Evaluation Of Urine Cytology Research Articles

Interobserver Variability in the Evaluation of Urine Cytology using The Paris System for Urine Cytopathology Classification: An Institutional Experience

Interobserver Variability in the Evaluation of Urine Cytology using The Paris System for Urine Cytopathology Classification: An Institutional Experience

Pitfalls in Urinary Tract Cytology: Algorithmic Approach and The Paris System

Urine cytology is sensitive for detection of high-grade urothelial carcinoma. However, urine is a hostile medium for the exfoliated cells leading to degenerative changes with various interpretation challenges. Chances of misinterpretation can be avoided if the interpreter is conversant with potential pitfalls during evaluation of urine cytology. The causes may be due to pre-analytic, analytic, or post-analytic factors which include method of collection (voided versus cystoscopic versus bladder washing versus other procedures), use of preservative if any, and availability of relevant clinical history. Most common pitfalls are related to low-grade urothelial neoplasms; however, clinically critical are those which are mimickers of high-grade urothelial carcinoma (HGUC).

Malignant Cells in Urine Cytology: Not Always High-Grade Urothelial Carcinoma

Abstract The main purpose of urine cytology is the detection of high-grade urothelial carcinoma (HGUC). When malignant cells of nonurothelial origin are present, it is often misdiagnosed as HGUC due to the rarity of this event and difficulty in distinguishing subtle cytomorphologic differences. To arrive at the appropriate diagnosis, evaluation of urine cytology specimens requires correlation with clinical and radiologic findings and utilization of cytologic-histologic correlation. We present the case of a 64-year-old woman with gross hematuria. Imaging located an infiltrative mass involving the left renal pelvis, highly suggestive of urothelial carcinoma. Lymphadenopathy and multiple bony lesions in the spine were concerning for metastatic disease. Urine cytology specimens taken during cystoscopy contained malignant cells, which were interpreted as HGUC. The workup of a subsequent lymph node biopsy showed a metastatic high grade carcinoma of renal origin with SMARCB1 loss. This finding led to the reexamination of the urine cytology specimens, revealing the malignant cells were not HGUC but rather renal carcinoma. This case highlights a potential pitfall in the evaluation of urine cytology and the importance of cytologic-histologic correlation.

Complications and clinical utility of ultrasonographically guided pyelocentesis and antegrade pyelography in cats and dogs: 49 cases (2007-2015).

To describe the diagnostic utility and clinical safety of ultrasonographically guided percutaneous pyelocentesis and antegrade pyelography in cats and dogs. Retrospective case series. 39 cats and 10 dogs with 55 affected kidneys. Medical records were reviewed to identify cats and dogs that underwent ultrasonographically guided pyelocentesis and antegrade pyelography between June 1, 2007, and December 31, 2015. Data collected included procedure descriptions; results of diagnostic imaging, urine cytologic evaluation, and bacterial culture; and evidence of complications. Animals were assigned to the pyelocentesis group (underwent only pyelocentesis) or to the antegrade pyelography group (underwent pyelocentesis followed immediately by pyelography). The diagnostic rate for pyelography was 94% (31/33; 95% confidence interval [CI], 80.4% to 98.9%). The total, minor, and major complication rates for both treatment groups combined were 25% (95% CI, 15.8% to 38.3%), 24% (95% CI, 14.4% to 36.3%), and 2% (95% CI, 0.09% to 9.6%), respectively. Performing bacterial culture of urine obtained by pyelocentesis did not provide an advantage over performing bacterial culture of urine obtained from the lower urinary tract. Findings indicated that ultrasonographically guided pyelocentesis and antegrade pyelography were well-tolerated techniques for investigating upper urinary tract disease in cats and dogs and that pyelography had a higher diagnostic rate than previously reported; therefore, pyelography should be considered for identification of mechanical and functional ureteral patency abnormalities in cats and dogs.

