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Kannan N, Gochhait D, Ramanitharan M, Siddaraju N. A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update. Diagn Cytopathol 2024; 52:187-199. [PMID: 38164657 DOI: 10.1002/dc.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Owing to certain inherent limitations of earlier reporting systems, "The Paris System for Reporting Urinary Cytology (TPS)" was implemented in 2015 to standardize reporting urine cytology with more stringent cytomorphologic criteria. We share our post-TPS experience, comparing it with the conventional system (CS). AIM To assess and compare the cyto-histopathologic/cystoscopic agreement between the conventional and the Paris systems (CS and TPS) for reporting urine cytology. MATERIALS AND METHODS It is a cross-sectional study involving urine samples from 170 patients divided into two groups (CS and TPS). Of the 170 cases, 85 were reported according to the CS, and 85 were reported according to TPS with all the relevant clinical, radiologic, and cystoscopic findings. Using the kappa statistics, both groups were statistically analyzed for sensitivity, specificity, predictive values, and agreement. RESULTS The sensitivity and specificity for high-grade urothelial carcinoma (HGUC) as per TPS were 83.33% and 94.59%, respectively, while they were 73.47% and 80.56% for the conventional system. The agreement for HGUC with TPS was 87.06% with a kappa value of 0.7416, while it was 76.5% with a kappa value of 0.53 for the CS. Implementing the TPS minimized usage of the atypical urothelial cells (AUC) category, increasing the clarity in detecting HGUC. CONCLUSION TPS provides better agreement with histopathology than the CS for diagnosing HGUC, which is attributable to stringent TPS criteria that prompt cytopathologists to look more diligently for morphologic and numeric criteria.
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Affiliation(s)
- Narasimhapriyan Kannan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Manikandan Ramanitharan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Kim JM, Lee J, Sung SH. Application of The Paris System in neobladder washing cytology: Comparison between the original diagnosis and correlation with histopathology. Diagn Cytopathol 2023; 51:744-750. [PMID: 37610033 DOI: 10.1002/dc.25215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND In urinary diversion after radical cystectomy, the incidence of recurrent urothelial carcinoma (UC) in upper urinary tract or urethra are reported in 2%-17% of the patients. Urine cytology plays a pivotal role in detecting the recurrence of UC. However, cytologic diagnosis in urinary diversion including neobladder is often challenging due to significant degenerative changes and necro-inflammatory background. Since the proposal of The Paris System (TPS) for reporting cytology, the utility of TPS in urinary diversion specimen has not been studied yet. The objective of this study is to evaluate the diagnostic usefulness of TPS compared with the original diagnosis and correlate with the matched histopathological results. METHODS Urinary diversion cytology specimens with concurrent or subsequent biopsy or resection at EUMC in recent 16 years (from January 2002 to December 2018) are retrospectively reviewed and reclassified according to TPS criteria. The TPS categories and the original diagnoses were compared and correlated with follow-up histology. RESULTS Concurrent or subsequent biopsy or resection within a 6-month period was available in 45 cases from 28 patients. When applying TPS, the rate of atypical and suspicious categories decreased by 13.4% and 11.1%. Using TPS increased the value of sensitivity, NPV, and accuracy to 93.75%, 93.75%, and 90.91%, respectively. CONCLUSION Application of TPS reduced the rate of indeterminate diagnoses and moreover, improved the sensitivity and accuracy of urinary diversion cytology. Therefore, we believe that diversion urine cytology diagnosis according to TPS is useful to screen patients for detection of recurrence in routine clinical practice.
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Affiliation(s)
- Ji Min Kim
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Junghye Lee
- Department of Forensic Medicine, Postmortem Investigation Division, National Forensic Service, Wonju, South Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
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Iodinated Contrast Medium Affects Urine Cytology Assessment: A Prospective, Single-Blind Study and Its Impact on Urological Practice. Diagnostics (Basel) 2022; 12:diagnostics12102483. [PMID: 36292171 PMCID: PMC9600466 DOI: 10.3390/diagnostics12102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022] Open
Abstract
During endoscopic procedures for suspected urothelial tumors of the upper urinary tract, radiographic imaging using an iodinated contrast medium is often required. However, following ureteropyelography, we detected changes in cytology characteristics not correlating with real cytology findings in naive urine. The aim of our study was to assess cytology changes between naive and postcontrast urine according to The Paris System of cytology classification. Methods: We prospectively assessed urine samples from 89 patients (23 patients with histologically proven urothelial cancer and 66 healthy volunteers). The absence of malignancy was demonstrated by CT urography and/or ureteroscopy. The study was single blind (expert cytopathologist) and naïve Paris system for urine cytology assessment was used. Furthermore, additional cytological parameters were analyzed (e.g., specimen cellularity, degree of cytolysis, cytoplasm and nucleus color, chromatin and nucleo-cytoplasmic ratio). Results: Our study showed statistically significant differences when comparing naïve and postcontrast urine in healthy volunteers (only 51 % concordance, p = 0.001) versus malignant urine specimens (82 % concordance). The most important differences were in the shift from The Paris System category 2 (negative) to 1 (non-diagnostic) and from category 2 (negative) to 3 (atypia). Other significant changes were found in the assessment of specimen cellularity (p = 0.0003), degree of cytolysis (p = 0.001), cytoplasm color (p = 0.003), hyperchromasia (p = 0.001), course chromatin (p = 0.002), nucleo-cytoplasmatic ratio (p = 0.001) and nuclear borders’ irregularity (p = 0.01). Conclusion: Our unique study found crucial changes in the cytological assessment of naive and postcontrast urine and we confirm that postcontrast urine is more often assessed as abnormal, suspect or non-diagnostic. Therefore, before urine collection for cytology, the clinician should avoid administration of iodinated contrast into the urinary tract.
