Suspicious Urine Cytology Research Articles

Significance of Suspicious Urine Cytology (Class III) in Diagnostic Cystoscopy Follow-up of Bladder Cancer

Significance of Suspicious Urine Cytology (Class III) in Diagnostic Cystoscopy Follow-up of Bladder Cancer

The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem

Purpose To investigate whether outpatient blue-light flexible cystoscopy could solve the diagnostic challenge of positive or suspicious urine cytology findings despite normal white-light flexible cystoscopy results and normal findings on computerized tomography urography, in patients investigated for urothelial cancer. Material and methods In a multicentre study, a total of 70 examinations were performed with the use of blue-light flexible cystoscopy (photodynamic diagnosis) after intravesical instillation of the fluorescence agent hexaminolevulinate. The examination started with a conventional white-light flexible cystoscopy and then the settings were switched to use blue light. Suspicious lesions were biopsied. Afterwards, the patients were interviewed regarding their experience of the examinations. Results Bladder cancer was diagnosed in 29 out of 70 (41%) cases, among them 14/29 (48%) had malignant lesions seen only in blue light. The majority had carcinoma in situ (21/29). Normal findings were seen in 41 cases that underwent BLFC. During the further course, malignancy of the bladder was detected in six cases (9%) and malignancy of the upper urinary tract was detected in one case (1%). The majority of patients (93%) preferred the blue-light flexible cystoscopy performed at the outpatient clinic instead of the transurethral resection under general anaesthesia. Conclusion Blue-light flexible cystoscopy at the outpatient clinic may be a useful tool to solve unclear cases of a malignant or suspicious urinary cytology suggestive of bladder cancer. The procedure was well tolerated by the patients.

The predictive value of positive and suspicious urine cytology: Are they different?

Urine cytology evaluation is an effective test in the detection of high-grade urothelial carcinoma (HGUC). While the guideline distinguishes the 2 categories: "positive for HGUC" (PHGUC) and "suspicious for HGUC" (SHGUC), the association between these categories with their subsequent follow-up biopsies remains unclear. This study aims to determine and compare the positive predictive value (PPV) of the specimens in PHGUC and SHGUC categories with their respective histologic diagnoses. During the period of 03/01/2008 to 07/31/2018, urine cytology cases diagnosed as PHGUC and SHGUC with subsequent bladder biopsy within 12 months were retrieved. All cases were correlated with first biopsy obtained during 12 months of cytology specimen. Biopsy result with HGUC, carcinoma in situ, or non-urothelial carcinoma diagnoses were considered as concordance. 378 cases (229 SHGUC and 149 PHGUC) were identified from 263 patients. For the 229 SHGUC cases, the PPV was 72% (n = 166) and for the 149 PHGUC cases, the PPV was 85% (n = 127). While both categories have high PPV, they are statistically significant (p < 0.0001). Additionally, 33 cases were found to have low-grade urothelial carcinoma (LGUC), constituting a portion of discordant results. PHGUC and SHGUC categories are both associated with a high risk of malignancy, however, there is a statistically significant difference between them in our study, supporting the PSRUC guidelines of two separate categories. In instances when urine cytology is discordant with biopsy results, further investigation and clinical follow up is warranted. LGUC appears to remain a common pitfall especially in the suspicious category.

MP73-02 MALIGNANT URINARY CYTOLOGY OF UNKNOWN ORIGIN-BLUE LIGHT FLEXIBLE CYSTOSCOPY AT THE OUTPATIENT CLINIC MAY BE A VALUABLE DIAGNOSTIC TOOL

INTRODUCTION AND OBJECTIVE:The diagnostic process may be extensive in patients with positive or suspicious urinary cytology when white-light flexible cystoscopy (WLFC) is negative. The next step wo...