Evaluation of Urine Cytology in Urothelial Carcinoma with respect to the Paris System for Reporting Urinary Cytology

Evaluation of Urine Cytology in Urothelial Carcinoma with respect to the Paris System for Reporting Urinary Cytology

The Use of a Google Search in the Diagnosis of a Rare Condition

This study aims to describe the use of the Internet in aiding the diagnosis of a rare lower urinary tract finding in a primiparous woman. A case of bladder schistosomiasis was reviewed. After the referral from the obstetrics service with a bladder lesion noted on dating ultrasound, an asymptomatic primipara with 9 weeks of gestational age presented for cystoscopy. A polypoid lesion was noted, and suspected diagnosis of schistosomiasis was made using a Google image search. Urine cytologic evaluation confirmed the diagnosis, and the patient was treated without need for further invasive testing or bladder biopsy. The usefulness of Internet searches and other electronic resources should be appreciated in the diagnosis of rare conditions.

The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: A multi-institutional study

Background and objectiveFew studies have addressed the predictive value of positive urine cytology for prognosis in patients with upper tract urothelial carcinoma (UTUC). We investigated whether the status of preoperative urine cytology could provide additional prognostic information following radical nephroureterectomy (RNU). Materials and methodsThe study included 474 patients with primary nonmetastatic UTUC (pTa-4N0M0) from a retrospective multi-institutional cohort. The median follow-up period was 35 months. Associations between the status of urine cytologic evaluation and outcomes were analyzed using multivariate Cox regression models. Urine cytology was evaluated preoperatively using voided samples. Disease recurrence was defined as any relapse in nonbladder lesions and was coded separately from intravesical recurrence. ResultsPositive urine cytology was detected in 184 patients (38.8%) preoperatively. Disease recurrence occurred in 127 patients, while intravesical recurrence occurred in 219 patients; 83 patients died of UTUC during follow-up. Kaplan-Meier analysis revealed that only the incidence of intravesical recurrence was significantly associated with the status of urine cytologic evaluation (P = 0.024); the intravesical recurrence-free survival rates at 1 and 3 years following RNU were 61.4% and 46.2% in patients with positive urine cytology and 71.1% and 51.6% in their counterparts, respectively. Multivariate analysis showed that gender (hazard ratio [HR] = 1.74, 95% confidence interval [CI]; 1.28–2.43), tumor multifocality in RNU specimens (HR = 1.64, 95% CI; 1.09–2.47), and positive urine cytology (HR = 1.41, 95% CI; 1.08–1.85) were independent risk factors for subsequent intravesical recurrence. ConclusionsThe results showed the prognostic value of positive urine cytology in patients with primary UTUC, and preoperative positive urine cytology may be associated with a significant increase in the prevalence of intravesical recurrence following RNU.

Cytologic Features of Prostatic Adenocarcinoma in Urine: Comparison with Urothelial Carcinoma

BACKGROUNDProstate adenocarcinoma (PACa) cells are rarely identified in urine cytology specimens and might be easily overlooked or misdiagnosed as urothelial neoplasm when clinically unsuspected.METHODSWe reviewed 19 urine cytology specimens obtained from 13 patients with PACa and evaluated the characteristic features discriminating PACa from urothelial carcinoma (UCa). For comparison, 27 cases of high-grade UCa (HGUCa) and 10 cases of urothelial carcinoma in situ (UCis) were also evaluated.RESULTSThe urine cytologic evaluation of PACa revealed clustered cells forming 3-dimensional syncytial fragments with occasional microacinar grouping in a clean background. Most tumor cells were small and uniform with a high nuclear-to-cytoplasmic ratio and indistinct cell borders. The nuclei were round-to-oval and the cytoplasm was scanty and thin. One or more centrally-located prominent nucleoli were characteristically noted in one half of the cases. The nucleoli had a well-defined, large, round and eosinophilic appearance. In four high-grade cases, large tumor cells were encountered and had relatively monotonous cells with smooth-outlined cell clusters, well-defined and thin cytoplasm, and round nuclei with characteristic prominent nucleoli.CONCLUSIONSCombining the information of prostate cancer and the recognition of cytomorphologic features of PACa will help differentiate PACa from HGUCa and UCis.

