Abstract
Background. Urine cytology is deemed a sensitive method in detection of high-grade urothelial carcinoma. In contrast, detection of low-grade urothelial carcinoma (LGUC) and its differentiation from reactive lesions is difficult with urinary cytology. Objective. Our study aims to determine the effectiveness of morphometric parameters in differentiating reactive urothelial cells from LGUC by cytological examination of urine specimens. Methods. Voided urine samples were used for the study, while the cases were randomized into two groups: those diagnosed with LGUC (first group; N=10) and those which were not diagnosed with LGUC (second group; N=10). The morphometric parameters of major nuclear diameter (MaND), minor nuclear diameter (MiND), mean nuclear area (MNA), cell diameter (CD), mean cell area (MCA), as well as MaND/CD, MiND/CD, MiND/MaND and MNA/MCA ratios were measured on 100 urothelial cells for each case through ScopeImage® 9.0 software. Results. A statistically significant difference was found between the mean values of MiND/CD (p=0.017) and MNA/MCA (p=0.002) ratios of groups. The mean value of both parameters in the first group constituted 0.2 and higher, and below 0.2 in the second group. Conclusion. The ratios of MiND/CD and MNA/MCA in urothelial cells proved significantly higher in patients with LGUC than benign/reactive cases. The reliability of these findings in differentiating LGUC from benign/reactive lesions needs to be verified through studies examining a large number of cases. These parameters can be assessed much faster through a special software enabling an automatic measurement and thus can be used in routine cytological examination.
Highlights
Urinary cytology constitutes a significant percentage of non-gynecological cases in routine cytopathology practice, and it continues to be one of the difficult specimens forpathologists
The mean values of parameters such as major nuclear diameter (MaND), minor nuclear diameter (MiND) and mean nuclear area (MNA), as well as MaND/cell diameter (CD), MiND/CD and MNA/mean cell area (MCA) ratios were higher in urothelial cells of low-grade urothelial carcinoma (LGUC) cases
Shin et al reported that the MNA/MCA ratio is efficient with good sensitivity and specificity for differentiating malignant urothelial cells, both high- and low-grade, from the benign ones, since the value of parameter in cases of LGUC was significantly higher than that of the benign urothelial cells [27]
Summary
Urinary cytology constitutes a significant percentage of non-gynecological cases in routine cytopathology practice, and it continues to be one of the difficult specimens for (cyto)pathologists. Some cytological diagnostic criteria were attempted to be determined for LGUC, while McCroskey et al reported that most of the features described previously as diagnosticwere observed almost in cases negative for LGUC [2]. While the presence of three-dimensional papillary structures with fibrovascular cores is a unique diagnostic clue of LGUC in cytology, it is only seen in about 2% of cases This type of papillary structures can be observed in any low-grade papillary lesion, including papillomas, papillary urothelial neoplasia of low malignant potential, and LGUC. Aim The main purpose is to determine the effectiveness of morphometric parameters in differentiating benign/reactive urothelial cells from LGUC by cytological examination of voided urine specimens. Independent sample t test was used for determination of the p value and p value ≤ 0.05 was considered significant
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