229 - Prediction of tumor recurrence in patients in follow up for bladder cancer with suspicious urinary cytology using molecular and cytogenetic approaches

229 - Prediction of tumor recurrence in patients in follow up for bladder cancer with suspicious urinary cytology using molecular and cytogenetic approaches

Clinical Value of Dividing False Positive Urine Cytology Findings into Three Categories: Atypical, Indeterminate, and Suspicious of Malignancy

The aim of this study was to evaluate 10 years of false positive urine cytology records, along with follow-up histologic and cytologic data, to determine the significance of suspicious urine cytology findings. We retrospectively reviewed records of urine samples harvested between January 2002 and December 2012 from voided and catheterized urine from the bladder. Among the 21,283 urine samples obtained during this period, we located 1,090 eligible false positive findings for patients being evaluated for the purpose of confirming urothelial carcinoma (UC). These findings were divided into three categories: atypical, indeterminate, and suspicious of malignancy. Of the 1,090 samples classified as false positive, 444 (40.7%) were categorized as atypical, 367 (33.7%) as indeterminate, and 279 (25.6%) as suspicious of malignancy. Patients with concomitant UC accounted for 105 (23.6%) of the atypical samples, 147 (40.1%) of the indeterminate samples, and 139 (49.8%) of the suspicious of malignancy samples (p<0.0001). The rate of subsequent diagnosis of UC during a 1-year follow-up period after harvesting of a sample with false positive urine cytology initially diagnosed as benign was significantly higher in the suspicious of malignancy category than in the other categories (p<0.001). The total numbers of UCs were 150 (33.8%) for atypical samples, 213 (58.0%) for indeterminate samples, and 199 (71.3%) for samples categorized as suspicious of malignancy. Urine cytology remains the most specific adjunctive method for the surveillance of UC. We demonstrated the clinical value of dividing false positive urine cytology findings into three categories, and our results may help clinicians better manage patients with suspicious findings.

693 COMPARISON BETWEEN THE FINDINGS OF CTU'S DECODED BY A CONVENTIONAL RADIOLOGISTS OR AN EXPERIENCED URO-RADIOLOGIST AND THE ENDOSCOPIC FINDINGS IN PATIENTS WITH SUSPECTED UPPER URINARY TRACT TCC

You have accessJournal of UrologyUrothelial Cancer: upper Tract Tumors (I)1 Apr 2013693 COMPARISON BETWEEN THE FINDINGS OF CTU'S DECODED BY A CONVENTIONAL RADIOLOGISTS OR AN EXPERIENCED URO-RADIOLOGIST AND THE ENDOSCOPIC FINDINGS IN PATIENTS WITH SUSPECTED UPPER URINARY TRACT TCC Tomer Erlich, Orith Portnoy, Nir Kleinmann, Zohar Dotan, Menachem Laufer, Yoram Mor, Jacob Ramon, and harry winkler Tomer ErlichTomer Erlich ramat gan, Israel More articles by this author , Orith PortnoyOrith Portnoy ramat gan, Israel More articles by this author , Nir KleinmannNir Kleinmann ramat gan, Israel More articles by this author , Zohar DotanZohar Dotan ramat gan, Israel More articles by this author , Menachem LauferMenachem Laufer ramat gan, Israel More articles by this author , Yoram MorYoram Mor ramat gan, Israel More articles by this author , Jacob RamonJacob Ramon ramat gan, Israel More articles by this author , and harry winklerharry winkler ramat gan, Israel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.249AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES CT Urography (CTU) is the gold standard diagnostic imaging in patients suspected to have upper urinary tract urothelial carcinoma (UTTCC) while uretero-nephroscopy (RIRS) can serve as an additive diagnostic tool with simultaneous therapeutic option. Yet, contemporary urological literature still considers endoscopy as non-mandatory procedure. We aimed to compare between the findings of CTU's decoded by community radiologists and an experienced uro-radiologist with the endoscopic findings in patients with suspected UTTCC METHODS Retrospective data were collected for patients who underwent diagnostic RIRS for suspected UTTCC between 2004-2011. Indication for endoscopy was either persistent hematuria, suspicious urine cytology or findings on CTU RESULTS 62 patients underwent CTU followed by a diagnostic RIRS performed by a single endourologist. In 34 cases, CTU studies were available and were independently decoded initially by community radiologists and subsequently by a single experienced uro-radiologist. The average patients' age was 61±11.8 years (34-87). The average follow-up was 31 months. In 16 patients (47%) the endoscopic and CTU findings decoded by community radiologists were inconsistent. Fourteen patients (41%) had false positive CTU findings with a normal RIRS, while in 2 patients (6%) the CTU was interpreted as normal and a tumor was eventually found on endoscopy. On the other hand, the RIRS and CTU findings of a single experienced uro-radiologist were inconsistent in 6 patients (18%); all of them had false positive CTU findings with a normal ureteronephroscopy. CONCLUSIONS In order to reduce the inconsistency between CTU and endoscopic findings, CTU should be preferably decoded by an experienced uro-radiologist. Nevertheless, RIRS should be still considered as a mandatory initial procedure in order to avoid unnecessary radical surgery in a significant number of patients and to prevent the possibility of missing the diagnosis of a tumor in others © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e284 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tomer Erlich ramat gan, Israel More articles by this author Orith Portnoy ramat gan, Israel More articles by this author Nir Kleinmann ramat gan, Israel More articles by this author Zohar Dotan ramat gan, Israel More articles by this author Menachem Laufer ramat gan, Israel More articles by this author Yoram Mor ramat gan, Israel More articles by this author Jacob Ramon ramat gan, Israel More articles by this author harry winkler ramat gan, Israel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Cytologic and cystoscopic predictors of recurrence and progression in patients with low‐grade urothelial carcinoma