Racial differences in treatment and outcomes among patients with early stage bladder cancer

Black patients are at greater of risk of death from bladder cancer than white patients. Potential explanations for this disparity include a more aggressive phenotype and delays in diagnosis resulting in higher stage disease. Alternatively, black patients may receive a lower quality of care, which may explain this difference. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data for the years from 1992 through 2002, the authors identified patients with early stage bladder cancer. Multivariate models were fitted to measure relations between race and mortality, adjusting for differences in patients and treatment intensity. Next, shared-frailty proportional hazards models were fitted to evaluate whether the disparity was explained by differences in the quality of care provided. Compared with white patients (n = 14,271), black patients (n = 342) were more likely to undergo restaging resection (12% vs 6.5%; P < .01) and urine cytologic evaluation (36.8% vs 29.7%; P < .01), yet they received fewer endoscopic evaluations (4 vs 5; P < .01). The use of aggressive therapies (cystectomy, systemic chemotherapy, radiation) was found to be similar among black patients and white patients (12% vs 10.2%, respectively; P = .31). Although black patients had a greater risk of death compared with white patients (hazards ratio [HR], 1.23; 95% confidence interval [95% CI], 1.07-1.42), this risk was attenuated only modestly after adjusting for differences in treatment intensity and provider effects (HR, 1.22; 95% CI, 1.06-1.42). Although differences in initial treatment were evident, they did not appear to be systematic and had unclear clinical significance. Whereas black patients are at greater risk of death, this disparity did not appear to be caused by differences in the intensity or quality of care provided.

Changes in Specimen Preparation Method May Impact Urine Cytologic Evaluation

Changes in Specimen Preparation Method May Impact Urine Cytologic Evaluation

Changes in Specimen Preparation Method May Impact Urine Cytologic Evaluation

This study was performed to identify differences in the frequency of specific cytologic diagnoses obtained between specimens prepared by the filtration and ThinPrep (Cytyc, Marlborough, MA) techniques and to assess how these cytologic diagnoses correlated with pathologic findings. Data were collected from 2,347 voided urine specimens analyzed 8 months before and after ThinPrep implementation. Urine cytologic and bladder biopsy specimens were obtained as part of clinical follow-up, and positive diagnoses were considered evidence of malignancy. After ThinPrep implementation, the proportion of specimens diagnosed as negative significantly decreased (85.5% vs 78.6%; P<.001), clusters (5.8% vs 5.6%; P=.597) and positive (2.8% vs 3.3%; P=.143) diagnoses remained similar, and atypical (3.1% vs 8.4%; P<.001) and "suspicious" diagnoses (2.7% vs 4.1%; P<.001) increased. After 1 year of follow-up, there was no significant difference in the percentage of patients diagnosed with bladder carcinoma between the 2 methods for all cytologic categories.

25 Interobserver agreement in the evaluation of urine cytology for the detection of urothelial malignancy

Introduction: Urine cytology is a test used to diagnose and monitor for urothelial malignancy. It is a biological test for which there is no gold standard. The diagnosis offered is based on the subjective interpretation by the cytopathologist viewing the slide. As in all biological systems for which there is no gold standard, the interpretation is subject to clinical disagreement and interobserver variation. The aim of this study is to evaluate the agreement between cytopathologists in the interpretation of urine cytology.Materials and Methods: Two hundred urine cytology slides were collected over a six month period, from a busy metropolitan pathology firm. The series was made up of four categories, normal, atypical, suspicious for malignancy, and malignant. Each category contained fifty representative slides. The slides were reviewed by two independent reviewers as quality control and masked prior to been given randomly to four raters for assessment. The raters consisted of two screening scientists and two cytopathologists. Each rater received each slide in a random fashion and was asked to independently categorise the slide into one of the above categories. The level of agreement was analysed using Cohen weighted Kappa statistics.Results: The interobserver agreement in the assessment of urine cytology by cytopathologits in the detection of urothelial malignancy is moderate using Cohen's kappa weighted statistics.Conclusions: The interobserver agreement in the assessment of urine cytology by cytopathologists is moderate and as such should be born in mind when investigating patients for urothelial malignancy.