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Allison DB, Zhang ML, Vohra P, VandenBussche CJ. The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens. Diagnostics (Basel) 2022; 12:diagnostics12040931. [PMID: 35453979 PMCID: PMC9025489 DOI: 10.3390/diagnostics12040931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Since the release of The Paris System for Reporting Urinary Cytology (TPS), the assessment of urine cytology specimens has primarily focused on the detection of high-grade urothelial carcinoma (HGUC) and carcinoma in situ (CIS). Fortunately, the malignant cells in these lesions tend to be loosely cohesive, resulting in the natural exfoliation of individual malignant cells into the urine. However, HGUC/CIS lesions occasionally exfoliate larger fragments which can be difficult to assess due to cellular overlap and fragment three-dimensionality. Furthermore, reactive benign urothelial fragments and fragments from low-grade urothelial neoplasms (LGUN) may also be seen in urine specimens and contain atypical cytomorphologic features. As a result, the significance of urothelial tissue fragments (UTFs) is often unclear. Herein, we discuss the literature on UTFs before and after the implementation of TPS, as well as strategies to help overcome this diagnostic challenge.
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Affiliation(s)
- Derek B. Allison
- Department of Pathology and Laboratory Medicine, Lexington, KY 40536, USA;
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - M. Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Poonam Vohra
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Christopher J. VandenBussche
- Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-410-955-1180
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Ulldemolins Aznar P, Muñoz Vicente E, Roselló-Sastre E. [How has the Paris System contributed to urine cytology? Evaluating the contribution of the Paris System to urine cytology. A comparative study of the Paris System and the Papanicolaou method in a tertiary centre]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55:125-134. [PMID: 35483768 DOI: 10.1016/j.patol.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Paris System (PS) has replaced the classical Papanicolaou System (PapS) in reporting urine cytology, due to its improved sensitivity and negative predictive value (NPV) without loss of specificity. Furthermore, it has enabled the risk of malignancy to be established in each cytological category. The aim of this study is to compare the Paris System with previous results and determine the changes in sensitivity, specificity, positive predictive value, NPV and risk of malignancy in our centre, MATERIALS AND METHODS: Evaluation of the diagnostic power of urine cytology by means of a retrospective cohort study, comparing two series of 400 cytological studies, one using the Papanicolaou System and the other the Paris System. RESULTS In the detection of high-grade urothelial carcinoma, Paris System has better specificity (93.82% PapS vs 98.64% PS; P=.001) and PPV (39.5% PapS vs 70.6% PS; P=.044) than Papanicolaou System, without changes in sensitivity (53.5% PapS vs 37.5% PS; P=.299) or NPV (96.4% PapS vs 94.8% PS; P=.183). The risk of malignancy for the atypical category increases from low to high levels (1.6% PapS vs 40.0% PS; P=.001); the other categories showed no significant statistical changes. CONCLUSION The Paris System improves specificity and positive predictive value and establishes a better indication of risk of malignancy for each category, enabling specific clinical management in each case.
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Affiliation(s)
| | - Elia Muñoz Vicente
- Servicio de Anatomía Patológica, Hospital General Universitari de Castellón, Castellón de la Plana, Castellón, España
| | - Esther Roselló-Sastre
- Servicio de Anatomía Patológica, Hospital General Universitari de Castellón, Castellón de la Plana, Castellón, España.
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Allison DB, Kates M, VandenBussche CJ. Indeterminate atypia in urinary tract cytology: Does it really matter? Diagn Cytopathol 2021; 50:176-183. [PMID: 34870896 DOI: 10.1002/dc.24912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
The study of atypia in urinary cytology has been ongoing for decades but most studies have focused primarily on test performance in patients with concurrent biopsies and/or limited follow-up periods. While these data are useful, many studies fail to consider patient factors that may alter the pretest probability, which can subsequently affect test performance. An isolated diagnosis of malignancy in urinary cytology usually has a high positive predictive value and allows a urologist to conduct a rigorous workup of the patient to establish a tissue diagnosis. However, it is less certain how an atypical diagnosis impacts patient care, given that many patients have a history of bladder cancer and are already under surveillance with cystoscopy at regular screening intervals. Furthermore, a discrete negative urine cytology is unlikely to allow a patient to forego a cystoscopy procedure due to limitations in the sensitivity of urine cytology. Over the last several years, the introduction of The Paris System for Reporting Urinary Cytology (TPS) has improved the predictive value of atypical diagnoses, but additional studies are needed to evaluate the performance of these diagnoses in specific clinical situations. Such data could better inform urologists on how to manage patients with atypical diagnoses. This review discussed the diagnosis of atypia in urinary cytology and the impact of such a diagnosis in various clinical contexts.
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Affiliation(s)
- Derek B Allison
- Department of Pathology and Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Max Kates
- James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Nguyen L, Nilforoushan N, Krane JF, Bose S, Bakkar R. Should "suspicious for high-grade urothelial carcinoma" and "positive for high-grade urothelial carcinoma" remain separate categories? Cancer Cytopathol 2020; 129:156-163. [PMID: 33036060 DOI: 10.1002/cncy.22357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/31/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Paris System (TPS) for Reporting Urinary Cytology aims to standardize urine cytology reporting. Per TPS, the diagnosis of "suspicious for high-grade urothelial carcinoma (SHGUC)" is applied in cases that have few urothelial cells with severe atypia but are quantitatively insufficient for a diagnosis of "high-grade urothelial carcinoma (HGUC)." In our study, we compared the diagnostic accuracy and risk of malignancy (ROM) of these 2 categories to assess whether they could be combined in clinical practice to perhaps improve overall interobserver variability. METHODS All urine specimens with a diagnosis of either SHGUC or HGUC from January 2016 to July 2019 were retrieved from the pathology database of 2 large academic institutions. Only cases with follow-up biopsies within 6 months were included. RESULTS One hundred eighty-nine cases met the study criteria. Of these, 122 had a cytologic diagnosis of SHGUC, and 67 had a diagnosis of HGUC. Ninety-five (78%) cases from the SHGUC group and 64 (96%) cases from the HGUC group had biopsy-proven HGUC. The majority of cases with discordance had a history of treatment with either intravesical bacillus Calmette-Guérin or mitomycin. The difference in the rate of biopsy-proven HGUC between the SHGUC category and the HGUC category (95/122 vs 64/67, respectively) was statistically significant (P < .001). CONCLUSIONS The difference in ROM between SHGUC and HGUC was statistically significant in our study cohort. Intravesical chemotherapy was frequently observed in negative biopsy cases in both groups. Our preliminary findings suggest that the 2 TPS categories should remain separate.
