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Gómez Del Cañizo C, González Ginel I, Martín-Arriscado Arroba C, de la Calle Moreno A, Hernández Arroyo M, Rodríguez Antolín A, Guerrero Ramos F. Voided urine cytology is a useful tool predicting non-muscle-invasive bladder cancer risk before surgery. Urol Oncol 2024; 42:246.e15-246.e21. [PMID: 38664179 DOI: 10.1016/j.urolonc.2024.03.014] [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: 11/20/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To determine the accuracy of voided urinary cytology (VUC) in predicting of non-muscle-invasive bladder cancer (NMIBC) risk stratification before surgery. METHODS We prospectively collected data from all patients diagnosed with bladder cancer in our institution over 2 years. We have analyzed VUC accuracy of positive and suspicious VUC in the detection of high-risk tumors and negative and atypical VUC in the detection of low-risk tumors. To test this accuracy, we assessed sensitivity, specificity, positive (PPV) and negative predictive values (NPV), diagnostic odds ratio (DOR), and generated ROC curves (receiver operating characteristic curve). RESULTS With 224 patients included, the positive VUC subcategory showed a specificity of 92.4% (95%CI: 83.2%-97.5%) and a PPV of 91.4 (95%CI: 81%-97.1%). DOR in this subgroup was 6.81. In the suspicious VUC, specificity was 90.9% (95%CI: 81.3%-96.6%), PPV was 88% (95%CI: 75.7%-95.5%) and DOR was 4.23. Combined analysis of positive and suspicious cytologies for detecting high-risk NMIBC showed a sensitivity of 65% (95%CI: 57.3%-73.2%) and a DOR of 9.51. Negative VUC showed high specificity in detecting low-risk (93.2% [95%CI: 87.9%-96.7%]) and a DOR of 6.90 (95%CI: 3.07-15.46). Atypical VUC was the least accurate and had rather low specificity and predictive values. CONCLUSIONS VUC appears to be a good, inexpensive and easily available method to determine risk stratification before surgery. This can be useful in daily practice to determine which patients should receive a single instillation of MMC and to prioritize patients more likely to have a high- risk tumor.
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Affiliation(s)
- Carmen Gómez Del Cañizo
- Urology Department, University Hospital 12 de Octubre. Av. de Córdoba, s/n 28041, Madrid, Spain.
| | - Ignacio González Ginel
- Urology Department, University Hospital 12 de Octubre. Av. de Córdoba, s/n 28041, Madrid, Spain
| | - Cristina Martín-Arriscado Arroba
- Statistical Clinical Research Unit, Research Institute 1+12, University, Hospital 12 de Octubre. Av. de Córdoba, s/n 28041, Madrid, Spain
| | - Ana de la Calle Moreno
- Urology Department, University Hospital 12 de Octubre. Av. de Córdoba, s/n 28041, Madrid, Spain
| | - Mario Hernández Arroyo
- Urology Department, University Hospital 12 de Octubre. Av. de Córdoba, s/n 28041, Madrid, Spain
| | | | - Félix Guerrero Ramos
- Urology Department, University Hospital 12 de Octubre. Av. de Córdoba, s/n 28041, Madrid, Spain
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Arora S, Singh P, Kumar A, Srivastava N, Kolte S, Yadav A. Impact of Implementing Paris System on Diagnostic Precision and Management of Urinary Bladder Neoplasms. Indian J Surg Oncol 2024; 15:225-235. [PMID: 38741619 PMCID: PMC11088611 DOI: 10.1007/s13193-023-01864-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/09/2023] [Indexed: 05/16/2024] Open
Abstract
The diagnosis of atypia has always been under question both by the pathologist and the clinician. It was one of the main aims of the Paris system (TPS) to reduce the number of cases under the AUC (Atypical urothelial cells) category. With the strict criteria laid down by the Paris system, the rate of diagnosis of this category has reduced markedly. This study was done to test the impact of implementing TPS categories and criteria in comparison to our previously used system. TPS is one of the important deciding factors for the management of the patient. The management of patients with AUC diagnosis often varies depending on the treating physician (urologist/nonurologist). For further categorization of the diagnosis of AUC, markers like p53 and Ki67 can be used. One hundred urinary cytology specimens received for the period of 6 months were included in the study. The presentation of the categorical variables was done in the form of numbers and percentages (%). Interrater kappa agreement was used to find out the strength of the agreement between the Paris system and the traditional system. Using histopathological diagnosis as the gold standard, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic accuracy were calculated. Immunohistochemistry was performed on the cell block for Ki67 and p53, and their values were correlated with histopathological examination, using Spearman's rank correlation. The interrater kappa agreement analyzed between the traditional reporting system and the Paris system was 0.522. Around 32% (6/19) of cases that were reported as AUC by the traditional system were recategorized under negative for high-grade urothelial carcinoma (NHGUC) by the Paris system. Thus, obliviating the need for further management and decreasing the unnecessary cost of the health care system with a decrease in patient anxiety. Histopathology was available in 28 cases and diagnostic accuracy of urine cytology classified by TPS was 89.2% with a sensitivity of 94.4%, specificity of 80%, positive likelihood ratio of 89.4, and negative likelihood ratio of 88.6. The correlation coefficient of p53 with grading of carcinoma was found to be strong at 0.864. The correlation coefficient of Ki67 with grading of carcinoma was also as strong as 0.885. TPS along with immunohistochemistry improves the performance of urine cytology by reclassifying the AUC category into other groups and increases the sensitivity for detecting HGUC.
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Affiliation(s)
- Sheetal Arora
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Priyanka Singh
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Aman Kumar
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Namita Srivastava
- Department of Community Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Sachin Kolte
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Amit Yadav
- Department of Pathology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
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Mahmoud Daoud R, Ali AH, Salim Fredericks S, Daoud S, Gomaa HR, AlHashimi FS. Utility of the Paris System in Urine Cytology for Improved Screening of High-Grade Urothelial Carcinoma in Bahrain. Cureus 2024; 16:e57189. [PMID: 38681345 PMCID: PMC11056096 DOI: 10.7759/cureus.57189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Urothelial carcinoma, a prevalent and aggressive urological malignancy, necessitates early detection for improved prognosis. Urine cytology serves as a cost-effective screening tool, but inconsistencies in reporting due to the lack of standardized criteria limit its efficacy. The Paris System for reporting urinary cytology (TPS) was introduced to address this issue, aiming to improve diagnostic accuracy. This retrospective study investigates the effectiveness of urine cytology in detecting high-grade urothelial carcinoma (HGUC) using TPS classification, specifically focusing on atypical urothelial cells (AUC) categorized as TPS-III and suspicious for high-grade urothelial carcinoma (SHGUC) categorized as TPS-IV. METHODS We reviewed 470 urine cytology samples collected over two years at a tertiary healthcare center in Bahrain. All samples were re-evaluated using TPS classification by two independent consultant cytopathologists blinded to the original cytology report. The analysis included only samples categorized as TPS-III or TPS-IV with corresponding histopathology reports from confirmatory biopsies performed within four months of urine collection. Biopsy results were categorized as either benign/low-grade urothelial carcinoma (non-HGUC) or malignant (HGUC). The positive predictive value (PPV) of urine cytology for HGUC detection was calculated for both TPS-III and TPS-IV categories. Statistical significance was assessed using Fisher's exact test. RESULTS Among the 470 urine cytology samples, 40 (8.5%) were classified as TPS-III or TPS-IV. Within this subset, 16 patients underwent confirmatory biopsies. Histopathological analysis revealed HGUC in 12 (75%) patients and non-HGUC (benign or low-grade) in 4 (25%) patients. The PPV of TPS-III for HGUC was 50%, while TPS-IV demonstrated a higher PPV of 90%. However, the difference between these values was not statistically significant (p = 0.25). This study explored the utility of TPS classification in urine cytology for HGUC detection. While SHGUC (TPS-IV) exhibited a numerically higher PPV compared to AUC (TPS-III), the lack of statistical significance necessitates further investigation. Our findings highlight the potential of TPS to improve the accuracy of urine cytology. TPS implementation has been shown to reduce the number of inconclusive "atypical" diagnoses, leading to more targeted investigations. CONCLUSION Our study suggests that SHGUC (TPS-IV) within TPS classification framework might hold promise as a more specific indicator for HGUC compared to AUC (TPS-III). However, further research with larger cohorts is necessary to definitively establish the clinical significance of this observation. This investigation paves the way for future studies exploring the potential of TPS, particularly the SHGUC category, as a reliable screening tool for HGUC, potentially leading to earlier diagnoses and improved patient outcomes.
