Portugal
| | - Ricardo Ribeiro
- Tumor & Microenvironment Group, i3S/INEB, Instituto de Investigação e Inovação em Saúde/Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
- Faculty of Medicine, Environmental Health Institute, University of Lisbon, Lisbon, Portugal
- Departament of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vânia Grenha
- Department of Urology, Centro Hospitalar Do Alto Ave, Guimarães, Portugal
| | - Mónica Martínez-Fernández
- Genomes and Disease Lab., Research Center of Molecular Medicine and Chronic Diseases (CIMUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marta Duenas
- Molecular Oncology Unit, CIEMAT, Madrid, Spain
- CIBERONC, Institute of Biomedical Research, University Hospital “12 de Octubre”, Madrid, Spain
| | - Cristian Suárez-Cabrera
- Molecular Oncology Unit, CIEMAT, Madrid, Spain
- CIBERONC, Institute of Biomedical Research, University Hospital “12 de Octubre”, Madrid, Spain
| | - Jesus M. Paramio
- Molecular Oncology Unit, CIEMAT, Madrid, Spain
- CIBERONC, Institute of Biomedical Research, University Hospital “12 de Octubre”, Madrid, Spain
| | - Lorena Diéguez
- International Iberian Nanotechnology Laboratory, Department of Life Sciences, Braga, Portugal
| | - Paulo P. Freitas
- International Iberian Nanotechnology Laboratory, Department of Nanoelectronics Engineering, Braga, Portugal
| | - Marta I. Oliveira
- International Iberian Nanotechnology Laboratory, Department of Life Sciences, Braga, Portugal
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A new 7-point method facilitates accurate diagnosis of high-grade urothelial carcinoma in routine urinary cytology practice. J Am Soc Cytopathol 2020; 10:103-109. [PMID: 33092994 DOI: 10.1016/j.jasc.2020.09.003] [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: 07/23/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study was designed to identify the minimal and necessary cell morphologies to be considered for high-precision diagnosis of high-grade urothelial carcinoma (HGUC) in a routine urinary cytology practice. MATERIALS AND METHODS We included 338 urine cytology specimens from 11 medical facilities in Japan. Six experts evaluated these Papanicolaou-stained specimens using their own diagnostic criteria to categorize them within an initial 4-tiered classification system. Of the 338 cases, 70 HGUC and 32 benign cases (with a complete consensus diagnosis of 6 experts) were included for the analysis. Two of the cytologists evaluated the specimens for 20 specific cellular features. The results were analyzed using a contingency table and by discriminant analysis. RESULTS Of the original 338 cases, 165 were originally diagnosed as HGUC, but only 70 (42.4%) were scored as malignant by all participating cytologists; of the 101 benign cases, only 32 (31.7%) were classified as such in all examinations. These specimens were re-evaluated by 6 experts using a panel of 20 specific cellular features used to distinguish between HGUC and benign diseases; tests of significance and discriminant analyses identified 7 critical features that were most useful for cytological diagnosis. Statistical analysis revealed that a focus on these 7 features led to a diagnosis of HGUC with a probability of over 95%. CONCLUSIONS The accuracy of our presently used method to evaluate urinary cytology is not consistently high. This novel classification system, which focuses on 7 critical features, facilitates the high accurate diagnosis of HGUC in routine cytology practice.
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Pierconti F, Martini M, Cenci T, Fiorentino V, Sacco E, Bientinesi R, Pugliese D, Iacovelli R, Schinzari G, Larocca LM, Bassi PF. Methylation study of the Paris system for reporting urinary (TPS) categories. J Clin Pathol 2020; 74:102-105. [PMID: 32527754 DOI: 10.1136/jclinpath-2020-206633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
AIMS Bladder EpiCheck is one of several urinary tests studied to identify bladder tumours and analyses 15 methylation biomarkers determining bladder cancer presence on the basis of methylation profile. METHODS 374 patients diagnosed with high-grade non-muscle invasive bladder cancer were treated and followed for 1 year with voided urine cytology and white-light cystoscopy and biopsies according to European Association of Urology Guidelines. 268 cases were diagnosed with high-grade papillary carcinoma, while 106 cases were carcinoma in situ. Bladder EpiCheck test was performed together with cytology in all cases. RESULTS Comparing cytological categories of negative for high-grade urothelial carcinoma (NHGUC) and atypical urothelial cells (AUCs), we found that an EpiScore <60 correlates with NHGUC (p=0.0003, Fisher's exact test), while comparing AUC and suspicious for high-grade urothelial carcinoma (SHGUC) or SHGUC and high-grade urothelial carcinoma (HGUC) categories, an EpiScore ≥60 correlates with SHGUC and HGUC, respectively (p=0.0031 and p=0.0027, Fisher's exact test). In each TPS category, we found that sensitivity, specificity, Positive Predicitve Value (PPV) and Negative Predictive Value (NPV) of the Bladder EpiCheck test in HGUC category were higher than those observed in SHGUC group (sensitivity=98%, specificity=100%, NPV=85.7%, PPV=100% vs sensitivity=86.6%, specificity=52.3%, NPV=84.6%, PPV=56.5%). CONCLUSIONS Analysing methylation study results, we demonstrated that different TPS cytological categories also carry a distinct molecular signature. Moreover, our results confirm that cytological categories SHGUC and HGUC are different entities also from a molecular point of view and should continue to represent distinct groups in TPS.