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Affiliation(s)
- Luan Nguyen
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Neshat Nilforoushan
- Department of Pathology, University of California Los Angeles, Los Angeles, California
| | - Jeffrey F Krane
- Department of Pathology, University of California Los Angeles, Los Angeles, California
| | - Shikha Bose
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rania Bakkar
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
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Zhang ML, Miki Y, Hang JF, Vohra M, Peyton S, McIntire PJ, VandenBussche CJ, Vohra P. A review of upper urinary tract cytology performance before and after the implementation of The Paris System. Cancer Cytopathol 2020; 129:264-274. [PMID: 32897658 DOI: 10.1002/cncy.22343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022]
Abstract
Urinary cytology (UC) is one of the primary diagnostic modalities used for the screening and surveillance of urothelial carcinoma. Despite its widespread use, UC has suffered from a lack of standardized or reproducible criteria and wide interobserver variability, particularly of the designation of atypical urothelial cells. The Paris System for Reporting Urinary Cytology (TPS), published in 2016, aimed to provide a standardized approach for evaluating UC by creating diagnostic categories with specific cytomorphologic criteria. Recent studies have primarily investigated the application of TPS on lower urinary tract specimens and have mostly shown that TPS implementation has improved the performance of UC specimens. Only a few studies have reported the impact of TPS on upper urinary tract (UUT) cytology. Additionally, there is uncertainty as to which cytological features are most predictive of high-grade urothelial carcinoma (HGUC) in the UUT. This review summarizes the literature regarding the utility and performance of UUT cytology and highlights findings before and after the implementation of TPS.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yurina Miki
- Department of Cellular Pathology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Manjiv Vohra
- Environmental Chemical Corp, Burlingame, California
| | - Stephen Peyton
- QML Pathology, Anatomical Pathology, Brisbane, Queensland, Australia
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | | | - Poonam Vohra
- Department of Anatomic Pathology, University of California, San Francisco, California
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Zhang ML, VandenBussche CJ, Hang JF, Miki Y, McIntire PJ, Peyton S, Vohra P. A review of urinary cytology in the setting of upper tract urothelial carcinoma. J Am Soc Cytopathol 2020; 10:29-35. [PMID: 32792229 DOI: 10.1016/j.jasc.2020.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
Abstract
Urothelial carcinomas of the upper urinary tract (UUT) are uncommon. Cytological examination of voided urine or washings from the UUT has been part of the standard workup for upper tract urothelial carcinoma (UTUC); however, its value remains controversial. The lack of uniform terminology and specific diagnostic criteria could also have contributed to the inferior performance of urinary cytology for detecting UTUC. The Paris System for Reporting Urinary Cytology (TPS) has provided a standardized reporting system for urinary cytology specimens with clearly defined cytomorphologic diagnostic criteria and found acceptance on an international level after its implementation in 2016. Recent studies have shown that TPS has led to improved diagnostic performance of urinary cytology; however, most of these studies had focused on the evaluation of lower urinary tract cytology specimens. Only a limited number of new research studies have analyzed the effect of TPS when applied to UUT cytology specimens. In the present report, we have summarized the current understanding and utility of UTUC, including its molecular biology, and reviewed the current literature.
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Affiliation(s)
- M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yurina Miki
- Department of Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Stephen Peyton
- Department of Anatomical Pathology, QML Pathology, Brisbane, Queensland, Australia
| | - Poonam Vohra
- Department of Anatomic Pathology, University of California, San Francisco, San Francisco, California.
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Kuan KC, Segura SE, Ahlstedt J, Khader SN, Hakima L. The predictive value of positive and suspicious urine cytology: Are they different? Diagn Cytopathol 2020; 48:998-1002. [PMID: 32558388 DOI: 10.1002/dc.24531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Urine cytology evaluation is an effective test in the detection of high-grade urothelial carcinoma (HGUC). While the guideline distinguishes the 2 categories: "positive for HGUC" (PHGUC) and "suspicious for HGUC" (SHGUC), the association between these categories with their subsequent follow-up biopsies remains unclear. This study aims to determine and compare the positive predictive value (PPV) of the specimens in PHGUC and SHGUC categories with their respective histologic diagnoses. METHODS During the period of 03/01/2008 to 07/31/2018, urine cytology cases diagnosed as PHGUC and SHGUC with subsequent bladder biopsy within 12 months were retrieved. All cases were correlated with first biopsy obtained during 12 months of cytology specimen. Biopsy result with HGUC, carcinoma in situ, or non-urothelial carcinoma diagnoses were considered as concordance. RESULTS 378 cases (229 SHGUC and 149 PHGUC) were identified from 263 patients. For the 229 SHGUC cases, the PPV was 72% (n = 166) and for the 149 PHGUC cases, the PPV was 85% (n = 127). While both categories have high PPV, they are statistically significant (p < 0.0001). Additionally, 33 cases were found to have low-grade urothelial carcinoma (LGUC), constituting a portion of discordant results. CONCLUSION PHGUC and SHGUC categories are both associated with a high risk of malignancy, however, there is a statistically significant difference between them in our study, supporting the PSRUC guidelines of two separate categories. In instances when urine cytology is discordant with biopsy results, further investigation and clinical follow up is warranted. LGUC appears to remain a common pitfall especially in the suspicious category.