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Affiliation(s)
| | - Ali H Ali
- Emergency Medicine, Salmaniya Medical Complex, Manama, BHR
| | | | - Salma Daoud
- General Practice, Albaraka Fertility Hospital, Manama, BHR
| | - Hamza R Gomaa
- Orthopedics and Neurosurgery, Bahrain Defense Force Royal Medical Services, Riffa, BHR
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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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Levy JJ, Liu X, Marotti JD, Kerr DA, Gutmann EJ, Glass RE, Dodge CP, Suriawinata AA, Vaickus LJ. Uncovering additional predictors of urothelial carcinoma from voided urothelial cell clusters through a deep learning-based image preprocessing technique. Cancer Cytopathol 2023; 131:19-29. [PMID: 35997513 DOI: 10.1002/cncy.22633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/19/2022] [Accepted: 06/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Urine cytology is commonly used as a screening test for high-grade urothelial carcinoma for patients with risk factors or hematuria and is an essential step in longitudinal monitoring of patients with previous bladder cancer history. However, the semisubjective nature of current reporting systems for urine cytology (e.g., The Paris System) can hamper reproducibility. For instance, the incorporation of urothelial cell clusters into the classification schema is still an item of debate and perplexity among expert cytopathologists because several previous works have disputed their diagnostic relevance. METHODS In this work, an automated preprocessing tool for urothelial cell cluster assessment was developed that divides urothelial cell clusters into meaningful components for downstream assessment (ie, population-based studies, workflow automation). RESULTS In this work, an automated preprocessing tool for urothelial cell cluster assessment was developed that divides urothelial cell clusters into meaningful components for downstream assessment (ie, population-based studies, workflow automation). Results indicate that cell cluster atypia (i.e., defined by whether the cell cluster harbored multiple atypical cells, thresholded by a minimum number of cells), cell border overlap and smoothness, and total number of clusters are important markers of specimen atypia when considering assessment of urothelial cell clusters. CONCLUSIONS Markers established through techniques to separate cell clusters may have wider applicability for the design and implementation of machine learning approaches for urine cytology assessment.
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Affiliation(s)
- Joshua J Levy
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Xiaoying Liu
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Jonathan D Marotti
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Darcy A Kerr
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Edward J Gutmann
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Ryan E Glass
- University of Pennsylvania Medical Center East, Pittsburgh, Pennsylvania, USA
| | - Caroline P Dodge
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Arief A Suriawinata
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Louis J Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
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Levy JJ, Liu X, Marotti JD, Kerr DA, Gutmann EJ, Glass RE, Dodge CP, Vaickus LJ. Large-scale longitudinal comparison of urine cytological classification systems reveals potential early adoption of The Paris System criteria. J Am Soc Cytopathol 2022; 11:394-402. [PMID: 36068164 DOI: 10.1016/j.jasc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Urine cytology is used to screen for urothelial carcinoma in patients with hematuria or risk factors (eg, smoking, industrial dye exposure) and is an essential clinical triage and longitudinal monitoring tool for patients with known bladder cancer. However, urine cytology is semisubjective and thus susceptible to issues including specimen quality, interobserver variability, and "hedging" towards equivocal ("atypical") diagnoses. These factors limit the predictive value of urine cytology and increase reliance on invasive procedures (cystoscopy). The Paris System for Reporting Urine Cytology (TPS) was formulated to provide more quantitative/reproducible endpoints with well-defined criteria for urothelial atypia. TPS is often compared to other assessment techniques to justify its adoption. TPS results in decreased use of the atypical category and better reproducibility. Previous reports comparing diagnoses pre- and post-TPS have not considered temporal differences between diagnoses made under prior systems and TPS. By aggregating across time, studies may underestimate the magnitude of differences between assessment methods. MATERIALS AND METHODS We conducted a large-scale longitudinal reassessment of urine cytology using TPS criteria from specimens collected from 2008 to 2018, prior to the mid-2018 adoption of TPS at an academic medical center. RESULTS Findings indicate that differences in atypical assignment were largest at the start of the period and these differences progressively decreased towards insignificance just prior to TPS implementation. CONCLUSIONS This finding suggests that cytopathologists had begun to utilize the quantitative TPS criteria prior to official adoption, which may more broadly inform adoption strategies, communication, and understanding for evolving classification systems in cytology.
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Affiliation(s)
- Joshua J Levy
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire; Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire.
| | - Xiaoying Liu
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | - Jonathan D Marotti
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | - Darcy A Kerr
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | - Edward J Gutmann
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | | | - Caroline P Dodge
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
| | - Louis J Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Dartmouth College Geisel School of Medicine, Hanover, New Hampshire
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Urinary Comprehensive Genomic Profiling Correlates Urothelial Carcinoma Mutations with Clinical Risk and Efficacy of Intervention. J Clin Med 2022; 11:jcm11195827. [PMID: 36233691 PMCID: PMC9571552 DOI: 10.3390/jcm11195827] [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: 08/04/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/15/2022] Open
Abstract
The clinical standard of care for urothelial carcinoma (UC) relies on invasive procedures with suboptimal performance. To enhance UC treatment, we developed a urinary comprehensive genomic profiling (uCGP) test, UroAmplitude, that measures mutations from tumor DNA present in urine. In this study, we performed a blinded, prospective validation of technical sensitivity and positive predictive value (PPV) using reference standards, and found at 1% allele frequency, mutation detection performs at 97.4% sensitivity and 80.4% PPV. We then prospectively compared the mutation profiles of urine-extracted DNA to those of matched tumor tissue to validate clinical performance. Here, we found tumor single-nucleotide variants were observed in the urine with a median concordance of 91.7% and uCGP revealed distinct patterns of genomic lesions enriched in low- and high-grade disease. Finally, we retrospectively explored longitudinal case studies to quantify residual disease following bladder-sparing treatments, and found uCGP detected residual disease in patients receiving bladder-sparing treatment and predicted recurrence and disease progression. These findings demonstrate the potential of the UroAmplitude platform to reliably identify and track mutations associated with UC at each stage of disease: diagnosis, treatment, and surveillance. Multiple case studies demonstrate utility for patient risk classification to guide both surgical and therapeutic interventions.
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Peña KB, Riu F, Hernandez A, Guilarte C, Badia J, Parada D. Usefulness of the Urine Methylation Test (Bladder EpiCheck®) in Follow-Up Patients with Non-Muscle Invasive Bladder Cancer and Cytological Diagnosis of Atypical Urothelial Cells—An Institutional Study. J Clin Med 2022; 11:jcm11133855. [PMID: 35807141 PMCID: PMC9267544 DOI: 10.3390/jcm11133855] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
Urothelial bladder cancer is a heterogeneous disease and one of the most common cancers worldwide. Bladder cancer ranges from low-grade tumors that recur and require long-term invasive surveillance to high-grade tumors with high mortality. After the initial contemporary treatment in non-muscle invasive bladder cancer, recurrence and progression rates remain high. Follow-up of these patients involves the use of cystoscopies, cytology, and imaging of the upper urinary tract in selected patients. However, in this context, both cystoscopy and cytology have limitations. In the follow-up of bladder cancer, the finding of urothelial cells with abnormal cytological characteristics is common. The main objective of our study was to evaluate the usefulness of a urine DNA methylation test in patients with urothelial bladder cancer under follow-up and a cytological finding of urothelial cell atypia. In addition, we analyzed the relationship between the urine DNA methylation test, urine cytology, and subsequent cystoscopy study. It was a prospective and descriptive cohort study conducted on patients presenting with non-muscle invasive urothelial carcinoma between 1 January 2018 and 31 May 2022. A voided urine sample and a DNA methylation test was extracted from each patient. A total of 70 patients, 58 male and 12 female, with a median age of 70.03 years were studied. High-grade urothelial carcinoma was the main histopathological diagnosis. Of the cytologies, 41.46% were cataloged as atypical urothelial cells. The DNA methylation test was positive in 17 urine samples, 51 were negative and 2 were invalid. We demonstrated the usefulness of a DNA methylation test in the follow-up of patients diagnosed with urothelial carcinoma. The methylation test also helps to diagnose urothelial cell atypia.
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Affiliation(s)
- Karla B. Peña
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
- Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43007 Reus, Spain
| | - Francesc Riu
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
- Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43007 Reus, Spain
| | - Anna Hernandez
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
| | - Carmen Guilarte
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
| | - Joan Badia
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
| | - David Parada
- Molecular Pathology Unit, Department of Pathology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (K.B.P.); (F.R.); (A.H.); (C.G.)
- Institut d’Investigació Sanitària Pere Virgili, 43204 Reus, Spain;
- Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43007 Reus, Spain
- Correspondence:
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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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Onder S, Kurtulan O, Kavuncuoglu A, Akdogan B. Comparison of Diagnostic Performances of Urine Cytology Before and After the Use of The Paris System Criteria: An Institutional Experience from Turkey. J Cytol 2021; 38:133-139. [PMID: 34703089 PMCID: PMC8489696 DOI: 10.4103/joc.joc_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/10/2021] [Accepted: 06/09/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Urine cytology remains to be the test of choice in the detection of high-grade urothelial carcinomas (HGUC) due to its favorable sensitivity. However, a significant rate of cases is reported under atypical/indeterminate categories, which result in a decrease in its specificity. Providing standardized cytologic criteria, one of the aims of The Paris System (TPS) is to reduce the use of indeterminate diagnoses and provide a higher predictive value in these categories. Aims: We compared the diagnostic performances of TPS and our original reporting system, and also investigated the interobserver reproducibility of the cytologic criteria used. Materials and Methods: A total of 386 urine samples were reviewed retrospectively. Original cytologic diagnoses have been made using similar cytologic features proposed by TPS. All slides were recategorized after the use of the cytologic criteria as described by TPS guideline. Results: After TPS, specificity of the test increased from 39.6% to 63.5, sensitivity decreased from 92.5% to 88.8%, and diagnostic accuracy increased from 63.6% to 75%. The use of negative category increased threefold. Frequencies of indeterminate categories of atypical urothelial cells (AUC) and suspicious for HGUC (SHGUC) decreased by 36% and 56.5%, respectively. A subsequent detection of HGUC after AUC and SHGUC categories increased by 38% and 64%, respectively. Interobserver agreement for TPS categorization was 39%. Conclusions: TPS improved diagnostic accuracy of urine cytology by reducing the use of indeterminate categories, and resulted in increase in their predictive value for subsequent diagnosis of HGUC. However, reproducibility of diagnostic categories seemed to be imperfect.