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Affiliation(s)
- Francesco Pierconti
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Dario Pugliese
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Roberto Iacovelli
- Department of Oncology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy, Rome, Italy
| | - Giovanni Schinzari
- Department of Oncology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Pier Francesco Bassi
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
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13
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Bakkar R, Mirocha J, Fan X, Frishberg DP, de Peralta-Venturina M, Zhai J, Bose S. Impact of the Paris system for reporting urine cytopathology on predictive values of the equivocal diagnostic categories and interobserver agreement. Cytojournal 2019; 16:21. [PMID: 31741668 PMCID: PMC6826565 DOI: 10.4103/cytojournal.cytojournal_30_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/04/2019] [Indexed: 12/18/2022] Open
Abstract
Background: The Paris System (TPS) acknowledges the need for more standardized terminology for reporting urine cytopathology results and minimizing the use of equivocal terms. We apply TPS diagnostic terminologies to assess interobserver agreement, compare TPS with the traditional method (TM) of reporting urine cytopathology, and evaluate the rate and positive predictive value (PPV) of each TPS diagnostic category. A survey is conducted at the end of the study. Materials and Methods: One hundred urine samples were reviewed independently by six cytopathologists. The diagnosis was rendered according to TPS categories: negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), low-grade urothelial neoplasm (LGUN), suspicious for high-grade urothelial carcinoma (SHGUC), and high-grade urothelial carcinoma (HGUC). The agreement was assessed using kappa. Disagreements were classified as high and low impacts. Statistical analysis was performed. Results: Perfect consensus agreement was 31%, with an overall kappa of 0.362. Kappa by diagnostic category was 0.483, 0.178, 0.258, and 0.520 for NHGUC, AUC, SHGUC, and HGUC, respectively. Both TM and TPS showed 100% specificity and PPV. TPS showed 43% sensitivity (38% by TM) and 70% accuracy (66% by TM). Disagreements with high clinical impact were 27%. Of the 100 cases, 52 were concurrent biopsy-proven HGUC. The detection rate of biopsy-proven HGUC was 43% by TPS (57% by TM). The rate of NHGUC was 54% by TPS versus 26% by TM. AUC rate was 23% by TPS (44% by TM). The PPV of the AUC category by TPS was 61% versus 43% by TM. The survey showed 33% overall satisfaction. Conclusions: TPS shows adequate precision for NHGUC and HGUC, with low interobserver agreement for other categories. TPS significantly increased the clinical significance of AUC category. Refinement and widespread application of TPS diagnostic criteria may further improve interobserver agreement and the detection rate of HGUC.
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Affiliation(s)
- Rania Bakkar
- Address: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James Mirocha
- Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Xuemo Fan
- Address: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David P Frishberg
- Address: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Jing Zhai
- Address: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shikha Bose
- Address: Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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14
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Rai S, Lali BS, Venkataramana CG, Philipose CS, Rao R, Prabhu GGL. A Quest for Accuracy: Evaluation of The Paris System in Diagnosis of Urothelial Carcinomas. J Cytol 2019; 36:169-173. [PMID: 31359918 PMCID: PMC6592122 DOI: 10.4103/joc.joc_67_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Urine cytology is an important screening tool of patients for urothelial carcinoma (UC) and follow-up of patients with treated disease. Ease of procurement, cost-effectiveness, and lower turnaround time are the major advantages. OBJECTIVE To compare current system of reporting (CSR) at our institute with The Paris System (TPS) and analyze utility of urine cytology based on TPS reporting in correlation with urine culture and histopathology. MATERIALS AND METHODS One-year retrospective study of 90 cases was undertaken wherein cases presenting with painless hematuria and clinically suspicious of UC were included. Urine cytology slides were reviewed and reported with TPS guidelines. These findings were correlated with histopathological diagnosis and urine culture as indicated. Statistical analysis was done using SPSS 17 software. RESULTS With TPS guidelines, 11.1% and 5.6% cases were reported as high-grade UC (HGUC) and low-grade urothelial neoplasm (LGUN), respectively. Suspicious for HGUC category included 17.8% of cases. The rate of reporting "atypical urothelial cells (AUC)" was significantly lower (11.1%) with TPS on comparison with CSR (16.7%). Histopathological correlation of positive predictive value for HGUC was better (100%) on using TPS when compared with CSR (64.3%). Among 11 cases with microbial growth on urine culture, 9.1% were reported as atypical. Sensitivity and accuracy of TPS in detecting UC were 83.3% and 86.52%, respectively. Both were higher when compared with CSR. CONCLUSION In comparison to CSR, criteria of TPS limit the AUC category and enhance the sensitivity and accuracy of detecting HGUC. Adopting TPS for urinary cytology will ensure uniformity and accuracy of HGUC diagnosis.
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Affiliation(s)
- Sharada Rai
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Bhagat S. Lali
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Chaithra G. Venkataramana
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Cheryl S. Philipose
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Ranjitha Rao
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - GG Laxman Prabhu
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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15
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Law J, Ali O, Dobrin A, Brar H, Luke PP, Sener A. Significance of atypical urinary cytology in the evaluation of patients with end-stage renal disease for kidney transplantation - a retrospective study. Transpl Int 2019; 32:1085-1094. [PMID: 31100185 DOI: 10.1111/tri.13464] [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: 10/14/2018] [Revised: 01/03/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
To determine what percentage of renal transplant candidates have atypical urinary cytology, what proportion have urothelial carcinoma and whether cystoscopy is necessary with atypical cytology. All end-stage renal disease (ESRD) patients (703) presenting for renal transplantation at our institution were retrospectively reviewed. Individuals producing sufficient urine were screened with urine cytology and those with atypical cytology or risk factors for bladder cancer underwent cystoscopy. Four hundred and thirty patients had available urinary cytology and, of these, 151 (35%) had atypical cytology. Of patients with atypical cytology, three were identified to have urothelial carcinoma. However, three additional patients with urothelial carcinoma did not present with atypical cytology. In total, 6 of 703 (0.85%) patients had bladder cancer. All were treated with transurethral resection and eventually underwent renal transplant. One patient has had disease progression post-transplant to distant metastases. This is the largest study to date evaluating the incidence of urothelial carcinoma in ESRD patients presenting for transplant workup. We found the incidence of bladder cancer to be higher than in the general Canadian population, however, most lesions were low grade. We found atypical cytology in transplant candidates to be a poor predictor for these low-grade lesions and do not recommend routine cystoscopy for atypical cytology.