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Affiliation(s)
- Kevin C Kuan
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sheila E Segura
- Indiana University/School of Medicine, Indianapolis, Indiana, USA
| | - Jeffrey Ahlstedt
- The University of Alabama at Birmingham/School of Medicine, Birmingham, Alabama, USA
| | - Samer N Khader
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Laleh Hakima
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
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Wang YH, Hang JF, Wen CH, Liao KC, Lee WY, Lai CR. Diagnostic Agreement for High-Grade Urothelial Cell Carcinoma in Atypical Urine Cytology: A Nationwide Survey Reveals a Tendency for Overestimation in Specimens with an N/C Ratio Approaching 0.5. Cancers (Basel) 2020; 12:cancers12020272. [PMID: 31979119 PMCID: PMC7072605 DOI: 10.3390/cancers12020272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 11/16/2022] Open
Abstract
In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, p < 0.01). Three cases with an N/C ratio near 0.5 were overestimated. Poor interobserver concordance of diagnosis and TPS criteria was revealed. Compared with other cytological features, the N/C ratio assessment was quantitative and more reproducible, but a tendency to overestimate cells was noted when the N/C ratio was approximately 0.5. Continuing education programs should emphasize the accurate assessment of N/C ratio to improve the application of TPS.
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Affiliation(s)
- Yeh-Han Wang
- Department of Anatomic Pathology, Taipei Institute of Pathology, Taipei 10374, Taiwan;
- Institute of Public Health, National Yang-Ming University, Taipei 11221, Taiwan
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Correspondence:
| | - Chien-Hui Wen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
| | - Kuan-Cho Liao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan;
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Ying Lee
- Department of Cytopathology, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
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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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Courtade-Saïdi M, Cochand-Priollet B, Vielh P, Piaton E. [A new terminology for urinary cytopathology: The Paris System for Reporting Urinary Cytology (2015)]. Ann Pathol 2019; 39:344-351. [PMID: 31255415 DOI: 10.1016/j.annpat.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 01/10/2023]
Abstract
As for the Bethesda system for cervical and thyroid cytopathology, a terminology for reporting urinary cytology has been published in 2015. The new "Paris System" provides a consensus terminology for urinary cytology which underlines the criteria for the recognition of high-grade urothelial carcinoma (HGUC) and of those excluding HGUC, or suspicious for HGUC. It also focuses on new rules to recognize and report the subgroup of "atypical urothelial cells". Here we describe and illustrate the various categories as in the reference book. We analyse the main diagnostic criteria, including microscopic features as well as the risk of malignancy associated to every diagnostic category.
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Affiliation(s)
- Monique Courtade-Saïdi
- Département d'anatomie et cytologie pathologiques, institut universitaire du cancer Toulouse oncopôle, 1, avenue Irène Joliot-Curie, 31059 Toulouse cedex, France.
| | - Béatrix Cochand-Priollet
- Département de pathologie, université Paris Descartes, hôpital Cochin, 27, rue du Faubourg Saint-Jacques, 75679 Paris cedex 14, France
| | - Philippe Vielh
- Laboratoire national de santé, Grand Duché de Luxembourg, 1, rue Louis-Rech, 3555 Dudelange, Luxembourg
| | - Eric Piaton
- Centre de pathologie est, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
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14
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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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15
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Glass R, Rosca O, Raab S, Szabelska J, Chau K, Sheikh‐Fayyaz S, Cocker R. Applying the Paris system for reporting urine cytology to challenging cytology cases. Diagn Cytopathol 2019; 47:675-681. [DOI: 10.1002/dc.24166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Ryan Glass
- Department of PathologyStaten Island University Hospital Staten Island New York
| | - Oana Rosca
- Department of PathologyStaten Island University Hospital Staten Island New York
| | - Stephen Raab
- Department of PathologyUniversity of Mississippi Jackson Mississippi
| | | | - Karen Chau
- Department of PathologyNorthwell Health Lake Success New York
| | | | - Rubina Cocker
- Department of PathologyNorthwell Health Lake Success New York
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16
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Impact of intravesical therapy for non-muscle invasive bladder cancer on the accuracy of urine cytology. World J Urol 2019; 37:2051-2058. [DOI: 10.1007/s00345-018-02624-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022] Open
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17
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Gelwan E, Zhang ML, Allison DB, Cowan ML, DeLuca J, Fite JJ, Wangsiricharoen S, Williamson B, Zhou A, VandenBussche CJ. Variability among observers utilizing the CellSolutions BestCyte Cell Sorter imaging system for the assessment of urinary tract cytology specimens. J Am Soc Cytopathol 2019; 8:18-26. [PMID: 30929755 DOI: 10.1016/j.jasc.2018.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/29/2018] [Accepted: 10/08/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Image analysis systems are not currently commonly used for evaluating urinary cytology specimens. We evaluated whether the BestCyte Cell Sorter (CellSolutions, Greensboro, NC) imaging system can reliably identify atypical cells in urinary cytology specimens. METHODS Fifty-three consecutive urine cytology specimens underwent 2 preparations: one slide using SurePath (SP; BD Diagnostics, Sparks, MD)™ for routine clinical evaluation, and a second slide using the CellSolutions F50 system for analysis by the BestCyte Cell Sorter (BCCS) scanning system. Eight observers reviewed atypical cells flagged by BCCS and assigned a BCCS diagnosis to each of the 53 specimens. The observers also blindly reviewed the SP preparation (when available) and assigned an SP diagnosis. The SP diagnoses given by one "expert" observer was considered as a reference diagnosis. RESULTS There was fair-to-moderate agreement among observers for identifying any atypia and high-grade atypia (Fleiss kappa: 0.417 and 0.338, respectively) using BCCS. Review of SP preparations had slightly better agreement (Fleiss kappa: 0.558 and 0.564, respectively). Intraobserver agreement between the two methods varied greatly between individuals (Cohen's kappa range: 0.260 to 0.647). When a consensus diagnosis could be reached among the observers for cases with surgical follow-up, the consensus diagnosis was concordant in 11 of 12 instances, with one instance being a one-step discrepancy. CONCLUSIONS Specimen review by BCCS resulted in slightly greater interobserver variability than review of routine SP preparations. This may have been due to variations in observer experience and comfort with the use of a digital imaging system, which is further suggested by the wide range of intraobserver agreement among individuals.