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Affiliation(s)
- Sevgen Onder
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Olcay Kurtulan
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Altan Kavuncuoglu
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Shang D, Liu Y, Xu X, Chen Z, Wang D. Diagnostic value comparison of CellDetect, fluorescent in situ hybridization (FISH), and cytology in urothelial carcinoma. Cancer Cell Int 2021; 21:465. [PMID: 34488763 PMCID: PMC8419965 DOI: 10.1186/s12935-021-02169-3] [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: 05/03/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the clinical effectiveness of a novel CellDetect staining technique, compared with fluorescent in situ hybridization (FISH), and urine cytology, in the diagnosis of urothelial carcinoma (UC). Methods A total of 264 patients with suspicious UC were enrolled in this study. All tissue specimens were collected by biopsy or surgery. Urine specimen was obtained for examinations prior to the surgical procedure. CellDetect staining was carried out with CellDetect kit, and FISH was performed with UroVysion detection kit, according to the manufacturer’s instructions. For urine cytology, all specimens were centrifuged using the cytospin method, and the slides were stained by standard Papanicolaou stain. Results In this study, there were 128 cases of UC and 136 cases of non-UC, with no significant difference in gender and age between the two groups. Results for sensitivity of CellDetect, FISH, and urine cytology were 82.8%, 83.6%, and 39.8%, respectively. The specificity of the three techniques were 88.2%, 90.4%, and 86.0%, respectively. The sensitivity of CellDetect and FISH are significantly superior compared to the conventional urine cytology; however, there was no significant difference in specificity among three staining techniques. In addition, the sensitivity of CellDetect in lower urinary tract UC, upper urinary tract UC, non-muscle-invasive bladder cancer (NMIBC), and muscle-invasive bladder cancer (MIBC) were 83.3%, 81.8%, 83.5%, and 72.0%, respectively. The screening ability of CellDetect has no correlation with tumor location and the tumor stage. The sensitivity of CellDetect in low-grade UC and high-grade UC were 51.6 and 92.8%. Thus, screening ability of CellDetect in high-grade UC is significantly superior compared to that in low-grade UC. Conclusions CellDetect and FISH show equal value in diagnosing UC, both are superior to conventional urine cytology. Compared to FISH, CellDetect is cost effective, easy to operate, with extensive clinical application value to monitor recurrence of UC, and to screen indetectable UC.
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Affiliation(s)
- Donghao Shang
- Department of Urology, Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Yuting Liu
- Department of Pathology, Capital Medical University, Beijing, 100069, China
| | - Xiuhong Xu
- Department of Urology, Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhenghao Chen
- Department of Urology, Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Daye Wang
- Department of Pathology, Capital Medical University, Beijing, 100069, China.
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Kawano T, Tachibana Y, Inokuchi J, Kang JH, Murata M, Eto M. Identification of Activated Protein Kinase Cα (PKCα) in the Urine of Orthotopic Bladder Cancer Xenograft Model as a Potential Biomarker for the Diagnosis of Bladder Cancer. Int J Mol Sci 2021; 22:ijms22179276. [PMID: 34502182 PMCID: PMC8430461 DOI: 10.3390/ijms22179276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
Bladder cancer has a high recurrence rate; therefore, frequent and effective monitoring is essential for disease management. Cystoscopy is considered the gold standard for the diagnosis and continuous monitoring of bladder cancer. However, cystoscopy is invasive and relatively expensive. Thus, there is a need for non-invasive, relatively inexpensive urinary biomarker-based diagnoses of bladder cancer. This study aimed to investigate the presence of activated protein kinase Cα (PKCα) in urine samples and the possibility of PKCα as a urinary biomarker for bladder cancer diagnosis. Activated PKCα was found to be present at higher levels in bladder cancer tissues than in normal bladder tissues. Furthermore, high levels of activated PKCα were observed in urine samples collected from orthotopic xenograft mice carrying human bladder cancer cells compared to urine samples from normal mice. These results suggest that activated PKCα can be used as a urinary biomarker to diagnose bladder cancer. To the best of our knowledge, this is the first report describing the presence of activated PKCα in the urine of orthotopic xenograft mice.
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Affiliation(s)
- Takahito Kawano
- Center for Advanced Medical Innovation, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (T.K.); (Y.T.)
| | - Yoko Tachibana
- Center for Advanced Medical Innovation, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (T.K.); (Y.T.)
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Correspondence: (J.I.); (J.-H.K.); (M.M.); (M.E.)
| | - Jeong-Hun Kang
- Division of Biopharmaceutics and Pharmacokinetics, National Cerebral and Cardiovascular Center Research Institute, 6-1 Shinmachi, Kishibe, Suita, Osaka 564-8565, Japan
- Correspondence: (J.I.); (J.-H.K.); (M.M.); (M.E.)
| | - Masaharu Murata
- Center for Advanced Medical Innovation, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (T.K.); (Y.T.)
- Correspondence: (J.I.); (J.-H.K.); (M.M.); (M.E.)
| | - Masatoshi Eto
- Center for Advanced Medical Innovation, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan; (T.K.); (Y.T.)
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Correspondence: (J.I.); (J.-H.K.); (M.M.); (M.E.)
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Pierconti F, Martini M, Fiorentino V, Cenci T, Capodimonti S, Straccia P, Sacco E, Pugliese D, Cindolo L, Larocca LM, Bassi PF. The combination cytology/epichek test in non muscle invasive bladder carcinoma follow-up: Effective tool or useless expence? Urol Oncol 2021; 39:131.e17-131.e21. [DOI: 10.1016/j.urolonc.2020.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
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14
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Alsibai KD, Daste G, Ferlicot S, Fabre M, Steenkeste K, Salleron J, Hammoudi Y, Fontaine-Aupart MP, Eschwege P. Fluorescence Emitted by Papanicolaou-Stained Urothelial Cells Improves Sensitivity of Urinary Conventional Cytology for Detection of Urothelial Tumors. World J Oncol 2020; 11:204-215. [PMID: 33117464 PMCID: PMC7575278 DOI: 10.14740/wjon1305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/12/2020] [Indexed: 01/17/2023] Open
Abstract
Background Urinary conventional cytology (UCCy) is easy to perform, but its low sensitivity, especially for low-grade urothelial neoplasms (LGUNs), limits its indications in the management of patients at risk of bladder cancer. The authors aim at obtaining a complementary test that would effectively increase the sensitivity of UCCy on voided urines by analyzing fluorescence of Papanicolaou-stained urothelial cells with no change of method in slide preparation. Methods In this retrospective study of 155 patients, 91 Papanicolaou-stained voided urines were considered satisfactory under fluorescence microscopy (FMi). The results of FMi were compared with UCCy (using transmission microscopy) and correlated to cystoscopy, histology and follow-up data. Results The results are given for all patients and for two groups of them according to the patients’ main complaints (group 1: 33 patients followed up for a previously treated bladder tumor; group 2: 58 patients with persistent urinary symptoms). Overall negative predictive value (NPV) and sensitivity of FMi were 100% vs. 73.7% and 64.3% respectively for UCCy (P = 0.0001). Sensitivity of FMi for LGUN was unexpectedly high with a value of 100% vs. 46.2% for UCCy (P = 0.0002). FMi was significantly superior to UCCy for detecting urothelial tumors in every group of patients and would allow a better characterization of atypical urothelial cells (AUCs) defined by the Paris System for Reporting Urine Cytology (TPS). Conclusions Because of its sensitivity and NPV of 100%, FMi could complement UCCy to screen voided urines allowing a better detection of primary urothelial tumors or early recurrences of previously treated urothelial carcinoma. Moreover, this “dual screening” would allow completing efficiently cystoscopy to detect flat dysplasia, carcinoma in situ (CIS) and extra bladder carcinoma.