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Affiliation(s)
- Jeffrey Law
- Department of Surgery (Urology), Western University, London, ON, Canada
| | - Omar Ali
- Department of Surgery (Urology), Western University, London, ON, Canada
| | - Andrei Dobrin
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Harmenjit Brar
- Department of Surgery (Urology), Western University, London, ON, Canada
| | - Patrick P Luke
- Department of Surgery (Urology), Western University, London, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Alp Sener
- Department of Surgery (Urology), Western University, London, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
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16
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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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17
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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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18
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Pierconti F, Martini M, Straccia P, Fiorentino V, Musarra T, Larocca LM, Lopez-Beltran A. Hypochromatic large urothelial cells in urine cytology are indicative of high grade urothelial carcinoma. APMIS 2018; 126:705-709. [DOI: 10.1111/apm.12877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 06/20/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Francesco Pierconti
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Teresa Musarra
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Antonio Lopez-Beltran
- Faculty of Medicine; Unit of Anatomical Pathology; Cordoba University; Cordoba Spain
- The Champalimaud Clinical Center; Lisbon Portugal
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19
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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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20
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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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21
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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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22
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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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23
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Pierconti F, Rossi ED, Straccia P, Fadda G, Larocca LM, Bassi PF, Sacco E, Schinzari G. The risk of malignancy of atypical urothelial cells of undetermined significance in patients treated with chemohyperthermia or electromotive drug administration. Cancer Cytopathol 2018; 126:200-206. [DOI: 10.1002/cncy.21957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023]
Affiliation(s)
| | - Esther Diana Rossi
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | - Patrizia Straccia
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | - Guido Fadda
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | | | | | - Emilio Sacco
- Institute of Urology; Catholic University of the Sacred Heart; Rome Italy
| | - Giovanni Schinzari
- Institute of Oncology; Catholic University of the Sacred Heart; Rome Italy
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24
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Wang Y, Auger M, Kanber Y, Caglar D, Brimo F. Implementing The Paris System for Reporting Urinary Cytology results in a decrease in the rate of the “atypical” category and an increase in its prediction of subsequent high-grade urothelial carcinoma. Cancer Cytopathol 2017; 126:207-214. [DOI: 10.1002/cncy.21958] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/02/2017] [Accepted: 11/21/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Yujing Wang
- Department of Pathology; McGill University Health Center, McGill University; Montreal Quebec Canada
| | - Manon Auger
- Department of Pathology; McGill University Health Center, McGill University; Montreal Quebec Canada
| | - Yonca Kanber
- Department of Pathology; McGill University Health Center, McGill University; Montreal Quebec Canada
| | - Derin Caglar
- Department of Pathology; McGill University Health Center, McGill University; Montreal Quebec Canada
| | - Fadi Brimo
- Department of Pathology; McGill University Health Center, McGill University; Montreal Quebec Canada
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25
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Zheng X, Si Q, Du D, Harshan M, Zhang Z, Haines K, Shi W, Chhieng DC. The Paris System for urine cytology in upper tract urothelial specimens: A comparative analysis with biopsy and surgical resection. Cytopathology 2017; 29:184-188. [DOI: 10.1111/cyt.12505] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 01/08/2023]
Affiliation(s)
- X. Zheng
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Q. Si
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - D. Du
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Harshan
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Z. Zhang
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - K. Haines
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - W. Shi
- Department of Pathology; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - D. C. Chhieng
- Department of Pathology; University of Washington; Seattle WA USA
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26
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Renshaw AA, Gould EW. High-grade urothelial carcinoma in urine cytology with jet black and smooth or glassy chromatin. Cancer Cytopathol 2017; 126:64-68. [PMID: 29072816 DOI: 10.1002/cncy.21947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some high-grade urothelial carcinomas (UCs) in urine cytology can have jet black, smooth, or glassy chromatin, but to the authors' knowledge, the incidence and criteria for diagnosis are not well described. The current study was performed to define the incidence and appearance of high-grade UC in urine cytology in cytospin preparations with jet black and smooth or glassy chromatin. METHODS Cytospin preparations from 331 cases with biopsy follow-up (230 benign/low-grade UCs and 101 malignant UCs) were reviewed. RESULTS Cases with malignant cells with jet black and smooth or glassy chromatin were identified in a total of 60 cases (59.4% of all malignancies). These comprised 18 carcinoma in situ cases, 28 high-grade papillary UCs, 8 invasive UCs, 3 squamous cell carcinomas, 2 adenocarcinomas, and 1 melanoma. Of the 93 high-grade UCs, 51 (54.8%) had cells with either jet black and smooth or glassy chromatin. These cells were the only type of malignant cell in 6 of 101 cases (5.9%). All cases had at least 50 cells with jet black nuclei. Nuclei with jet black and smooth chromatin often were smaller than normal urothelial cells, often but not always elongate, had irregular nuclear outlines including pointed areas, and usually were accompanied by necrosis. Cells with glassy chromatin often were larger than normal urothelial cells, had rounder but still irregular nuclei, and also had frequent necrosis. CONCLUSIONS Malignant urothelial cells in urine cytology with jet black chromatin are common and can be diagnosed as "positive for malignancy" based on their irregular nuclear outline, increased cellularity (≥50 abnormal cells), and frequent necrosis. Cancer Cytopathol 2018;126:64-8. © 2017 American Cancer Society.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
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27
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Long T, Layfield LJ, Esebua M, Frazier SR, Giorgadze DT, Schmidt RL. Interobserver reproducibility of The Paris System for Reporting Urinary Cytology. Cytojournal 2017; 14:17. [PMID: 28828030 PMCID: PMC5545779 DOI: 10.4103/cytojournal.cytojournal_12_17] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/05/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). METHODS Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. RESULTS The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. CONCLUSIONS Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.
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Affiliation(s)
- Theresa Long
- Address: Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Lester J. Layfield
- Address: Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Magda Esebua
- Address: Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - Shellaine R. Frazier
- Address: Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
| | - D. Tamar Giorgadze
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Robert L. Schmidt
- Department of Pathology and Laboratory Medicine and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
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VandenBussche CJ, Yarmus L, Illei PB. The utility of bronchial brushings in the modern era of flexible bronchoscopy. J Am Soc Cytopathol 2017; 6:1-7. [PMID: 31042627 DOI: 10.1016/j.jasc.2016.09.001] [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: 02/07/2016] [Revised: 09/07/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Bronchoscopic procedures allow for the procurement of cellular material for diagnosis, molecular studies, and staging. Procurement modalities include bronchoalveolar lavage (BAL), bronchial washing (BW), transbronchial ultrasound-guided needle aspiration (TBNA), transbronchial biopsy (TBBX), endobronchial biopsy (EB), and bronchoscopic brushing (BB). These specimens, taken concurrently, often circumvent the need for an open biopsy, and allow for more appropriate and efficient patient management. Although BB is a well-established method for obtaining cytologic material, it often introduces artifacts and may contain abundant material such as benign and/or metaplastic bronchial epithelium, both of which may result in atypical or false-positive diagnoses. We examined the utility of BB specimens at our institution in recent years. METHODS 210 BB specimens were identified at our institution over a 2-year period, allowing for at least a 2-year follow-up period. The diagnoses were compiled and compared against results from simultaneously obtained BAL, BW, TBNA, TBBX, and EB specimens, as well as any follow-up during the subsequent 2- to 4-year period. RESULTS BB specimens were diagnosed as malignant (n = 44), benign (130), indeterminate (30), and non-diagnostic (6). There were no false-positive diagnoses. There were 6 instances in which malignancy was not definitively diagnosed on a non-BB specimen but definitively diagnosed on BB. CONCLUSION BB specimens rarely provide the only diagnostic material during a bronchoscopic procedure, though they possess excellent specificity for malignancy. Indeterminate diagnoses have a positive predictive value of approximately 73%.