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Affiliation(s)
- Elise Gelwan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Derek B Allison
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan L Cowan
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Juliana DeLuca
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J Judd Fite
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Bonnie Williamson
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Zhou
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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18
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Abstract
The utility of urine cytology has shifted from the identification of red blood cells, crystals, or parasites to its currently used role of detection of cancer cells exfoliated in urine samples. A variety of ancillary tests have been developed to complement the diagnostic ability of urine cytology. Furthermore, urine testing will continue to evolve as the pathogenesis of genitourinary tract diseases in depth is understood. This article focuses on the diagnostic advances in urine cytology from the cytomorphological perspective, past and current reporting schemes, and the application of ancillary testing in urine samples.
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Affiliation(s)
- Juan Xing
- University of Pittsburgh Medical Center, UPMC Shadyside Hospital, 5150 Centre Avenue, POB2, Suite 201.2, Pittsburgh, PA 15232, USA
| | - Jordan P Reynolds
- Cleveland Clinic Foundation, Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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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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20
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Allison DB, Sharma R, Cowan ML, VandenBussche CJ. Evaluation of Sienna Cancer Diagnostics hTERT Antibody on 500 Consecutive Urinary Tract Specimens. Acta Cytol 2018; 62:302-310. [PMID: 29874657 DOI: 10.1159/000489181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Telomerase activity can be detected in up to 90% of urothelial carcinomas (UC). Telomerase activity can also be detected in urinary tract cytology (UTC) specimens and indicate an increased risk of UC. We evaluated the performance of a commercially available antibody that putatively binds the telomerase reverse transcriptase (hTERT) subunit on 500 UTC specimens. STUDY DESIGN Unstained CytospinTM preparations were created from residual urine specimens and were stained using the anti-hTERT antibody (SCD-A7). Two algorithms were developed for concatenating the hTERT result and cytologic diagnosis: a "no indeterminates algorithm," in which a negative cytology and positive hTERT result are considered positive, and a "high-specificity algorithm," in which a negative cytology and positive hTERT result are considered indeterminate (and thus negative for comparison to the gold standard). RESULTS The "no indeterminates algorithm" and "high-specificity algorithm" yielded a sensitivity of 60.6 and 52.1%, a specificity of 70.4 and 90.7%, a positive predictive value of 39.1 and 63.8%, and a negative predictive value of 85.0 and 85.8%, respectively. CONCLUSIONS A positive hTERT result may identify a subset of patients with an increased risk of high-grade UC (HGUC) who may otherwise not be closely followed, while a negative hTERT immunocytochemistry result is associated with a reduction in risk for HGUC.
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Affiliation(s)
- Derek B Allison
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rajni Sharma
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Morgan L Cowan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher J VandenBussche
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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21
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VandenBussche CJ, Allison DB, Gupta M, Ali SZ, Rosenthal DL. A 20-year and 46,000-specimen journey to Paris reveals the influence of reporting systems and passive peer feedback on pathologist practice patterns. Cancer Cytopathol 2018; 126:381-389. [DOI: 10.1002/cncy.22006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher J. VandenBussche
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Derek B. Allison
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Mohit Gupta
- Department of Urology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Syed Z. Ali
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Radiology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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22
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Fite JJ, Rosenthal DL, VandenBussche CJ. When words matter: A “suspicious” urinary tract cytology diagnosis improves patient follow-up among nonurologists. Cancer Cytopathol 2018; 126:282-288. [DOI: 10.1002/cncy.21971] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/08/2022]
Affiliation(s)
- J. Judd Fite
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Gynecology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Christopher J. VandenBussche
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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23
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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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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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25
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Roy M, Kaushal S, Jain D, Seth A, Iyer VK, Mathur SR. An institutional experience with The Paris System: A paradigm shift from ambiguous terminology to more objective criteria for reporting urine cytology. Cytopathology 2017; 28:509-515. [DOI: 10.1111/cyt.12448] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2017] [Indexed: 01/02/2023]
Affiliation(s)
- M. Roy
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. Kaushal
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - D. Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - A. Seth
- Department of Urology; All India Institute of Medical Sciences; New Delhi India
| | - V. K. Iyer
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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26
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Suh J, Go H, Sung C, Baek S, Hwang H, Jeong S, Cho Y. Modification of The Paris System for urinary tract washing specimens using diagnostic cytological features. Cytopathology 2017; 28:516-523. [DOI: 10.1111/cyt.12450] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 12/13/2022]
Affiliation(s)
- J. Suh
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - H. Go
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - C. Sung
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S. Baek
- Department of Clinical Epidemiology and Biostatistics; University of Ulsan College of Medicine; Seoul Korea
| | - H. Hwang
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - S. Jeong
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Y. Cho
- Department of Pathology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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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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28