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Affiliation(s)
- Kinan Drak Alsibai
- Service d'Anatomie Pathologique, Centre des Ressources Biologiques, Centre Hospitalier de Cayenne, 97306 Cayenne Cedex, France.,These authors should be considered joint first authors
| | - Ghislaine Daste
- Centre de Pathologie Cellulaire et Moleculaire (CPCM-Labs), 31750 Escalquens, France.,These authors should be considered joint first authors
| | - Sophie Ferlicot
- Service d'Anatomo-Pathologie, Universite Paris-Sud, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, 94276 Le Kremlin-Bicetre Cedex, France
| | - Monique Fabre
- Service d'Anatomie Pathologique, Universite Paris-Descartes, Hopital Universitaire Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, 75743 Paris Cedex, France
| | - Karine Steenkeste
- Institut des Sciences Moleculaires d'Orsay (ISMO), CNRS, Universite et Paris-Saclay, 91405 Orsay Cedex, France
| | - Julia Salleron
- Service de Biostatistiques, Institut de Cancerologie de Lorraine, 54519 Vandoeuvre-les-Nancy Cedex, France
| | - Yacine Hammoudi
- Service d'Urologie, Universite Paris-Sud, Hopital Bicetre, Assistance Publique-Hopitaux de Paris, 94276 Le Kremlin-Bicetre Cedex, France
| | | | - Pascal Eschwege
- Service d'Urologie, Universite de Lorraine, CNRS UMR 7039 CRAN, Centre Hospitalier Regional Universitaire, 54035 Nancy Cedex, France
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Danakas A, Sweeney M, Cheris S, Agrawal T. Urinary tract cytology: a cytologic-histopathologic correlation with The Paris System, an institutional study. J Am Soc Cytopathol 2020; 10:56-63. [PMID: 33132054 DOI: 10.1016/j.jasc.2020.09.013] [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: 05/03/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Urothelial carcinoma (UC) requires lifelong monitoring, commonly through urinary cytology and cystoscopy. Urine cytology has a relatively high sensitivity for detecting high-grade urothelial carcinoma (HGUC); however, its sensitivity for low-grade urothelial neoplasm (LGUN) is significantly lower with wide interobserver variability. The Paris System (TPS) was proposed to create standardized diagnostic categories with defined cytomorphologic criteria. We attempt to evaluate diagnostic efficacy of identifying UC using TPS through cytologic-histologic correlation. MATERIALS AND METHODS A retrospective search identified 170 cases of urine cytology cases with concurrent biopsies collected during a 2-year time period at University of Rochester Medical Center. Patient age, sex, smoking history, prior malignancy diagnoses, cystoscopy findings, specimen collection method, UroVysion results, and 1-year follow-up of surgical pathology cases were included. RESULTS Cytologic-histologic correlation was identified in 59% of cases, with 18% true positives and 41% true negatives. Discordant results were identified in 41% of cases; of these, 4% were false positives, 11% false negatives, 12% potential sampling bias, and 14% were low-grade urothelial carcinoma (LGUC). The analysis of this 2-year study finds a positive predictive value of urine cytology for HGUC to be 81%, a negative predictive value of 79%, a sensitivity of 61%, a specificity of 91%, and an accuracy of 79%. CONCLUSIONS Our results support TPS's ability to improve the reliability and accuracy of interpretations in urine cytology for HGUC. Nevertheless, additional studies are essential to improve the diagnostic accuracy of LGUN, and urine adequacy, in order to improve patient care and early detection, while identifying potential sampling bias.
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Affiliation(s)
- Alexandra Danakas
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Melissa Sweeney
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Sachica Cheris
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Tanupriya Agrawal
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York.
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Renshaw AA, Gould EW. High-grade urothelial carcinoma with hypochromatic chromatin in urine cytology. J Am Soc Cytopathol 2020; 10:25-28. [PMID: 33132055 DOI: 10.1016/j.jasc.2020.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Some high-grade urothelial carcinomas (UCs) in urine cytology have hypochromatic chromatin, but the incidence and criteria for diagnosis are not well described. MATERIALS AND METHODS Urine cytology cases with biopsy follow up were reviewed. RESULTS Cytospin preparations from 331 cases with biopsy follow up (230 benign/low-grade UC, 101 malignant) were reviewed. There were no false-positive cases. Cases with malignant cells with hypochromatic chromatin were identified in a total of 17 cases (16.8% of all malignancies). These comprised 2 carcinoma in situ, 11 high-grade papillary UC, 3 invasive UC, and 1 adenocarcinoma. Sixteen of 93 high-grade UCs (17.2%) had cells with hypochromatic chromatin. These cells were the only type of malignant cell in 4 of 101 cases (4.0%). All cases had cells with high nuclear-to-cytoplasmic ratios and markedly indented and irregular nuclear membranes that could be identified on both cytology and subsequent histology. CONCLUSIONS Malignant urothelial cells in urine cytology with hypochromatic chromatin can be present in 17% of cases and can be diagnosed as "positive for malignancy" based on their high nuclear-to-cytoplasmic ratio, and markedly indented and irregular nuclear membranes.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida; Miami Cancer Institute, Miami, Florida.
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida; Miami Cancer Institute, Miami, Florida
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Tian W, Shore KT, Shah RB. Significant reduction of indeterminate (atypical) diagnosis after implementation of The Paris System for Reporting Urinary Cytology: A single-institution study of more than 27,000 cases. Cancer Cytopathol 2020; 129:114-120. [PMID: 32931158 DOI: 10.1002/cncy.22349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Urinary cytology is a noninvasive and cost-effective diagnostic and surveillance test in the clinical management of urothelial carcinoma (UC). The Paris System for Reporting Urinary Cytology (TPS), published in 2016, introduced definite diagnostic criteria aimed at improving performance in detecting high-grade UC (HGUC) and decreasing the indeterminate (atypical) diagnosis. METHODS The authors retrospectively reviewed and compared urinary cytology diagnoses reported between January 2013 and December 2014 (pre-TPS, 7658 cases) and between May 2016 and April 2018 (post-TPS, 20,026 cases) to assess the influence of TPS in their practice. The time in between was used as a learning period. Follow-up information and correlation with the UroVysion fluorescence in situ hybridization test were obtained when available. RESULTS Urinary cytology diagnoses pre-TPS included negative for UC (NUC) (n = 5293; 69.2%), atypical urothelial cells (AUC) (n = 2227; 29%), and suspicious/positive for HGUC (SHGUC/HGUC) (n = 138; 1.8%). Diagnoses post-TPS included negative for HGUC (NHGUC) (n = 18,507; 92.4%), AUC (n = 1237; 6.2%), and SHGUC/HGUC (n = 282; 1.4%). Comparing the pre-TPS and post-TPS periods, AUC diagnoses decreased from 29% to 6.2% (P < .00001), and the specificity and positive predictive value of AUC to detect HGUC significantly improved from 49% to 86% (P < .00001) and from 9% to 39% (P = .002), respectively. The correlation of an AUC diagnosis with a positive UroVysion test improved from 17% to 38% (P < .00001), whereas overall use of the UroVysion test was decreased. CONCLUSIONS Implementation of TPS resulted in a significant reduction in AUC diagnoses that had a superior correlation with a subsequent biopsy and a UroVysion test, resulting in potential reductions in test use and medical cost.
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Affiliation(s)
- Wei Tian
- Division of Urologic Pathology, Inform Diagnostics, Irving, Texas
| | - Karen T Shore
- Weiss School of Natural Sciences, Rice University, Houston, Texas
| | - Rajal B Shah
- Division of Urologic Pathology, Inform Diagnostics, Irving, Texas.,Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
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Nwafor CC, Etuk EB, Obioha K, Udoh EA. Urine Cytology as Seen in Uyo, Nigeria: How Relevant Is It to Medical Practice? Niger J Surg 2020; 26:95-98. [PMID: 33223804 PMCID: PMC7659756 DOI: 10.4103/njs.njs_48_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/15/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
Aim: The aim of this study is to know the pattern of urine cytology (UC) requests seen in Uyo and how relevant they were to the management of the patients. Materials and Methods: This retrospective study was carried out in the Department of Pathology, University of Uyo Teaching Hospital. The extracted data from the cytology registers were analyzed using the Statistical Package for the Social Sciences version 17. Results: A total of 46 patients did UC during the period. The patients were aged between 21 years and 90 years, with a mean age of 56.89 ± 14.65. Thirty (67.4%) were male. The age group of 60–69 years accounted for most cases (37.8%). Suspicion of bladder cancer was the most common indication as it was seen in 28.9% (n = 13) of cases. Thirty-eight cases (84.4%) were referred from urology clinic, 2 each (4.4%) from general outpatient clinic, general surgery clinic, and from gynecology clinic. In 44.4% (n = 20) of cases, the cytological diagnosis was inflammatory smear, while the UC was normal in 24.4% (n = 11) cases. Malignant cells were seen in 11.1% of (n = 5) cases. Of the 13 cases that the indication was suspected bladder cancer, only four were positive for malignant cells and one was suspicious on UC. No malignant cell or suspicious cell was seen in any of the UC specimens from patients that had prostate cancer, lower urinary tract outlet obstruction with hematuria due to prostatic enlargement. Conclusion: UC should not be requested for in prostatic diseases since the reports are always negative or at most inflammatory. The department should start using The Paris System of UC reporting to assist the managing physician/surgeon to take the best decision.
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Affiliation(s)
| | | | - Kanu Obioha
- Department of Histopathology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Elijah A Udoh
- Department of Surgery, University of Uyo, Akwa Ibom State, Nigeria
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Pierconti F, Martini M, Cenci T, Fiorentino V, Sacco E, Bientinesi R, Pugliese D, Iacovelli R, Schinzari G, Larocca LM, Bassi PF. Methylation study of the Paris system for reporting urinary (TPS) categories. J Clin Pathol 2020; 74:102-105. [PMID: 32527754 DOI: 10.1136/jclinpath-2020-206633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
AIMS Bladder EpiCheck is one of several urinary tests studied to identify bladder tumours and analyses 15 methylation biomarkers determining bladder cancer presence on the basis of methylation profile. METHODS 374 patients diagnosed with high-grade non-muscle invasive bladder cancer were treated and followed for 1 year with voided urine cytology and white-light cystoscopy and biopsies according to European Association of Urology Guidelines. 268 cases were diagnosed with high-grade papillary carcinoma, while 106 cases were carcinoma in situ. Bladder EpiCheck test was performed together with cytology in all cases. RESULTS Comparing cytological categories of negative for high-grade urothelial carcinoma (NHGUC) and atypical urothelial cells (AUCs), we found that an EpiScore <60 correlates with NHGUC (p=0.0003, Fisher's exact test), while comparing AUC and suspicious for high-grade urothelial carcinoma (SHGUC) or SHGUC and high-grade urothelial carcinoma (HGUC) categories, an EpiScore ≥60 correlates with SHGUC and HGUC, respectively (p=0.0031 and p=0.0027, Fisher's exact test). In each TPS category, we found that sensitivity, specificity, Positive Predicitve Value (PPV) and Negative Predictive Value (NPV) of the Bladder EpiCheck test in HGUC category were higher than those observed in SHGUC group (sensitivity=98%, specificity=100%, NPV=85.7%, PPV=100% vs sensitivity=86.6%, specificity=52.3%, NPV=84.6%, PPV=56.5%). CONCLUSIONS Analysing methylation study results, we demonstrated that different TPS cytological categories also carry a distinct molecular signature. Moreover, our results confirm that cytological categories SHGUC and HGUC are different entities also from a molecular point of view and should continue to represent distinct groups in TPS.