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Affiliation(s)
| | - Lonny Yarmus
- Department of Medicine-Interventional Pulmonology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter B Illei
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hassan M, Solanki S, Kassouf W, Kanber Y, Caglar D, Auger M, Brimo F. Impact of Implementing the Paris System for Reporting Urine Cytology in the Performance of Urine Cytology: A Correlative Study of 124 Cases. Am J Clin Pathol 2016; 146:384-90. [PMID: 27543983 DOI: 10.1093/ajcp/aqw127] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We assessed the performance of urine cytology using the Paris System for Reporting Urine Cytology (PSRUC) in comparison to our current system. METHODS In total, 124 specimens with histologic correlation were reviewed and assigned to the PSRUC categories: benign, atypical urothelial cells (AUCs), suspicious for high-grade urothelial carcinoma (SHGUC), and high-grade urothelial carcinoma (HGUC). Original cytological diagnoses were recorded. RESULTS Fewer cases were given an AUC diagnosis using the PSRUC in comparison to the original diagnoses (26% vs 39%), while the association of AUCs with subsequent HGUC increased from 33% to 53% with the PSRUC. Using the PSRUC resulted in a higher number of low-grade carcinomas assigned to the benign (40%) rather than the AUC (22%) category. The performance of SHGUC/HGUC diagnoses was similar in both systems (predictive value = 94%). CONCLUSIONS The PSRUC seems to improve the performance of urine cytology by limiting the AUC category to cases that are more strongly associated with HGUC.
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Affiliation(s)
| | - Sharaddha Solanki
- Department of Urology, McGill University and McGill University Health Center, Montreal, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University and McGill University Health Center, Montreal, Canada
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Yang CS, Chen S, Cramer HM, Wu HH. High apoptotic index in urine cytology is associated with high-grade urothelial carcinoma. Cancer Cytopathol 2016; 124:546-51. [PMID: 27070653 DOI: 10.1002/cncy.21720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The significance of apoptosis and its association with high-grade urothelial carcinoma (HGUC) in urine cytology has yet to be determined. METHODS A computerized search of the study laboratory information system was performed over a 3-year period for all urine cytology specimens processed using the SurePath liquid-based preparation technique. Only those cases with correlating surgical pathology obtained within 6 months after the urine cytologic samples were included in the current study. Cases from ileal conduit samples were excluded. A semiquantitative numerical scoring system (apoptotic index) was used to assess the amount of pyknosis or karyorrhexis, with 0 indicating none, 1 indicating < 10 per 10 high-power fields, 2 indicating 10 to 30 per 10 high-power fields, and 3 indicating > 30 per 10 high-power fields. Statistical analysis using the Pearson chi-square test was performed. RESULTS A total of 228 cases including 105 benign cases, 79 cases of HGUC, and 44 cases of low-grade urothelial carcinoma (LGUC) diagnosed on follow-up surgical pathology were selected. A score of 0 was observed in 70 benign, 11 HGUC, and 8 LGUC cases; a score of 1 was observed in 31 benign, 21 HGUC, and 23 LGUC cases; a score of 2 was observed in 3 benign, 27 HGUC, and 9 LGUC cases; and a score of 3 was observed in 1 benign, 20 HGUC, and 4 LGUC cases. CONCLUSIONS Excluding ileal conduit urine specimens, the finding of a high apoptotic index (score ≥ 2) with the presence of pyknosis or karyorrhexis in ≥10 per 10 high-power fields in the urine cytology appears to be significantly associated with HGUC (P<.05). Cancer Cytopathol 2016;124:546-51. © 2016 American Cancer Society.
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Affiliation(s)
- Chi-Shun Yang
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shaoxiong Chen
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Harvey M Cramer
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Allison DB, Olson MT, Lilo M, Zhang ML, Rosenthal DL, VandenBussche CJ. Should the BK polyomavirus cytopathic effect be best classified as atypical or benign in urine cytology specimens? Cancer Cytopathol 2016; 124:436-42. [DOI: 10.1002/cncy.21705] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Derek B. Allison
- Department of Pathology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Matthew T. Olson
- Department of Pathology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Mohammed Lilo
- Department of Pathology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Mingjuan L. Zhang
- Department of Pathology; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Department of Pathology; Johns Hopkins University School of Medicine; Baltimore Maryland
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Brimo F, Auger M. The atypical urothelial cell category in the Paris System: Strengthening the Achilles' heel. Cancer Cytopathol 2015; 124:305-6. [PMID: 26692545 DOI: 10.1002/cncy.21668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Fadi Brimo
- Department of Pathology, McGill University and McGill University Health Center, Montreal, Quebec, Canada
| | - Manon Auger
- Department of Pathology, McGill University and McGill University Health Center, Montreal, Quebec, Canada
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Anderlini R, Manieri G, Lucchi C, Raisi O, Soliera AR, Torricelli F, Varani M, Trenti T. Automated urinalysis with expert review for incidental identification of atypical urothelial cells: An anticipated bladder carcinoma diagnosis. Clin Chim Acta 2015; 451:252-6. [PMID: 26460065 DOI: 10.1016/j.cca.2015.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 09/29/2015] [Accepted: 10/05/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most common diagnostic technique for the detection of malignant/atypical urothelial cells (m/AUC) is urinary cytology (Ucytol). Urinary sediment (Used) examination, often prescribed for asymptomatic, healthy subjects, can incidentally identify suspicious/AUC (s/AUC) in routine daily practice. METHODS Unstained, unfixed and uncentrifuged urine samples were analyzed with an automated intelligent microscopy (AIM) system. From January 2010, any incidental identification of s/AUC through expert revision of unclassified cell images was reported, according to internal protocols, as an additional note on the patients' laboratory report. Patients' symptomatology or previous history was unknown to the pathologist. All referrals from January 2010 to December 2014, with the s/AUC note, were reviewed and cross-referenced with Ucytol and histology data from a central database. RESULTS Of the 162 patients identified with s/AUC (0.1/1000 samples), 84% (n=136) performed further Ucytol and/or histological examinations. The sensitivity of the identification of non-transitory AUC at Used was 87.5%. Positive histological examinations were 91.2% classified as high-grade urothelial carcinoma. CONCLUSIONS Routine Used examination, with an AIM and expert revision, can identify the presence of AUC in a clinical laboratory setting, and for some subjects, may anticipate bladder carcinoma diagnosis.