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Zhang ML, Zhou AG, Rosenthal DL, VandenBussche CJ. Urinary tract washing specimens containing atypical urothelial tissue fragments are significantly associated with urothelial neoplasia. Diagn Cytopathol 2017; 45:795-799. [DOI: 10.1002/dc.23767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 04/06/2017] [Accepted: 05/30/2017] [Indexed: 01/20/2023]
Affiliation(s)
- M. Lisa Zhang
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Amy G. Zhou
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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29
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Hang J, Charu V, Zhang ML, VandenBussche CJ. Digital image analysis supports a nuclear‐to‐cytoplasmic ratio cutoff value of 0.5 for atypical urothelial cells. Cancer Cytopathol 2017; 125:710-716. [DOI: 10.1002/cncy.21883] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Jen‐Fan Hang
- Department of PathologyThe Johns Hopkins University School of MedicineBaltimore Maryland
- Department of Pathology and Laboratory MedicineTaipei Veterans General HospitalTaipei Taiwan
- School of MedicineNational Yang‐Ming UniversityTaipei Taiwan
| | - Vivek Charu
- Department of PathologyThe Johns Hopkins University School of MedicineBaltimore Maryland
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimore Maryland
| | - M. Lisa Zhang
- Department of PathologyMassachusetts General HospitalBoston Massachusetts
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30
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Zhang ML, Rosenthal DL, VandenBussche CJ. Upper urinary tract washings outperform voided urine specimens to detect upper tract high-grade urothelial carcinoma. Diagn Cytopathol 2017; 45:700-704. [DOI: 10.1002/dc.23746] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 11/05/2022]
Affiliation(s)
- M. Lisa Zhang
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Dorothy L. Rosenthal
- Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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31
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Piaton E, Advenier AS, Carré C, Decaussin-Petrucci M, Mège-Lechevallier F, Hutin K, Nennig C, Colombel M, Ruffion A. p16/Ki-67 dual labeling and urinary cytology results according to the New Paris System for Reporting Urinary Cytology: Impact of extended follow-up. Cancer Cytopathol 2017; 125:552-562. [PMID: 28371465 DOI: 10.1002/cncy.21853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Overexpression of p16INK4a has been identified in urothelial malignancies both cytologically and histologically. In addition, p16/Ki-67 dual labeling has been shown to identify high-grade urothelial cancer cells and some progression cases within a 12-month delay. The Paris System for Reporting Urinary Cytology (TPS) was published in late 2015. Its aim is to clarify the criteria for diagnosing or, conversely, excluding high-grade urothelial carcinoma (HGUC). METHODS Dual labeling was performed on archived ThinPrep-based Papanicolaou slides. A total of 208 samples (negative for high-grade urothelial carcinoma [NHGUC], 59; consistent with low-grade urothelial neoplasia [LGUN], 24; atypical urothelial cells [AUC], 15; and suspicious for or showing HGUC, 110) were analyzed for p16/Ki-67 after reclassification according to TPS. We assessed the oncologic status of the patients with cystoscopy, urinary cytology, histology, and prolonged 36-month follow-up data. RESULTS The sensitivity of p16/Ki-67 for life-threatening lesions was not different from that of urinary cytology (82.8% vs 83.6%; P = 1). However, among patients with samples classified as NHGUC and AUC, disease-free survival was significantly shorter for dual-labeled cases versus cases with negative dual labeling (P < .0001). The same tendency was observed in patients with histologically proven LGUN (P < .0001). As for specificity in patients with negative cystoscopy and cytology combined, prolonged follow-up showed 90% overall survival at 24 months. CONCLUSIONS A long-term evaluation of p16/Ki-67 dual labeling may identify HGUC and progression in cases with negative/low-grade urinary cytology results, and there are potential implications for the clinical management of patients after the conservative treatment of non-muscle-invasive urothelial carcinoma. Cancer Cytopathol 2017;125:552-62. © 2017 American Cancer Society.
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Affiliation(s)
- Eric Piaton
- Centre de Pathologie Est, Hôpitaux de Lyon, Hôpital Femme-Mère-Enfant, Bron, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Anne-Sophie Advenier
- Université Claude Bernard Lyon 1, Lyon, France.,Service de Médecine Légale, Lyon, France
| | | | - Myriam Decaussin-Petrucci
- UMR INSERM U 1052/CNRS 5286, Université Claude Bernard Lyon, 1, France.,Centre de Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Florence Mège-Lechevallier
- Université Claude Bernard Lyon 1, Lyon, France.,Service d'Anatomie et Cytologie Pathologiques, Hôpital Edouard Herriot, Lyon, France
| | - Karine Hutin
- Centre de Pathologie Est, Hôpitaux de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Cindy Nennig
- Centre de Pathologie Est, Hôpitaux de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Marc Colombel
- Université Claude Bernard Lyon 1, Lyon, France.,Service d'Urologie, Hôpital Edouard Herriot, Lyon, France
| | - Alain Ruffion
- Université Claude Bernard Lyon 1, Lyon, France.,Service d'Urologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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32
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VandenBussche CJ. A review of the Paris system for reporting urinary cytology. Cytopathology 2017; 27:153-6. [PMID: 27221750 DOI: 10.1111/cyt.12345] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 01/28/2023]
Abstract
After the 2013 International Congress of Cytology in Paris, consensus groups were formed to establish an international reporting system for urinary tract (UT) specimens. The recommended guidelines, known as The Paris System (TPS) for Reporting Urinary Cytology, focus on reducing the rate of unnecessary indeterminate diagnoses while maintaining the excellent performance UT cytology has for identifying high-grade urothelial carcinoma. This review highlights the major features of TPS.
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Affiliation(s)
- C J VandenBussche
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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33
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Cowan ML, Rosenthal DL, VandenBussche CJ. Improved risk stratification for patients with high-grade urothelial carcinoma following application of the Paris System for Reporting Urinary Cytology. Cancer Cytopathol 2017; 125:427-434. [DOI: 10.1002/cncy.21843] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Morgan L. Cowan
- 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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Piaton E. [Bladder tumor histo-seminar - case 3: Urinary cytology. Atypical urothelial cells, cannot exclude high grade (AUC-H) or "suspicious for high-grade urothelial carcinoma" (SHGUC of the Paris classification)]. Ann Pathol 2016; 36:382-385. [PMID: 27838073 DOI: 10.1016/j.annpat.2016.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Eric Piaton
- Centre de pathologie et de neuropathologie Est, groupement hospitalier Est, 59, boulevard Pinel, 69677 Bron cedex, France.