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Affiliation(s)
- Francesco Pierconti
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Tonia Cenci
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Vincenzo Fiorentino
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Emilio Sacco
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Riccardo Bientinesi
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Dario Pugliese
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Roberto Iacovelli
- Department of Oncology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy, Rome, Italy
| | - Giovanni Schinzari
- Department of Oncology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Pier Francesco Bassi
- Department of Urology, Catholic University of the Sacred Heart, "Agostino Gemelli" School of Medicine, Rome, Italy
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Vosoughi A, Ordobazari A, Lora Gonzalez MA, Guido LP, Skiba M, Campuzano-Zuluaga G, Kryvenko ON, Gomez-Fernandez C, Garcia-Buitrago M, Jorda M. The Paris System "atypical urothelial cells" category: can the current criteria be improved? J Am Soc Cytopathol 2020; 10:3-8. [PMID: 32732113 DOI: 10.1016/j.jasc.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Paris System (TPS) for reporting urine cytology was developed for standardization of diagnosis focusing on the detection of high-grade urothelial carcinoma (HGUC). Probably the most challenging task for TPS is to provide criteria for the atypical urothelial cell (AUC) category. The TPS criteria for AUC include increased nuclear/cytoplasmic (N/C) ratio (>0.5) and 1 of the 3 minor criteria including nuclear hyperchromasia (NH), coarse chromatin (CC) and irregular nuclear membrane (INM). We evaluated TPS-AUC diagnostic value and investigated whether other morphologic parameters can improve its criteria. MATERIALS AND METHODS Urine samples with diagnoses of AUC collected during a 6-month period were re-reviewed. Data captured included N/C ratio >0.5, NH, CC, INM, and 2 additional criteria including enlarged nuclear size (ENS) and the presence of nucleolus (N). ENS was considered when the nucleus was 2 times larger than the urothelial cell or 3 times larger than lymphocyte. RESULTS By applying the TPS-AUC criteria, the rate of atypia diagnosis reduced in comparison to Pre-TPS (9% versus 13%, P = 0.02). Among the AUC minor criteria, NH was the best criterion with the highest interobserver agreement (IOA) and correlation with HGUC (k = 0.342, r = 0.61, P < 0.001) and strong PPV (93.6%). ENS had the highest PPV (95.8%) and, after NH, had the highest IOA and correlation with HGUC (k = 0.29, r = 0.52, P < 0.001). CONCLUSION TPS improves the diagnostic value of urine cytology, particularly in cases with atypia. ENS is a strong criterion for increasing the diagnostic value of AUC and potentially can improve TPS performance as a minor criterion.
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Affiliation(s)
- Aram Vosoughi
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Atousa Ordobazari
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Manuel A Lora Gonzalez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Luiz Paulo Guido
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Magdalena Skiba
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - German Campuzano-Zuluaga
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Garcia-Buitrago
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
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Ramasubramanian N, Stephen N, Gochhait D, Ganesh RN, Penumadu P, Subramani P, Ramesh A. Rhabdomyosarcoma of urinary bladder in a young man suspected and confirmed on urine cytology. Cytopathology 2020; 31:468-470. [PMID: 32196771 DOI: 10.1111/cyt.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/11/2020] [Accepted: 03/12/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Niranjani Ramasubramanian
- Department of Pathology, Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Norton Stephen
- Department of Pathology, Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pradeep Subramani
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ananthakrishnan Ramesh
- Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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22
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A Multiplex Test Assessing MiR663ame and VIMme in Urine Accurately Discriminates Bladder Cancer from Inflammatory Conditions. J Clin Med 2020; 9:jcm9020605. [PMID: 32102337 PMCID: PMC7073678 DOI: 10.3390/jcm9020605] [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: 01/28/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 01/03/2023] Open
Abstract
Bladder cancer (BlCa) is a common malignancy with significant morbidity and mortality. Current diagnostic methods are invasive and costly, showing the need for newer biomarkers. Although several epigenetic-based biomarkers have been proposed, their ability to discriminate BlCa from common benign conditions of the urinary tract, especially inflammatory diseases, has not been adequately explored. Herein, we sought to determine whether VIMme and miR663ame might accurately discriminate those two conditions, using a multiplex test. Performance of VIMme and miR663ame in tissue samples and urines in testing set confirmed previous results (96.3% sensitivity, 88.2% specificity, area under de curve (AUC) 0.98 and 92.6% sensitivity, 75% specificity, AUC 0.83, respectively). In the validation sets, VIMme-miR663ame multiplex test in urine discriminated BlCa patients from healthy donors or patients with inflammatory conditions, with 87% sensitivity, 86% specificity and 80% sensitivity, 75% specificity, respectively. Furthermore, positive likelihood ratio (LR) of 2.41 and negative LR of 0.21 were also disclosed. Compared to urinary cytology, VIMme-miR663ame multiplex panel correctly detected 87% of the analysed cases, whereas cytology only forecasted 41%. Furthermore, high miR663ame independently predicted worse clinical outcome, especially in patients with invasive BlCa. We concluded that the implementation of this panel might better stratify patients for confirmatory, invasive examinations, ultimately improving the cost-effectiveness of BlCa diagnosis and management. Moreover, miR663ame analysis might provide relevant information for patient monitoring, identifying patients at higher risk for cancer progression.
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Montalbo R, Izquierdo L, Ingelmo-Torres M, Galve P, Solé M, Franco A, Ribal MJ, Alcaraz A, Mengual L. Urine cytology suspicious for urothelial carcinoma: Prospective follow-up of cases using cytology and urine biomarker-based ancillary techniques. Cancer Cytopathol 2020; 128:460-469. [PMID: 32083810 DOI: 10.1002/cncy.22252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Urine cytology results that are suspicious for urothelial carcinoma (UC) are challenging. The objective of this study was to elucidate the clinical significance of such results in patients who have a negative cystoscopy. METHODS In this prospective study, 83 patients who had urine cytology that was suspicious of UC and a negative cystoscopy underwent a second cystoscopy and urine evaluation by cytology, UroVysion fluorescence in situ hybridization (FISH) assay, FGFR3 (fibroblast growth factor receptor 3) and TERT (telomerase reverse transcriptase) mutations and an 8-gene expression classifier (GEC). Results from all techniques were compared with patients' clinical outcomes. RESULTS The presence of tumor was identified in 41% of patients; of these, 82% had tumors identified at their second evaluation (76% high-grade [HG] tumors), and 18% had tumors identified at a later follow-up (50% were HG tumors). After The Paris System for Reporting urinary Cytology (TPS) reclassification, 53 cytology results still had an indeterminate diagnosis (13 were suspicious for HGUC, and 40 had atypical urothelial cells (AUCs)]. Complete results from second evaluations using urine cytology, cytology-TPS, FISH, and GEC were available for 6 cases that were suspicious for HGUC and 34 cases that had AUCs. The sensitivity of these techniques to detect HG tumors in cases that were suspicious for HGUC was 100%, except for cytology-TPS, for which the sensitivity was 50%. The sensitivity of cytology and cytology-TPS to detect HG tumors in cases with AUCs was 33%, whereas the sensitivity of fluorescence in situ hybridization and GEC in these cases was 83% and 75%, respectively, to detect HG tumors at the second evaluation. CONCLUSIONS The current results indicate the relevant clinical significance of indeterminate urine cytology findings and strongly suggest the use of complementary evaluations by urine biomarker-based, ancillary techniques to elucidate their significance.
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Affiliation(s)
- Ruth Montalbo
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Laura Izquierdo
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mercedes Ingelmo-Torres
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Pilar Galve
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Manel Solé
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Agustín Franco
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - María José Ribal
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Lourdes Mengual
- Laboratory and Department of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Anbardar MH, Monjazeb R. Reclassification of urinary cytology regarding The Paris System for Reporting Urinary Cytology with cytohistological correlation demonstrates high sensitivity for high-grade urothelial carcinoma. Diagn Cytopathol 2020; 48:446-452. [PMID: 31976626 DOI: 10.1002/dc.24387] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recently, The Paris System for Reporting Urinary Cytology (TPS) has led to major changes in the approach to evaluate urine cytology and pattern of reporting. The aim of this study was to reclassify urine cytology reports with TPS in order to determine the frequency of abnormal results compared with the previous system; also, we performed cytohistological correlation in abnormal cytological results. METHODS In this study, the voided urine specimens from the patients referred to Shiraz University of Medical Sciences affiliated laboratories were retrieved and analyzed using the laboratory's electronic records system; slides prepared from the samples were reviewed by single cytopathologist blindly according to the proposed criteria of TPS. RESULTS Totally, 1842 urine cytology slides from 828 patients were blindly evaluated by TPS criteria and compared with routine urine cytology classification. Then, available cytohistological correlation was done on 99 abnormal urine cytological results from 58 patients. Among the 26 cytology slides with atypical urothelial cell (AUC) in the previous classification, eight (30.70%) slides were downgraded to negative results, and four (15.30%) were upgraded to higher groups. Therefore, through the reclassification of the slides with TPS, 46% of the AUC changed to other groups. Diagnostic accuracy of the TPS classified urine cytology was 78%, including 87.88% sensitivity, 27.27% specificity, 64.44% positive predictive value, and 60% negative predictive value. CONCLUSION The findings of the present study confirmed the importance and utility of TPS regarding the reclassification of AUC to other groups and its high sensitivity for detecting high-grade urothelial carcinoma (HGUC).