Patients with low-grade urothelial carcinoma (LGUC) are at risk of recurrence and must undergo lifelong surveillance. To date, cytology and cystoscopy are the gold standard for the detection of de novo and recurrent LGUC. The objective of the current study was is to further characterize the role of cytology and cystoscopy in determining the risk of recurrence and progression in these patients. The authors retrospectively identified patients with LGUC who had urine cytology within 2 months of biopsy, and data were abstracted from their electronic charts. Electronic medical records were reviewed for cystoscopic findings and histologic and cytologic follow-up data over a 5-year period. Statistical analysis was performed with chi-square tests. In total, 76 patients were identified who had histologic follow-up material available, and 49% of those patients demonstrated progression or recurrence of urothelial carcinoma. The initial presence of multiple lesions on cystoscopy was associated with any recurrence or progression (67.7% vs 31%; P = .002), tumor size >2 cm was associated with initial positive or suspicious urine cytology (23.8% vs 3.7%; P = .076), and positive or suspicious initial cytology was associated with high-grade recurrence (58.3% vs 19.4%; P = .009). Cystoscopic findings, such as the presence of multiple lesions, together with concurrent positive or suspicious urine cytology, were associated with recurrence or progression of LGUC. These findings may help to identify high-risk patients.

Reflex UroVysion testing in suspicious urine cytology cases

UroVysion is a US Food and Drug Administration-approved fluorescence in situ hybridization (FISH) probe set for use in the detection of recurrent urothelial carcinoma and in patients with hematuria. The objective of the current study was to evaluate the usefulness of UroVysion as a reflex test in patients with a suspicious urine cytology diagnosis. The rationale was that a more aggressive workup might be indicated in patients with a suspicious cytology diagnosis and positive UroVysion test. The study population included 161 urine specimens diagnosed as suspicious over a period of 12 months. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (NPV) were calculated based on the histologic and cystoscopic correlation. The results using the reporting criteria suggested by the manufacturer demonstrated a sensitivity of 68.3%, a specificity of 39.7%, a PPV of 56.8%, and a NPV of 51.9%. The results using the presence of any cytogenetic abnormality as a positive FISH test demonstrated a sensitivity of 82.9%, a specificity of 21.7%, a PPV of 54.8%, and an NPV of 51.7%. A negative UroVysion test did not rule out the presence of low-grade or high-grade urothelial carcinoma in urine specimens diagnosed as suspicious. The use of less strict criteria dramatically increased the sensitivity of UroVysion FISH; however, there was a marked decrease in specificity noted. The results in this current study appear to indicate that a more aggressive workup of patients with a suspicious cytology, positive UroVysion result, and negative cystoscopic evaluation is not currently justified.

Traditional urinary cytology and tyrosinase RT-PCR in metastatic melanoma patients: correlation with clinical status

Background:The finding of a suspicious urinary cytology is not uncommon in melanoma patients, in as much as morphology alone is often unable to distinguish the variable cytological features of melanoma...