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35
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Lee PJ, Owens CL, Lithgow MY, Jiang Z, Fischer AH. Causes of false-negative for high-grade urothelial carcinoma in urine cytology. Diagn Cytopathol 2016; 44:994-999. [DOI: 10.1002/dc.23621] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Paul J. Lee
- Department of Pathology; University of Massachusetts Memorial Health Care; 1 Innovation Dr, Biotech 3 Worcester Massachusetts
| | - Christopher L. Owens
- Department of Pathology; University of Massachusetts Memorial Health Care; 1 Innovation Dr, Biotech 3 Worcester Massachusetts
| | - Marie Y. Lithgow
- Department of Pathology; University of Massachusetts Memorial Health Care; 1 Innovation Dr, Biotech 3 Worcester Massachusetts
| | - Zhong Jiang
- Department of Pathology; University of Massachusetts Memorial Health Care; 1 Innovation Dr, Biotech 3 Worcester Massachusetts
| | - Andrew H. Fischer
- Department of Pathology; University of Massachusetts Memorial Health Care; 1 Innovation Dr, Biotech 3 Worcester Massachusetts
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36
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Miki Y, Neat M, Chandra A. Application of The Paris System to atypical urine cytology samples: correlation with histology and UroVysion ® FISH. Cytopathology 2016; 28:88-95. [PMID: 27601215 DOI: 10.1111/cyt.12367] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate whether atypical urine cytology cases may be stratified more objectively using The Paris System (TPS) and whether reclassified cases correlate with histology and UroVysion® results. METHODS Atypical urine cytology cases subjected to UroVysion® testing over a period of 6 years were reviewed. Each case was reclassified according to TPS and correlated with histology and UroVysion® results. RESULTS A total of 91 cases were identified; 70.3% were reclassified as 'negative for high-grade urothelial carcinoma (HGUC)' and 14.3% as 'atypical urothelial cells (AUC)'. The histological correlation was available in 45 cases. In the 'negative for HGUC' category, 67.9% had no histological evidence of malignancy, but 17.9% were diagnosed as HGUC. In the 'AUC' category, histology revealed urothelial carcinoma in 70% of the cases (of these, 71.4% were high grade). There was no histological evidence of malignancy in 30% of cases; notably, all of which were from patients under surveillance. The sensitivity and specificity of UroVysion® were 85.7% and 33.3% in the 'AUC' group and 62.5% and 100% in the 'negative for HGUC' group. CONCLUSIONS The Paris System is an objective template for reporting urine cytology specimens, and is particularly useful in identifying HGUC cases and refining the category of 'AUC'.
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Affiliation(s)
- Y Miki
- Cellular Pathology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - M Neat
- Cancer Genetics, Guy's and Saint Thomas' NHS Foundation Trust, Viapath, London, UK
| | - A Chandra
- Cellular Pathology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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37
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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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38
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Joudi AM, Pambuccian SE, Wojcik EM, Barkan GA. The positive predictive value of “suspicious for high-grade urothelial carcinoma” in urinary tract cytology specimens: A single-institution study of 665 cases. Cancer Cytopathol 2016; 124:811-819. [DOI: 10.1002/cncy.21764] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/27/2016] [Accepted: 06/02/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Anthony M. Joudi
- Department of Pathology; Loyola University Medical Center; Maywood Illinois
| | | | - Eva M. Wojcik
- Department of Pathology; Loyola University Medical Center; Maywood Illinois
| | - Güliz A. Barkan
- Department of Pathology; Loyola University Medical Center; Maywood Illinois
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39
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Chandra A. Developments in non-gynaecological cytology reporting terminologies. Cytopathology 2016; 27:144-5. [PMID: 27221747 DOI: 10.1111/cyt.12348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A Chandra
- Department of Cellular Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK.
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40
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Granados R, Butrón M, Santonja C, Rodríguez JM, Martín A, Duarte J, Camarmo E, Corrales T, Aramburu JA. Increased risk of malignancy for non-atypical urothelial cell groups compared to negative cytology in voided urine. Morphological changes with LBC. Diagn Cytopathol 2016; 44:582-90. [DOI: 10.1002/dc.23489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 02/26/2016] [Accepted: 03/30/2016] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Carlos Santonja
- Pathology Department; University Hospital Fundación Jiménez Díaz; Av Reyes Católicos 2. 28040 Madrid
| | | | - Ana Martín
- Pathology Department; University Hospital of Getafe
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41
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Rosenthal DL. High apoptotic index in urine cytology is associated with high-grade urothelial carcinoma. Cancer Cytopathol 2016; 124:538-9. [PMID: 27070803 DOI: 10.1002/cncy.21723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/10/2022]
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42
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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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43
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Zhang ML, Rosenthal DL, VandenBussche CJ. The cytomorphological features of low-grade urothelial neoplasms vary by specimen type. Cancer Cytopathol 2016; 124:552-64. [PMID: 27019161 DOI: 10.1002/cncy.21716] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/25/2016] [Accepted: 03/04/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Urinary tract (UT) cytology has been used successfully to diagnose high-grade urothelial carcinoma but is reported to have poor sensitivity for low-grade urothelial neoplasms (LGUNs). However, the literature has shown that LGUN may be associated with atypical findings in UT specimens. The authors determined which features were most commonly observed, and whether the method of specimen procurement had an effect. METHODS A total of 326 specimens were identified over an 8-year period. One hundred fifty-three specimens were reviewed and graded for cellularity, number of tissue fragments (TFs), degeneration, inflammation, hyperchromasia, nuclear pleomorphism, nuclear border irregularity, nuclear size, cytoplasmic tails, nuclear eccentricity, and high-grade features. RESULTS Of the 153 specimens, 86 specimens (56.2%) demonstrated cellular atypia; of those, 51.2% were voided urine (VU) and 31.4% were UT washing (UW) specimens. The majority of specimens had many cells (46.5%), many single cells (44.2%), few to moderate TFs (46.5% and 27.9%, respectively), mild hyperchromasia (52.3%), mild nuclear pleomorphism (51.2%), mild nuclear border irregularity (60.5%), cytoplasmic tails (51.2%), and few to moderate eccentric nuclei (37.2% and 36.1%, respectively). The presence of TFs, cytoplasmic tails, and eccentric and enlarged nuclei were significantly more common in UW versus VU specimens (P = .036, .012, .014, and .027, respectively) and in UW versus benign UW controls (P = .001, .002, .002, and .003, respectively). CONCLUSIONS Approximately 50% of UT specimens with LGUN on follow-up demonstrated atypical features. Based on comparison with benign UW controls, TFs, cytoplasmic tails, nuclear eccentricity, and enlarged nuclei were more pronounced in neoplastic UW than VU specimens, suggesting that the method of urine specimen procurement affects the presence of certain low-grade features. Cancer Cytopathol 2016;124:552-64. © 2016 American Cancer Society.