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Affiliation(s)
- Mohammad Hossein Anbardar
- Department of Pathology, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Raha Monjazeb
- Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Wang X, Gu Y, Zhang S, Li G, Liu T, Wang T, Qin H, Jiang B, Zhu L, Li Y, Lei H, Li M, Zhang Q, Yang R, Fang F, Guo H. Unbiased enrichment of urine exfoliated cells on nanostructured substrates for sensitive detection of urothelial tumor cells. Cancer Med 2019; 9:290-301. [PMID: 31709750 PMCID: PMC6943141 DOI: 10.1002/cam4.2655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/14/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background Early detection of urothelial carcinoma (UC) by noninvasive diagnostic methods with high accuracy is still underscored. This study aimed to develop a noninvasive assay incorporating both enrichment of urine exfoliated cells and immunoassays for UC detection. Methods Polystyrene dishes were exposed to oxygen plasma and modified with 3‐aminopropyltriethoxysilane to prepare amine‐functionalized nanostructured substrates (NS). Performance characterization of NS was evaluated by atomic force microscope and X‐ray photoelectron spectroscopy. Urine exfoliated cells were captured by NS and then immunostained to detect urinary tumor cells (UTCs), which was called UTC assay. The receiver operating characteristic (ROC) curve, area under ROC curve (AUC), and Youden index were used to find the cutoff value of UTC assay. ROC analysis and McNemar test were used to compare the diagnostic accuracy of UTC assay with cytology. Kappa test was used to analyze the agreement of UTC assay and cytology with pathological diagnosis. Results Nanostructured substrates had good cell binding yields of nucleated cells and tumor cells. CK20+CD45−CD11b− cells were considered as UTCs. UTC number ≥ 1 per sample could be considered as a positive result. By AUC and Kappa analysis, UTC assay showed good performance in UC detection. McNemar test demonstrated that UTC assay had a superior sensitivity even in low‐grade subgroup and a similar specificity compared to cytology in UC diagnosis. Conclusions Nanostructured substrates could be used to enrich the exfoliated cells from urine samples. UTC assay with NS has the potential to play a role in UC detection. The value of this assay still needs additional validation by large, multi‐center studies.
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Affiliation(s)
- Xin Wang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Yuanyuan Gu
- PerMed Biomedicine Institute, Shanghai, China
| | - Shiwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Gangqiang Li
- Department of Pathology, Naval Characteristic Medical Center, Shanghai, China
| | - Tianyao Liu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Tianwei Wang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Haixiang Qin
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Bo Jiang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Lin Zhu
- PerMed Biomedicine Institute, Shanghai, China
| | - Yajun Li
- PerMed Biomedicine Institute, Shanghai, China
| | - Haozhi Lei
- PerMed Biomedicine Institute, Shanghai, China
| | - Ming Li
- Department of Pathology, The Affiliated Suzhou Municipal Hospital of Nanjing Medical University, Suzhou, China
| | - Qun Zhang
- PerMed Biomedicine Institute, Shanghai, China
| | - Rong Yang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
| | - Feng Fang
- Department of Pharmacology, Nanjing Medical University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, China
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26
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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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27
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Vlajnic T, Gut A, Savic S, Bubendorf L. The Paris System for reporting urinary cytology in daily practice with emphasis on ancillary testing by multiprobe FISH. J Clin Pathol 2019; 73:90-95. [DOI: 10.1136/jclinpath-2019-206109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022]
Abstract
AimsThe Paris System (TPS) was introduced in the diagnostic routine with the goal to simplify and standardise diagnostic reporting of urinary cytology. The diagnostic categories of TPS are based on defined cytological criteria, with a focus on high-grade urothelial carcinoma (HGUC). While the categories ‘negative for HGUC (NHGUC)’ and ‘HGUC’ are straightforward, the categories ‘atypical urothelial cells (AUC)’ and ‘suspicious of HGUC (SHGUC)’ remain inconclusive. In this study, we evaluated the feasibility of TPS in daily practice with special emphasis on ancillary fluorescence in situ hybridisation (FISH) testing in the setting of TPS categories.MethodsIn a 19-month period, TPS was prospectively applied in the routine diagnostic setting on 3900 urinary cytology cases comprising bladder and upper urinary tract washings and voided urine specimens. Additionally, we analysed the results of the FISH assay UroVysion prospectively performed on a cohort of 128 cases enriched for AUC and SHGUC categories.ResultsThe most frequently reported category was NHGUC (n=3496, 89.7%), followed by AUC (n=178, 4.6%), HGUC (n=155, 4%), SHGUC (n=61, 1.6%), low-grade urothelial neoplasia (n=6, 0.1%) and other malignancies (n=4, 0.1%). In the FISH cohort, 40/90 (44%) cases within the AUC category were FISH positive, consistent with urothelial neoplasia. In the SHGUC category, 16/21 (76%) cases were FISH positive.ConclusionsWhen prospectively applying TPS in urinary cytology, inconclusive atypia accounts only for a small subset of cases. FISH additionally improves the stratification between reactive and malignant cells in the indeterminate AUC and SHGUC categories.
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Rai S, Lali BS, Venkataramana CG, Philipose CS, Rao R, Prabhu GGL. A Quest for Accuracy: Evaluation of The Paris System in Diagnosis of Urothelial Carcinomas. J Cytol 2019; 36:169-173. [PMID: 31359918 PMCID: PMC6592122 DOI: 10.4103/joc.joc_67_18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Urine cytology is an important screening tool of patients for urothelial carcinoma (UC) and follow-up of patients with treated disease. Ease of procurement, cost-effectiveness, and lower turnaround time are the major advantages. OBJECTIVE To compare current system of reporting (CSR) at our institute with The Paris System (TPS) and analyze utility of urine cytology based on TPS reporting in correlation with urine culture and histopathology. MATERIALS AND METHODS One-year retrospective study of 90 cases was undertaken wherein cases presenting with painless hematuria and clinically suspicious of UC were included. Urine cytology slides were reviewed and reported with TPS guidelines. These findings were correlated with histopathological diagnosis and urine culture as indicated. Statistical analysis was done using SPSS 17 software. RESULTS With TPS guidelines, 11.1% and 5.6% cases were reported as high-grade UC (HGUC) and low-grade urothelial neoplasm (LGUN), respectively. Suspicious for HGUC category included 17.8% of cases. The rate of reporting "atypical urothelial cells (AUC)" was significantly lower (11.1%) with TPS on comparison with CSR (16.7%). Histopathological correlation of positive predictive value for HGUC was better (100%) on using TPS when compared with CSR (64.3%). Among 11 cases with microbial growth on urine culture, 9.1% were reported as atypical. Sensitivity and accuracy of TPS in detecting UC were 83.3% and 86.52%, respectively. Both were higher when compared with CSR. CONCLUSION In comparison to CSR, criteria of TPS limit the AUC category and enhance the sensitivity and accuracy of detecting HGUC. Adopting TPS for urinary cytology will ensure uniformity and accuracy of HGUC diagnosis.
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Affiliation(s)
- Sharada Rai
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Bhagat S. Lali
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Chaithra G. Venkataramana
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Cheryl S. Philipose
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Ranjitha Rao
- Department of Pathology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - GG Laxman Prabhu
- Department of Urology, Kasturba Medical College Hospital, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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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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30
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Law J, Ali O, Dobrin A, Brar H, Luke PP, Sener A. Significance of atypical urinary cytology in the evaluation of patients with end-stage renal disease for kidney transplantation - a retrospective study. Transpl Int 2019; 32:1085-1094. [PMID: 31100185 DOI: 10.1111/tri.13464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/03/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
Abstract
To determine what percentage of renal transplant candidates have atypical urinary cytology, what proportion have urothelial carcinoma and whether cystoscopy is necessary with atypical cytology. All end-stage renal disease (ESRD) patients (703) presenting for renal transplantation at our institution were retrospectively reviewed. Individuals producing sufficient urine were screened with urine cytology and those with atypical cytology or risk factors for bladder cancer underwent cystoscopy. Four hundred and thirty patients had available urinary cytology and, of these, 151 (35%) had atypical cytology. Of patients with atypical cytology, three were identified to have urothelial carcinoma. However, three additional patients with urothelial carcinoma did not present with atypical cytology. In total, 6 of 703 (0.85%) patients had bladder cancer. All were treated with transurethral resection and eventually underwent renal transplant. One patient has had disease progression post-transplant to distant metastases. This is the largest study to date evaluating the incidence of urothelial carcinoma in ESRD patients presenting for transplant workup. We found the incidence of bladder cancer to be higher than in the general Canadian population, however, most lesions were low grade. We found atypical cytology in transplant candidates to be a poor predictor for these low-grade lesions and do not recommend routine cystoscopy for atypical cytology.