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Affiliation(s)
- R Anderlini
- CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy.
| | - G Manieri
- Cytopathology Laboratory, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, Mirandola Hospital, Modena, Italy
| | - C Lucchi
- Cytopathology Laboratory, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, Mirandola Hospital, Modena, Italy
| | - O Raisi
- Cytopathology Laboratory, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, Mirandola Hospital, Modena, Italy
| | - A R Soliera
- CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy
| | - F Torricelli
- CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy
| | - M Varani
- CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy
| | - T Trenti
- CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy
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McCroskey Z, Bahar B, Hu Z, Wojcik EM, Barkan GA. Subclassifying atypia in urine cytology: what are the helpful features? J Am Soc Cytopathol 2015; 4:183-189. [PMID: 31051752 DOI: 10.1016/j.jasc.2014.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The diagnosis "atypical urothelial cells (AUC)" remains an unresolved problem, making many urologists dissatisfied and confused about the management strategy on these cases. To date, a few inspiring attempts were made to subclassify AUC into "atypical urothelial cells of undetermined significance" (AUC-US) and "atypical urothelial cells cannot exclude high grade" (AUC-H). The aim of our study was to investigate the most predictive for high-grade urothelial carcinoma (HGUC) cytomorphologic parameters and whether the proposed classification can be implemented in our institution. MATERIAL AND METHODS The electronic medical record system was searched for cytology specimens that were diagnosed as AUC from January 1, 2005 to March 1, 2013 and their relative clinical-pathological follow-up. All specimens were reviewed by an experienced cytopathologist by using 20 published "most predictive" for HGUC criteria. RESULTS A total of 162 AUC specimens were reclassified into 3 groups: AUC-H (n = 45), AUC-US (n = 51), and "negative for malignancy" (n = 66). The reclassification of AUC-H and "negative for malignancy" had 79% sensitivity, 77% specificity, 60% positive predictive value, and 89% negative predictive value to histologically proven HGUC diagnosis. CONCLUSIONS Our study demonstrated a good correlation between the presence of "HGUC-predictive" cytologic criteria and the final biopsy-proven HGUC in cytologic cases originally diagnosed as "atypical urothelial cells present." We identified 2 of the most predictive for HGUC on follow-up cytomorphologic parameters such as increased nuclear-cytoplasmic ratio >0.7 and coarse chromatin (16 abnormal cells per slide in average). These parameters, along with positive fluorescent in situ hybridization results can help during cytologic evaluation of urine specimens.
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Affiliation(s)
- Zulfia McCroskey
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois.
| | - Burak Bahar
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
| | - Zhihong Hu
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois
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Onur I, Rosenthal DL, VandenBussche CJ. Atypical urothelial tissue fragments in noninstrumented voided urine specimens are associated with low but significantly higher rates of urothelial neoplasia than benign-appearing urothelial tissue fragments. Cancer Cytopathol 2015; 123:186-92. [PMID: 25586692 DOI: 10.1002/cncy.21519] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interpretation of urothelial tissue fragments (UTF) in voided urine (VU) specimens is controversial. If UTF contain cytomorphologically atypical cells, the diagnosis often becomes more challenging. The authors previously analyzed the outcome of patients with benign-appearing UTF in 274 noninstrumented VU specimens. In this retrospective study, noninstrumented VU specimens containing UTF with atypical cytomorphological features (AUTF) were evaluated and compared with the previous results. METHODS The Johns Hopkins Hospital electronic pathology database was searched for VU cases containing UTF over a 5-year period. RESULTS A total of 170 noninstrumented VU specimens containing AUTF were identified. Twenty-four specimens had subsequent or coincidental surgical pathology specimens with the following overall rates of neoplasia: high-grade urothelial carcinoma: 8.8% (15 specimens), low-grade urothelial neoplasia: 1.2% (2 specimens), and prostate carcinoma invading the bladder: 0.6% (1 specimen). A total of 49 specimens (28.8%) were diagnosed with urolithiasis on follow-up. Twenty-five cases had follow-up cytology specimens, all of which were negative for malignancy. Of 72 cases without histopathologic, radiologic, or cytopathologic follow-up, 62 (86.1%) had a mean clinical follow-up of 22.5 months and 10 cases did not have clinical follow-up. CONCLUSIONS The presence of AUTF in noninstrumented VU is associated with low rates of urothelial neoplasia but a statistically higher risk of urothelial neoplasia than the presence of BUTF (10.0% vs 4.4%; P<.05). In particular, the rate of high-grade urothelial carcinoma is significantly higher in noninstrumented VU specimens containing AUTF than those containing BUTF (8.8% vs 0.7%; P<.0001). In addition, urolithiasis is associated with AUTF in a substantial percentage of noninstrumented VU specimens.