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Affiliation(s)
- Mingjuan L Zhang
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dorothy L Rosenthal
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Glass R, Cocker R, Rosen L, Coutsouvelis C, Chau K, Slim F, Brenkert R, Sheikh-Fayyaz S, Farmer P, Das K. The impact of subdividing the “atypical” category for urinary cytology on patient management. Diagn Cytopathol 2016; 44:477-82. [DOI: 10.1002/dc.23468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/10/2015] [Accepted: 02/22/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Ryan Glass
- Department of Pathology; Staten Island University Hospital; New York New York
| | - Rubina Cocker
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Lisa Rosen
- North Shore-LIJ Health System; Feinstein Institute for Medical Research; New York New York
| | | | - Karen Chau
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Farah Slim
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Ryan Brenkert
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Silvat Sheikh-Fayyaz
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Peter Farmer
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Kasturi Das
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
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45
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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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46
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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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47
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McCroskey Z, Pambuccian SE, Kleitherms S, Antic T, Cohen MB, Barkan GA, Wojcik EM. Accuracy and Interobserver Variability of the Cytologic Diagnosis of Low-Grade Urothelial Carcinoma in Instrumented Urinary Tract Cytology Specimens. Am J Clin Pathol 2015; 144:902-8. [DOI: 10.1309/ajcpe1o9ykmrsqkg] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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48
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VandenBussche CJ, Rosenthal DL, Olson MT. Adequacy in voided urine cytology specimens: The role of volume and a repeat void upon predictive values for high-grade urothelial carcinoma. Cancer Cytopathol 2015; 124:174-80. [DOI: 10.1002/cncy.21634] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/28/2015] [Accepted: 07/17/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Christopher J. VandenBussche
- Division of Cytopathology, Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Dorothy L. Rosenthal
- Division of Cytopathology, Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Matthew T. Olson
- Division of Cytopathology, Department of Pathology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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49
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Glass RE, Coutsouvelis C, Sheikh-Fayyaz S, Chau K, Rosen L, Brenkert R, Slim F, Epelbaum F, Das K, Cocker RS. Two-tiered subdivision of atypia on urine cytology can improve patient follow-up and optimize the utility of UroVysion. Cancer Cytopathol 2015; 124:188-95. [DOI: 10.1002/cncy.21630] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ryan E. Glass
- Department of Pathology; North Shore-LIJ Staten Island University Hospital; Staten Island, New York
| | | | - Silvat Sheikh-Fayyaz
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Karen Chau
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Lisa Rosen
- Department of Biostatistics; Feinstein Institute for Medical Research, North Shore-LIJ Health System; Manhasset, New York
| | - Ryan Brenkert
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Farah Slim
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Fanya Epelbaum
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Kasturi Das
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Rubina S. Cocker
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
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50
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Chen L, He H, Zarka MA, Zhou M, Magi-Galluzzi C. Upper tract urinary cytology to detect upper tract urothelial carcinoma: Using the Johns Hopkins Hospital template and evaluation of its feasibility. Cytojournal 2015; 12:17. [PMID: 26288652 PMCID: PMC4527050 DOI: 10.4103/1742-6413.161608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/10/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Primary upper urinary tract (UT) urothelial carcinoma (UC) is rare. UT washing cytology is often used during UT surveillance. The Johns Hopkins Hospital template (JHHT) is primarily designed to use on lower tract urine cytology and the data on applying JHHT on UT cytology is limited. We herein study the value of UT cytology in detecting UTUC using JHHT in a cohort. MATERIALS AND METHODS One hundred UT cytologic specimens were retrieved from our database during a 10-year period (2001-2011). For each patient, the cytology specimen with the highest degree of abnormality was selected. Histologic sections of these cases were also studied. RESULTS Seventy-six cases of UT cytology had histologic follow-up by either serial (>2) endoscopic biopsies or nephroureterectomy or ureterectomy. Among them, the cytologic diagnosis of positive or suspicious for high-grade UC (HGUC) was made in 15 cases; suspicious for low-grade UC (LGUC) in 3 cases; atypical urothelial cells (AUCs) of undetermined significance in 19 cases; and negative in 39 cases. Of the 15 cases with diagnosis of positive for HGUC or AUC-HGUC (AUC-H), 10 had histologically confirmed HGUC, 1 had LGUC, and 4 had benign histology. All 3 cases of cytologically suspicious for LGUC had LGUC on concomitant histology. Among the 19 washings with AUCs with unknown significance, 7 were LGUC, 1 was HGUC, and 11 were benign on histology. Six of 39 cases with negative cytology had UC (3 low-grade and 3 high-grade) on histology. Combining positive and AUC-H for UC diagnoses, sensitivity, and specificity for detecting HGUC were 71.4% and 91.9%, while for LGUC were 21.4% and 100%, respectively. CONCLUSIONS UT washing cytology has high specificity for detecting UC, especially HGUC. Using JHHT on UT washing cytology is feasible, but the category of LGUC may need modification.
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Affiliation(s)
- Longwen Chen
- Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Huiying He
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathology, Peking University, Health Science Center, Beijing, China
| | - Matthew A. Zarka
- Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Ming Zhou
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
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