Cost efficiency in the prospective diagnosis and follow-up of polyomavirus allograft nephropathy

Evaluation of urine cytology (UC) for decoy cells and quantitative determinations of viruria (urine viral load [UPCR])and viremia (viral load in blood [VLB]) have been proposed as surrogate markers of polyomavirus allograft nephropathy (PVAN). In this study, we present the experience with the concurrent evaluation of UC, UPCR, and VLB in 349 patients (940 sets of samples). Results were correlated with each other and with a previous, concurrent, or subsequent biopsy diagnosis of PVAN. Patients were followed up for a mean of 27 months posttransplantation. We conclude that both UC and UPCR are useful for screening of renal transplant recipients. Simultaneous performance of both UC and UPCR does not add useful clinical information. In patients with positive UC, performance of UPCR, however, can allow for the distinction between BK and JC polyoma viruses. Quantitative measurement of viremia is not indicated in patients lacking viruria because no patients with PVAN present with this combination of findings. In patients with viruria, a positive viremia strongly correlates with PVAN. Rationale selection of screening protocols based on the current knowledge of the infection and tailored to the available laboratory capabilities in each transplantation center can optimize the use of resources.

Cytologic evaluation of urine is important in evaluation of chronic prostatitis

Objectives. Cytologic examination of the urine has not been a recommended part of the diagnostic workup for patients presenting with chronic prostatitis. We identified 3 patients referred to our tertiary Prostatitis Research Clinic who had carcinoma in situ of the bladder discovered after evaluation of urine cytology. Methods. One hundred fifty consecutive patients referred to the Queen’s University Prostatitis Clinic during 2000 and 2001 underwent extensive evaluation, including collection of urine specimen for cytologic examination if they also had symptoms compatible with interstitial cystitis (urinary frequency, urgency, and suprapubic pain). Results. Three patients, who were referred to our tertiary prostatitis clinic after being evaluated and treated by other urologists for an average of 3.5 years for chronic prostatitis, were eventually diagnosed with carcinoma in situ of the bladder. The patients were older than the average patient referred to our specialized clinic (average age 61 years compared with 42 years for the average patient). All 3 patients complained of pain (suprapubic and/or perineal) and irritative voiding symptoms, and 2 had dysuria. Only 1 of these patients had microscopic hematuria. Conclusions. We recommend that urine cytology become a diagnostic test for men presenting with prostatitis-like symptoms, particularly if the symptom complex includes irritative voiding symptoms, dysuria, and suprapubic/bladder pain.

Urinary beta-glucuronidase activity as an initial screening test for urinary tract malignancy in high risk patients. Comparison with conventional urine cytologic evaluation

Routine urine cytology is not particularly useful as a screening test for urinary tract malignancy in the general population, due to its low detection rate. Bladder, ureteral, and pelvic lavage and flow cytometry increased the test sensitivity but could be applied only to a limited number of patients. A simple, sensitive screening test is needed. Two hundred eighty-two urine samples from 146 patients from the Urology Tumor Clinic patients during their initial visits were subject to cytologic evaluation and measurement of the activity of endogenous beta-glucuronidase, followed by confirmation procedures, including cystoscopy with biopsy, ultrasonography, radiography and/or computed tomography. Among 146 patients, 32 had confirmed transitional cell carcinoma and 14 renal cell carcinoma. The urinary beta-glucuronidase activity was higher in patients with cancer than in those without cancer in the Urology Service and in 80 normal healthy control subjects. The accuracy of the urine enzyme diagnostic system measured by the receiver-operating characteristic (ROC) plot was 98% or higher based on the number of patients. The upper threshold value determined by ROC analysis was 1.7 nmol/min/mumol creatinine. At this threshold value, the sensitivities of the enzyme assay for transitional cell carcinoma, renal cell carcinoma, and all cancers were, respectively, 94%, 98%, and 95%. These values were much higher than the corresponding sensitivities of urine cytology: 41%, 0%, and 22%. Urinary beta-glucuronidase is a much more sensitive test to screen for urinary tract malignancy than routine urine cytology in high risk patients, provided that a positive test is followed by diagnostic procedures for confirmation.

Flow Cytometry of Urine

Flow cytometry is becoming an increasingly important tool for the evaluation of urine cytology. Although it has established a strong foothold in oncologic DNA analysis, studies of whole cells and cell markers are only in their infancy. In addition, potential diagnostic applications such as those involving binding of E. coli strains to uroepeithelial cells will move flow cytometry from a research tool to a real diagnostic tool.