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Affiliation(s)
- Irem Onur
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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Fogazzi GB, Pallotti F, Garigali G. Atypical/malignant urothelial cells in routine urinary sediment: worth knowing and reporting. Clin Chim Acta 2014; 439:107-11. [PMID: 25451946 DOI: 10.1016/j.cca.2014.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Urinary cytology (Ucytol), which is performed in pathology laboratories on fixed and stained samples, represents the gold standard for the identification of atypical/malignant urothelial cells (A/MUC) due to urothelial carcinoma. In this paper we describe three patients in whom A/MUC, due to a bladder carcinoma, were identified with conventional urine sediment (Used) examination on unfixed and unstained samples. METHODS Included are urine samples prepared with conventional and standardized techniques as currently used in general clinical laboratories. Samples were examined with phase contrast microscopy. A/MUC were identified according to the criteria currently used for Ucytol. RESULTS A/MUC (i.e., cells with unusual and pleomorphic size and shape, increased nuclear/cytoplasmic ratio, increased number of nuclei, irregular nuclear borders and irregular chromatin patterns, either isolated or in clusters) were identified in the urine of three patients, all of whom were found to have bladder carcinoma by cystoscopy. CONCLUSIONS At variance with the common and widespread view, A/MUC can also be identified with conventional Used examination, even though Ucytol still represents the gold standard method.
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Affiliation(s)
- G B Fogazzi
- Clinical and Research Laboratory on Urinary Sediment, U.O. di Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - F Pallotti
- U.O. di Anatomia Patologica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - G Garigali
- Clinical and Research Laboratory on Urinary Sediment, U.O. di Nefrologia e Dialisi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Barasch S, Choi M, Stewart J, Das K. Significance of atypical category in voided urine specimens prepared by liquid-based technology: Experience of a single institution. J Am Soc Cytopathol 2014; 3:118-125. [PMID: 31051734 DOI: 10.1016/j.jasc.2013.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/16/2013] [Accepted: 10/07/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the clinical significance of atypical cytology in voided urine samples. We also studied any differences in outcome that may exist between the patients being surveyed versus high risk for urothelial carcinoma (UC). MATERIALS AND METHODS This was a retrospective study of all voided urine specimens with "atypical" cytology over a 10-year period. The patients were categorized into those with and without a prior diagnosis of UC as the "surveillance" and "de novo" (DG) groups. Follow-up was obtained. Clinical impact and outcomes of the 2 groups were compared. RESULTS In this study, 5.7% of voided urine specimens were atypical. Mean age of patients in years, male/female ratio, and time to diagnosis in days was 59 versus 71, 23:15 versus 22:1, and 95 versus 43 in the DG and surveillance group, respectively. Rate of progression to UC was similar in both groups. High-grade UC was significantly higher in the DG. CONCLUSIONS Approximately 20% of patients in the DG were subsequently diagnosed with UC. The common causes for the atypical diagnosis that did not progress to UC were stones and benign prostatic hyperplasia. In the absence of an etiology for the atypia, further investigations are warranted.
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Affiliation(s)
- Samuel Barasch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Michael Choi
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jimmie Stewart
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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Matsumoto K, Ikeda M, Hirayama T, Nishi M, Fujita T, Hattori M, Sato Y, Ohbu M, Iwam M. Clinical Value of Dividing False Positive Urine Cytology Findings into Three Categories: Atypical, Indeterminate, and Suspicious of Malignancy. Asian Pac J Cancer Prev 2014; 15:2251-5. [DOI: 10.7314/apjcp.2014.15.5.2251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Neumann S, Noegel AA. Nesprins in Cell Stability and Migration. CANCER BIOLOGY AND THE NUCLEAR ENVELOPE 2014; 773:491-504. [DOI: 10.1007/978-1-4899-8032-8_22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Arville B, O'Rourke E, Chung F, Amin M, Bose S. Evaluation of a triple combination of cytokeratin 20, p53 and CD44 for improving detection of urothelial carcinoma in urine cytology specimens. Cytojournal 2013; 10:25. [PMID: 24575145 PMCID: PMC3927070 DOI: 10.4103/1742-6413.123784] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/28/2013] [Indexed: 01/22/2023] Open
Abstract
Background: Atypical urine cytology results trigger cystoscopy or molecular tests, both of which are costly, complex and difficult to perform tests. Several immunostains are being investigated to improve cancer detection; however, cytology material is limited and restricts the use of multiple immunostains. This study was designed to determine the utility of a cocktail of three stains, cytokeratin (CK20), p53 and CD44 in urine cytology samples for improving the detection of urothelial carcinoma. Materials and Methods: Urine cytology specimens with cell blocks containing adequate cytologic material between 2005 and 2010 and subsequent follow-up biopsy and/or Urovysion test (102 cases including 29 negative, 56 atypical and 17 malignant) were included in the study and evaluated with the triple stain. Results were first validated on the positive and negative cases and then applied to the atypical cases to determine the utility in the diagnosis of urothelial carcinoma. Results: Based on the validation and published literature, two distinct immunoprofiles were defined – malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns. The malignant immunoprofile showed 88% sensitivity, 78% specificity, 74% positive predictive value (PPV) and 90% negative predictive value (NPV) for detecting urothelial carcinoma. These values improved to 95% sensitivity and 96% NPV when low-grade urothelial carcinoma cases were excluded. Summary: Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics. However Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.
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Affiliation(s)
- Brent Arville
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Emily O'Rourke
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Fai Chung
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mahul Amin
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Shikha Bose
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Siddappa S, Mythri K, Kowsalya R. Cytological findings in routine voided urine samples with hematuria from a tertiary care center in south India. J Cytol 2013; 29:16-9. [PMID: 22438611 PMCID: PMC3307445 DOI: 10.4103/0970-9371.93211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Regardless of the availability of newer and more sophisticated modalities of investigation, urinary tract cytology still remains the most commonly used non-invasive test for the diagnosis of bladder cancer. Aims: As hematuria is the commonest presenting symptom in patients with malignancy of urinary tract, we undertook this study to know the usefulness of urine cytology in evaluation of the hematuric patients for malignancy. Materials and Methods: A total of 21,557 fresh voided urine samples received at our tertiary care referral centre over a period of three years were included in the study. Of these, 1428 cases had hematuria, criteria of either gross or microscopic. Results: Among these hematuric cases included in the study, 32.5% (464 cases) were found to have positive finding of atypical cells. In these cases with atypia, 9.5% (136 cases) were proved to have malignancy both with the histopathological biopsy and cystoscopic findings. Other cases of atypia were found to be of reactive origin, either due to instrumentation or foreign body. A large number of hematuric cases, that is, 964 cases (67.5%) were negative for atypical cells. Conclusions: The limited ability of urine cytology to detect low grade bladder tumors, its subjectivity and lack of uniformity in reporting, all render urine cytology a less than perfect tool. With added collaboration between clinician and cytopathologist, urine cytology can be used an adjunct tool in evaluation of patients with hematuria.