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Affiliation(s)
- Jeffrey Law
- Department of Surgery (Urology), Western University, London, ON, Canada
| | - Omar Ali
- Department of Surgery (Urology), Western University, London, ON, Canada
| | - Andrei Dobrin
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Harmenjit Brar
- Department of Surgery (Urology), Western University, London, ON, Canada
| | - Patrick P Luke
- Department of Surgery (Urology), Western University, London, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Alp Sener
- Department of Surgery (Urology), Western University, London, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
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31
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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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Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, Watson D, Rane A, Hicks J, Hellawell G, Davies M, Srirangam SJ, Dawson L, Payne D, Williams N, Brew‐Graves C, Feber A, Kelly JD. Does urinary cytology have a role in haematuria investigations? BJU Int 2019; 123:74-81. [PMID: 30003675 PMCID: PMC6334509 DOI: 10.1111/bju.14459] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. PATIENT AND METHODS The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub-analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. RESULTS Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3-33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High-risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high-risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow-up. CONCLUSIONS Urine cytology will miss a significant number of muscle-invasive bladder cancer and high-risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Rachael Sarpong
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Pramit Khetrapal
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Simon Rodney
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - Hugh Mostafid
- Department of UrologyRoyal Surrey County HospitalGuildfordUK
| | - Joanne Cresswell
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Dawn Watson
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Abhay Rane
- Department of UrologyEast Surrey HospitalRedhillUK
| | - James Hicks
- Department of UrologyWorthing HospitalWorthingUK
| | | | - Melissa Davies
- Department of UrologySalisbury District HospitalSalisburyUK
| | | | | | - David Payne
- Department of UrologyKettering General HospitalKetteringUK
| | - Norman Williams
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Chris Brew‐Graves
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Andrew Feber
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - John D. Kelly
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
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33
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Dudley JC, Schroers-Martin J, Lazzareschi DV, Shi WY, Chen SB, Esfahani MS, Trivedi D, Chabon JJ, Chaudhuri AA, Stehr H, Liu CL, Lim H, Costa HA, Nabet BY, Sin MLY, Liao JC, Alizadeh AA, Diehn M. Detection and Surveillance of Bladder Cancer Using Urine Tumor DNA. Cancer Discov 2018; 9:500-509. [PMID: 30578357 DOI: 10.1158/2159-8290.cd-18-0825] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/02/2018] [Accepted: 12/18/2018] [Indexed: 01/14/2023]
Abstract
Current regimens for the detection and surveillance of bladder cancer are invasive and have suboptimal sensitivity. Here, we present a novel high-throughput sequencing (HTS) method for detection of urine tumor DNA (utDNA) called utDNA CAPP-Seq (uCAPP-Seq) and apply it to 67 healthy adults and 118 patients with early-stage bladder cancer who had urine collected either prior to treatment or during surveillance. Using this targeted sequencing approach, we detected a median of 6 mutations per patient with bladder cancer and observed surprisingly frequent mutations of the PLEKHS1 promoter (46%), suggesting these mutations represent a useful biomarker for detection of bladder cancer. We detected utDNA pretreatment in 93% of cases using a tumor mutation-informed approach and in 84% when blinded to tumor mutation status, with 96% to 100% specificity. In the surveillance setting, we detected utDNA in 91% of patients who ultimately recurred, with utDNA detection preceding clinical progression in 92% of cases. uCAPP-Seq outperformed a commonly used ancillary test (UroVysion, P = 0.02) and cytology and cystoscopy combined (P ≤ 0.006), detecting 100% of bladder cancer cases detected by cytology and 82% that cytology missed. Our results indicate that uCAPP-Seq is a promising approach for early detection and surveillance of bladder cancer. SIGNIFICANCE: This study shows that utDNA can be detected using HTS with high sensitivity and specificity in patients with early-stage bladder cancer and during post-treatment surveillance, significantly outperforming standard diagnostic modalities and facilitating noninvasive detection, genotyping, and monitoring.This article is highlighted in the In This Issue feature, p. 453.
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Affiliation(s)
| | - Joseph Schroers-Martin
- Department of Medicine, Stanford University, Stanford, California.,Stanford Cancer Institute, Stanford University, Stanford, California
| | | | - William Y Shi
- Department of Pathology, Stanford University, Stanford, California
| | - Simon B Chen
- Department of Pathology, Stanford University, Stanford, California
| | | | - Dharati Trivedi
- Department of Urology, Stanford University, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Jacob J Chabon
- Stanford Cancer Institute, Stanford University, Stanford, California
| | - Aadel A Chaudhuri
- Stanford Cancer Institute, Stanford University, Stanford, California.,Department of Radiation Oncology, Stanford University, Stanford, California
| | - Henning Stehr
- Department of Pathology, Stanford University, Stanford, California
| | - Chih Long Liu
- Department of Medicine, Stanford University, Stanford, California.,Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Stanford University, Stanford, California
| | - Harumi Lim
- Department of Pathology, Stanford University, Stanford, California
| | - Helio A Costa
- Department of Pathology, Stanford University, Stanford, California
| | - Barzin Y Nabet
- Stanford Cancer Institute, Stanford University, Stanford, California
| | | | - Joseph C Liao
- Stanford Cancer Institute, Stanford University, Stanford, California.,Department of Urology, Stanford University, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Ash A Alizadeh
- Department of Medicine, Stanford University, Stanford, California. .,Stanford Cancer Institute, Stanford University, Stanford, California.,Division of Oncology, Stanford University, Stanford, California.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
| | - Maximilian Diehn
- Stanford Cancer Institute, Stanford University, Stanford, California. .,Department of Radiation Oncology, Stanford University, Stanford, California.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California
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Simon CT, Skala SL, Magers MJ, Weizer A, Kaffenberger SD, Chinnaiyan AM, Spratt DE, Montgomery J, Mehra R, Lew M. The utility of upper urinary tract urine cytology before and after application of the Paris system. Diagn Cytopathol 2018; 47:421-427. [DOI: 10.1002/dc.24127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/20/2018] [Accepted: 10/24/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | - Stephanie L. Skala
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
| | | | - Alon Weizer
- Department of UrologyUniversity of Michigan Health System Ann Arbor Michigan
| | | | - Arul M. Chinnaiyan
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Daniel E. Spratt
- Department of UrologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Jeffrey Montgomery
- Department of UrologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Rohit Mehra
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
| | - Madelyn Lew
- Department of PathologyUniversity of Michigan Health System Ann Arbor Michigan
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35
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Sensitivity and specificity of 47 kDa polyclonal antibody for detection of bladder cancer cells in urine of hematuria patients. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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36
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Northrup V, Acar BC, Hossain M, Acker MR, Manuel E, Rahmeh T. Clinical follow up and the impact of the Paris system in the assessment of patients with atypical urine cytology. Diagn Cytopathol 2018; 46:1022-1030. [DOI: 10.1002/dc.24095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Victoria Northrup
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Deparment of Research Services; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
| | - Behram Cenk Acar
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Department of Pathology; Dalhousie University; Halifax Nova Scotia Canada
| | - Mohammad Hossain
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Department of Pathology; Dalhousie University; Halifax Nova Scotia Canada
| | - Matthew R. Acker
- Deparment of Urology; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Deparment of Urology; Dalhousie University; Halifax Nova Scotia Canada
| | - Eric Manuel
- Department of Medicine; Dalhousie Medicine New Brunswick; Saint John Canada
| | - Tarek Rahmeh
- Deparment of Laboratory Medicine; Saint John Regional Hospital, Horizon Health Network; Saint John New Brunswick Canada
- Department of Pathology; Dalhousie University; Halifax Nova Scotia Canada
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37
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Mikou P, Lenos M, Papaioannou D, Vrettou K, Trigka EA, Sousouris S, Constantinides C. Evaluation of the Paris System in atypical urinary cytology. Cytopathology 2018; 29:545-549. [DOI: 10.1111/cyt.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 01/21/2023]
Affiliation(s)
- P. Mikou
- Department of Cytopathology; Laiko Hospital; Athens Greece
| | - M. Lenos
- Department of Cytopathology; Laiko Hospital; Athens Greece
| | - D. Papaioannou
- Department of Histopathology; Diagnostic and Therapeutic Centre of Athens - Hygeia; Athens Greece
| | - K. Vrettou
- Department of Cytopathology; Laiko Hospital; Athens Greece
| | - E-A. Trigka
- First Histopathology Department; Athens Medical School; Laiko General Hospital; Athens Greece
| | - S. Sousouris
- Department of Cytopathology; Laiko Hospital; Athens Greece
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38
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Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, Kakkar N. Cytohistological correlation of urine cytology in a tertiary centre with application of the Paris system. Cytopathology 2018; 29:436-443. [DOI: 10.1111/cyt.12604] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Manish Rohilla
- Department of Cytology and Gynaecology Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Priya Singh
- Department of Cytology and Gynaecology Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Arvind Rajwanshi
- Department of Cytology and Gynaecology Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Nalini Gupta
- Department of Cytology and Gynaecology Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecology Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Pranab Dey
- Department of Cytology and Gynaecology Pathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
| | - Nandita Kakkar
- Department of Histopathology; Post Graduate Institute of Medical Education and Research; Chandigarh India
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39
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Zare S, Mirsadraei L, Reisian N, Liao X, Roma A, Shabaik A, Hasteh F. A Single Institutional Experience With the Paris System for Reporting Urinary Cytology: Correlation of Cytology and Histology in 194 Cases. Am J Clin Pathol 2018; 150:162-167. [PMID: 29878037 DOI: 10.1093/ajcp/aqy043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES The Paris System for Reporting Urinary Cytology (TPS) is designed to standardize the criteria and terminology used in urinary tract cytology reporting. The aim of this study was to evaluate the impact of implementing TPS and to analyze the correlation with follow-up biopsies in order to assess its reproducibility. METHODS Urinary tract cytology specimens with follow-up biopsies over a 2-year period were reviewed and reclassified according to TPS criteria. Surgical follow-up diagnoses were correlated with the initial cytology diagnoses and TPS interpretations, and the results were compared. RESULTS Applying TPS in comparison to our previous reporting system resulted in fewer cases in the atypia category (11.8% vs 24.2%) and higher specificity, accuracy, and predictive value. We observed acceptable interobserver agreement in diagnostic categories of this reporting system. CONCLUSIONS TPS improves the overall performance of urinary tract cytology by standardizing the criteria and terminology.