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Affiliation(s)
- Sujatha Siddappa
- Department of Pathology, Institute of Nephro Urology, Victoria Hospital Campus, Bangalore, India
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Muus Ubago J, Mehta V, Wojcik EM, Barkan GA. Evaluation of atypical urine cytology progression to malignancy. Cancer Cytopathol 2013; 121:387-91. [PMID: 23536358 DOI: 10.1002/cncy.21278] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/12/2012] [Accepted: 12/07/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND In urine cytology, the diagnosis of atypia is subjective and clinical management based on these results can be difficult to determine. In this study, the authors determined the percentage of atypical urine diagnoses that progressed to positive cytology or surgical pathology results over an 11-year period. METHODS In a retrospective review of the authors' institution, 1320 atypical urine cytology diagnoses were identified in specimens from 851 patients obtained from January 2000 through December 2010. All subsequent pathology reports were reviewed to determine which patients developed positive cytology/surgical pathology diagnoses. In total, 4106 cytology and surgical pathology specimen reports were reviewed. RESULTS At the authors' institution, 1320 of 16,299 of urine cytology specimens (8.1%) were diagnosed as atypical during the 11-year period. Overall, 271 of 1320 initial atypical urine specimens (21%) progressed to positive cytology or surgical pathology results with a mean time to progression of 155 days. Of the cases that progressed to malignancy, 118 were high-grade urothelial carcinoma and 92 were low-grade urothelial carcinoma. CONCLUSIONS The rate of atypia in urine specimens at this institution was 8.1%. Of the specimen types, atypia was the most common in urinary diversion specimens (16%) and the least common in upper tract cytology (3.8%). When diagnosed as atypical, upper tract specimens had the highest percentage of progression to high-grade carcinoma. Therefore, the authors concluded that the diagnosis of atypia in this specimen group has higher clinical significance and should be managed more aggressively. Cancer (Cancer Cytopathol) 2013;121:387-391. © 2013 American Cancer Society.
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Affiliation(s)
- Julianne Muus Ubago
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
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Piaton E, Decaussin-Petrucci M, Mege-Lechevallier F, Advenier AS, Devonec M, Ruffion A. Diagnostic terminology for urinary cytology reports including the new subcategories ‘atypical urothelial cells of undetermined significance’ (AUC-US) and ‘cannot exclude high grade’ (AUC-H). Cytopathology 2013; 25:27-38. [DOI: 10.1111/cyt.12050] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 12/31/2022]
Affiliation(s)
- E. Piaton
- Hospices Civils de Lyon; Centre de Pathologie Est; Hôpital Femme-Mère-Enfant; Bron France
- Université Claude Bernard Lyon 1; Lyon France
| | - M. Decaussin-Petrucci
- Université Claude Bernard Lyon 1; Lyon France
- Centre de Pathologie Sud; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - F. Mege-Lechevallier
- Université Claude Bernard Lyon 1; Lyon France
- Service d'Anatomie et Cytologie Pathologiques; Hôpital Edouard Herriot; Lyon France
| | - A.-S. Advenier
- Hospices Civils de Lyon; Centre de Pathologie Est; Hôpital Femme-Mère-Enfant; Bron France
| | - M. Devonec
- Université Claude Bernard Lyon 1; Lyon France
- Service d'Urologie; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - A. Ruffion
- Université Claude Bernard Lyon 1; Lyon France
- Service d'Urologie; Centre Hospitalier Lyon Sud; Pierre Bénite France
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Piaton E, Bubendorf L. L’hybridation in situ en fluorescence (FISH) utilisant le kit multisonde UroVysion® dans les cytologies urinaires atypiques. Ann Pathol 2012. [DOI: 10.1016/j.annpat.2012.09.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bubendorf L, Piaton E. UroVysion® multiprobe FISH in the triage of equivocal urinary cytology cases. Ann Pathol 2012; 32:e52-6, 438-43. [PMID: 23244486 DOI: 10.1016/j.annpat.2012.09.207] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/13/2012] [Indexed: 11/15/2022]
Abstract
The search for biological and clinical significance of equivocal urinary cytology has emerged as the most promising application of fluorescence in situ hybridization (FISH). Using the multiprobe UroVysion(®) assay, a negative FISH result in the presence of atypical urothelial cells favors the presence of reactive, benign alterations and helps to avoid unnecessary invasive procedures. However, a negative FISH result in case of a negative or equivocal cytology does not exclude low-grade urothelial neoplasia. Equivocal findings are a notorious problem after conservative treatment, particularly after BCG immunotherapy of carcinoma in situ, where even benign reactive changes can appear worrisome. In this situation, a positive FISH result in spite of non-high grade cytology independently indicates persistent or recurrent urothelial carcinoma. However, chromosomal abnormalities are not restricted to malignancy but may also occur in benign cells. Tetraploidy with a balanced duplication of the whole genome, or polyploidy can occur in non-neoplastic conditions of the bladder such as Decoy cells, radiotherapy-induced changes and urolithiasis. Thus, a positive FISH result in a patient with a history of pelvic irradiation does not prove cancer unless there is unequivocal 9p21 deletion. Recent studies show that an aggressive workup of patients with a suspicious cytology+positive UroVysion(®) result and negative cystoscopy is not currently justified. However, multi-target UroVysion(®) FISH remains an excellent tool to improve diagnosis in urinary cytopathology, provided that FISH results are interpreted in the light of the clinical situation, and that one reminds that FISH adds no diagnostic value in case of clearly positive, high-grade cytology.
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Affiliation(s)
- Lukas Bubendorf
- Institute for Pathology, University Hospital Basel/University of Basel, Schönbeinstrasse 40, 4031 Basel, Switzerland.
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Manna AK, Sarkar M, Bandyopadhyay U, Chakrabarti S, Pathak S, Sarkar DK. Cytological and morphometric study of urinary epithelial cells with histopathological correlation. Indian J Surg 2012; 76:26-30. [PMID: 24799780 DOI: 10.1007/s12262-012-0596-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/05/2012] [Indexed: 11/26/2022] Open
Abstract
This study has been done to asses the utility and accuracy of urinary cytology and morphometric study of exfoliated cells in early detection and follow-up of urothelial neoplasms and thereby help to reduce the disease-related mortality and morbidity. A total 100 patients with urinary symptoms were studied by cytological examination of urine along with morphometric analysis of suspicious epithelial cells. Immunostaining to detect CK-20 expression and p53 over expression was done in smears showing atypical cells. Histopathological confirmation was done in cases which were suspicious on cystoscopy. P value was determined by using unpaired t-test. Statistically significant difference was found between neoplastic and non-neoplastic lesions of the urinary bladder as far as morphometry is concerned. Urinary cytology along with morphometry is an important tool in early detection of urothelial neoplasms. It is also helpful to find out the recurrences during post-operative follow-up period. Overexpression of CK-20 and p53 immunostain in cytology can act as an adjunct to the cytological diagnosis.
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Affiliation(s)
- Asim Kumar Manna
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; D-17/14, Karunamoyee Housing Estate, Salt Lake, Kolkata, 700091 (WB) India
| | - Manisha Sarkar
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India
| | - Ujjal Bandyopadhyay
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India
| | - Srabani Chakrabarti
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India
| | - Swapan Pathak
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India
| | - Diptendra Kumar Sarkar
- Department of Pathology, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India ; Department of Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, 700 020 West Bengal India
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Mokhtar GA, Al-Dousari M, Al-Ghamedi D. Diagnostic significance of atypical category in the voided urine samples: A retrospective study in a tertiary care center. Urol Ann 2011; 2:100-6. [PMID: 20981196 PMCID: PMC2955223 DOI: 10.4103/0974-7796.68857] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/21/2010] [Indexed: 12/18/2022] Open
Abstract
Background: Voided urine samples continue to play an important role in the surveillance of urothelial malignancy and also as a screening mode for high risk patients. In some cases, it is difficult to reliably distinguish changes induced by inflammation, stone or other reactive condition from neoplasm, and these cases are categorized as atypical. The aim of our study is to evaluate the prevalence and the significance of atypical diagnosis in the voided urine samples and also to identify the cytomorphologic features that are seen more frequently in the atypical malignant urine samples. Materials and Methods: All voided urine cytology samples with a diagnosis of atypical urothelial cells, between the period of 2000 and 2009, were obtained from the cytology database. Only those cases with histologic follow-up were included in the study. The cytology and the histology slides were retrieved and reviewed. The following parameters were evaluated: cellularity, cell clusters, nuclear membrane irregularities, hyperchromasia and India-ink type nuclei, the presence of spindle cells and the cytoplasmic characteristics. Results: Out of 72 voided urine samples included in the study, 49 cases (68%) had a positive histologic diagnosis of urothelial malignancy in the follow-up histology; of these (55%) were high-grade urothelial carcinoma. Increased cellularity, papillary cell clusters, nuclear membrane irregularity, hyperchromasia and India-ink type nuclei were observed more frequently in the atypical malignant urine samples, while cytoplasmic vacuolization were seen more in the negative reactive urine samples. Conclusion: The atypical category diagnosis is associated with a significant proportion of urothelial carcinoma. It should be used by the pathologist to convey concern to the clinician in difficult cases that may require close follow-up.
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Affiliation(s)
- Ghadeer A Mokhtar
- Pathology Laboratory, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia
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Brimo F, Vollmer RT, Case B, Aprikian A, Kassouf W, Auger M. Accuracy of urine cytology and the significance of an atypical category. Am J Clin Pathol 2009; 132:785-93. [PMID: 19846822 DOI: 10.1309/ajcpprzlg9kt9axl] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The "atypical urothelial cell" cytologic category is nonstandardized. We subclassify atypical cases to "atypical, favor a reactive process" or "atypical, unclear if reactive or neoplastic." We evaluated the predictive significance of atypical cases by looking at their histologic follow-up. Among the 1,114 patients and 3,261 specimens included, 282 specimens had histologic follow-up. An atypical diagnosis did not carry a significant increased risk of urothelial neoplasia compared with the benign category. Although an "atypical unclear" diagnosis carried a higher rate of detection of high-grade cancer on follow-up biopsy in comparison with "atypical reactive" or "negative" diagnoses (26/58 [45%] vs 15/52 [29%] and 16/103 [15.5%], respectively), this difference was not statistically significant. These results suggest that dividing atypical cases into 2 categories based on the level of cytologic suspicion of cancer does not add clinically relevant information within the atypical category. They also raise the question of the significance of the atypical category altogether.
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49
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Lu DY, Nassar A, Siddiqui MT. High-grade urothelial carcinoma: comparison of SurePath liquid-based processing with cytospin processing. Diagn Cytopathol 2009; 37:16-20. [PMID: 18973118 DOI: 10.1002/dc.20957] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There is limited literature available comparing SurePath (SP) with conventional cytospins (CS) for urine cytology specimens, especially urothelial carcinoma. In this study, urinary tract cytology cases of high-grade urothelial carcinoma were assessed on SP and CS slides. Also, the morphologic differences of high-grade urothelial carcinoma between SP and CS were evaluated on a total of 35 cases of high-grade urothelial carcinoma. SP showed that the tumor cells tend to present as three-dimensional groups and have a smaller cell size than CS. In terms of nuclear features, SP and CS were found to be comparable in morphologic assessment of the tumor cells, with CS providing a slightly better visualization.
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Affiliation(s)
- David Y Lu
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
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50
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Park SW, Chang IH, Han JH, Kawk KW, Ahn SH. The Significance of Persistent Abnormal Urine Cytology. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sang Wook Park
- Department of Urology, Hanil General Hospital, Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea
| | - June Hyun Han
- Department of Urology, Hanil General Hospital, Seoul, Korea
| | - Kyung Won Kawk
- Department of Urology, Hanil General Hospital, Seoul, Korea
| | - Seung Hyun Ahn
- Department of Urology, Hanil General Hospital, Seoul, Korea
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