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Affiliation(s)
- Somaye Zare
- Department of Pathology, University of California San Diego, La Jolla
| | - Leili Mirsadraei
- Department of Pathology, University of California San Diego, La Jolla
| | - Niloufar Reisian
- Department of Pathology, University of California San Diego, La Jolla
| | - Xiaoyan Liao
- Department of Pathology, University of California San Diego, La Jolla
| | - Andres Roma
- Department of Pathology, University of California San Diego, La Jolla
| | - Ahmed Shabaik
- Department of Pathology, University of California San Diego, La Jolla
| | - Farnaz Hasteh
- Department of Pathology, University of California San Diego, La Jolla
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40
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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: 19] [Impact Index Per Article: 3.2] [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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41
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McIntire PJ, Snow JT, Robinson BD, Rao RA, Goyal A, Heymann JJ, Siddiqui MT. Improved correlation of urinary cytology specimens using The Paris System in biopsy-proven upper tract urothelial carcinomas. Cancer Cytopathol 2018; 126:498-504. [PMID: 29927548 DOI: 10.1002/cncy.22005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/28/2018] [Accepted: 04/10/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Urine cytology specimens are essential for screening and monitoring high-grade urothelial carcinomas. However, inconsistent reporting and equivocal diagnostic categories have remained a challenge. The Paris System for Reporting Urinary Cytology (TPS) was developed to provide clear cytomorphologic criteria for urine cytology specimens. Significant correlation between the surgical biopsy diagnosis (SD) and TPS diagnosis (PD) has been established in lower urothelial tract carcinomas, but to the authors' knowledge limited information is available regarding upper urinary tract carcinomas. METHODS A total of 56 cytology specimens from 35 patients within 90 days of an SD of upper urinary tract carcinoma were included. Cytology was re-reviewed and assigned a PD. The original diagnosis (OD) and PD were compared with the corresponding SD to determine which correlated best. RESULTS The PD corresponded to the SD in 35 of 56 cases (63%), which was greater than that for the OD and SD, which were concordant in 19 of 56 cases (34%). Both the OD and PD were concordant in 18 of 56 cases (32%), and neither corresponded in 20 of 56 cases (36%). A total of 27 of 33 cases of high-grade urothelial carcinoma/carcinoma in situ on SD (82%) were identified using the PD whereas only 15 cases (45%) were identified with the OD. The number of "atypical" diagnoses in the OD was reduced from 16 of 56 cases (29%) to 7 of 56 cases (13%) using the PD. Of the 14 of 56 "negative" OD (25%), only 4 remained after implementation of the PD. A diagnosis of low-grade urothelial neoplasm was established in 6 of 20 cases (30%) with the PD compared with 3 of 20 cases with the OD (15%). CONCLUSIONS The authors found that reclassification with TPS improved correlation with the SD compared with previous methodologies. Specifically, TPS increased the number of high-grade urothelial carcinoma diagnoses and decreased the number of equivocal or "atypical" diagnoses. Cancer Cytopathol 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Justin T Snow
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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42
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Pallaoro A, Mirsafavi RY, Culp WT, Braun GB, Meinhart CD, Moskovits M. Screening for canine transitional cell carcinoma (TCC) by SERS-based quantitative urine cytology. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:1279-1287. [DOI: 10.1016/j.nano.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/17/2018] [Accepted: 03/11/2018] [Indexed: 12/25/2022]
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43
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Pierconti F, Rossi ED, Straccia P, Fadda G, Larocca LM, Bassi PF, Sacco E, Schinzari G. The risk of malignancy of atypical urothelial cells of undetermined significance in patients treated with chemohyperthermia or electromotive drug administration. Cancer Cytopathol 2018; 126:200-206. [DOI: 10.1002/cncy.21957] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023]
Affiliation(s)
| | - Esther Diana Rossi
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | - Patrizia Straccia
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | - Guido Fadda
- Institute of Pathology; Catholic University of the Sacred Heart; Rome Italy
| | | | | | - Emilio Sacco
- Institute of Urology; Catholic University of the Sacred Heart; Rome Italy
| | - Giovanni Schinzari
- Institute of Oncology; Catholic University of the Sacred Heart; Rome Italy
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44
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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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45
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Neoh KH, Hassan AA, Chen A, Sun Y, Liu P, Xu KF, Wong AS, Han RP. Rethinking liquid biopsy: Microfluidic assays for mobile tumor cells in human body fluids. Biomaterials 2018; 150:112-124. [DOI: 10.1016/j.biomaterials.2017.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 12/27/2022]
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46
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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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47
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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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48
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Renshaw AA, Gould EW. High-grade urothelial carcinoma in urine cytology with jet black and smooth or glassy chromatin. Cancer Cytopathol 2017; 126:64-68. [PMID: 29072816 DOI: 10.1002/cncy.21947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Some high-grade urothelial carcinomas (UCs) in urine cytology can have jet black, smooth, or glassy chromatin, but to the authors' knowledge, the incidence and criteria for diagnosis are not well described. The current study was performed to define the incidence and appearance of high-grade UC in urine cytology in cytospin preparations with jet black and smooth or glassy chromatin. METHODS Cytospin preparations from 331 cases with biopsy follow-up (230 benign/low-grade UCs and 101 malignant UCs) were reviewed. RESULTS Cases with malignant cells with jet black and smooth or glassy chromatin were identified in a total of 60 cases (59.4% of all malignancies). These comprised 18 carcinoma in situ cases, 28 high-grade papillary UCs, 8 invasive UCs, 3 squamous cell carcinomas, 2 adenocarcinomas, and 1 melanoma. Of the 93 high-grade UCs, 51 (54.8%) had cells with either jet black and smooth or glassy chromatin. These cells were the only type of malignant cell in 6 of 101 cases (5.9%). All cases had at least 50 cells with jet black nuclei. Nuclei with jet black and smooth chromatin often were smaller than normal urothelial cells, often but not always elongate, had irregular nuclear outlines including pointed areas, and usually were accompanied by necrosis. Cells with glassy chromatin often were larger than normal urothelial cells, had rounder but still irregular nuclei, and also had frequent necrosis. CONCLUSIONS Malignant urothelial cells in urine cytology with jet black chromatin are common and can be diagnosed as "positive for malignancy" based on their irregular nuclear outline, increased cellularity (≥50 abnormal cells), and frequent necrosis. Cancer Cytopathol 2018;126:64-8. © 2017 American Cancer Society.
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Affiliation(s)
- Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
| | - Edwin W Gould
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
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49
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Macgregor-Ramiasa M, McNicholas K, Ostrikov K, Li J, Michael M, Gleadle JM, Vasilev K. A platform for selective immuno-capture of cancer cells from urine. Biosens Bioelectron 2017; 96:373-380. [DOI: 10.1016/j.bios.2017.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/31/2017] [Accepted: 02/07/2017] [Indexed: 02/05/2023]
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50
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Torous VF, Brancely D, VanderLaan PA. Implementation of the Paris System for Reporting Urinary Cytology results in lower atypical diagnostic rates. J Am Soc Cytopathol 2017; 6:205-210. [PMID: 31043244 DOI: 10.1016/j.jasc.2017.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (PSRUC) provides a standardized reporting schema for urine cytology with defined criteria for each diagnostic category. We report the impact at our institution of adopting the PSRUC on the frequency and distribution of urine cytology diagnoses, with particular attention to the "atypical" category as it serves as a potential laboratory quality control measure. MATERIALS AND METHODS Urine cytology specimen diagnoses were evaluated during 5-month periods prior to and after the introduction of PSRUC. The number of cases in each diagnostic category by either the laboratory as a whole or by individual cytopathologists were analyzed. Following confidential feedback given to individual cytopathologists, a third 5-month period of cytology diagnosis analysis was performed. RESULTS The overall laboratory atypical call rate was significantly lower in the post-PSRUC as compared with the pre-PSRUC period (29.5% versus 21.8%; P < 0.0001), with individual cytopathologist atypical call rate lower post-PSRUC (range: 10.2%-37.9%) compared with pre-PSRUC (range: 12.2%-45.0%). The institution of feedback based on these findings did not result in any further statistical change in the atypical call rate (21.8% versus 22.2%). CONCLUSIONS Adoption of PSRUC resulted in a significant decrease in the number of atypical diagnoses with little change in the suspicious or malignant categories. Future studies are needed to determine the effect of decreased atypical call rates on the sensitivity/specificity of urine cytopathology, as well as to see if other measures (such as continued cytopathologist feedback or educational modules) can further reduce atypical rates.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Dawn Brancely
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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