Inverted papilloma of urinary bladder: Is long-term cystoscopic surveillance needed? A single center’s experience

To review all cases of urinary bladder inverted papilloma (IP) in our institution and determine the need for cystoscopic surveillance. IP is an uncommon benign tumor of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) suggest possible malignant potential, leading to conflicting clinical conclusions regarding the need for surveillance. All consecutive patients from January 1991 to December 2004 with IP were included in this study. A single pathologist performed the histologic review. The patients had undergone cystoscopy and ultrasound evaluation of the kidneys every 6 months. Of the 52 patients, 45 were men and 7 were women. The average age at presentation was 58.9 +/- 11.8 years (range 30 to 79). No patient had a synchronous or previous bladder tumor. The most common complaint was macroscopic hematuria. Ten cases were incidental findings during bladder ultrasonography or cystoscopy. All were solitary tumors, most commonly found at the bladder neck. The average follow-up period was 62 +/- 23 months, with no recurrence. One case of subsequent noninvasive papillary TCC developed 15 months later. The initial histologic findings had revealed cytologic atypia, with suspicious urine cytology findings. On review, it was more compatible with TCC with an inverted pattern. Although our cases exhibited benign biologic behavior, the presence of cytologic atypia and suspicious urine cytology require exclusion of TCC with an inverted pattern. Thus, in histologically proven solitary bladder IP with no associated TCC, cystoscopic surveillance may not be necessary.

Suspicious urinary cytology with negative evaluation for malignancy in the diagnostic investigation of haematuria: how to follow up?

Aims: To define the natural history of patients with suspicious urinary cytology and negative initial evaluation for malignancy in the investigation of haematuria. Patients and methods: Data from the hospital...

Suspicious urine cytology (class III) in patients with bladder cancer: should it be considered as negative or positive?

Urine cytology is the gold standard in the diagnosis and follow-up of bladder cancer. Cytology, however, exhibits variable sensitivity depending on tumour grade and interpretation of urine specimens is highly dependent on the skill of the examiner. Positive cytology, classes IV and V by Papanicolaou classification, is a strong predictor for coexisting or subsequent malignancy, while the role of suspicious cytology, class III, is controversial. The objective of the study was to evaluate the role of the suspicious finding in cytological analysis, and whether it should be considered as a negative or positive sign for coexisting malignancy. Six hundred and fifty-two consecutive patients with bladder cancer were studied in a prospective multicenter trial. One hundred and fifty-one of the patients were newly diagnosed, and the remaining 501 patients were under follow-up. A voided urine sample was obtained prior to TURB or prior to routine follow-up cystoscopy in those under the surveillance and split for culture and cytology. The cytopathological results were analyzed by a central review and only patients with samples available for review analysis were included. Sensitivity and specificity, as well as positive (PPV) and negative (NPV) predictive values of urine cytology were calculated by classifying the class III samples as negative or positive. A total of 570 patients were evaluable. One hundred and twenty nine (22.6%) were newly diagnosed and 441 were under follow-up, of whom 117 (26.5%) had recurrence. Cytology was classified as suspicious in 33/129 (25.6%) patients with primary tumour, and in 41/441 (9.3%) of those under the follow-up, of whom 20 (48.8%) had recurrence. Sensitivity increased from to 31.0% to 56.6% in primary tumours (p < 0.001) and from 17.8% to 34.7% in recurrent tumours (p < 0.001) if class III was determined as positive, whereas the specificity decreased from 96.6% to 90.1% (p < 0.001). Accordingly, the NPV increased from 76.3% to 79.1% and the PPV decreased from 65.6% to 56.2%. The poor sensitivity of voided urine cytology improved significantly when suspicious samples were determined as positive while the specificity remained high, a clear advantage compared with most of the new tumour marker tests. In addition, nearly half of the follow-up patients with suspicious class III cytology had recurrence implying that this patient category is at substantial risk for co-existing malignancy. Therefore, it is recommended that suspicious class III cytology together with class IV and V specimens should be considered positive.

The role of urine cytology in the assessment of lower urinary tract symptoms.

To evaluate the role of urine cytology in the investigation of men with lower urinary tract symptoms (LUTS) in the absence of haematuria. The study comprised 336 men attending a LUTS assessment clinic, who had neither macroscopic nor microscopic haematuria. One sample of urine was collected for cytology. Those with suspicious urine cytology were investigated with intravenous urography and cystoscopy. Five men had abnormal urine cytology results; on further investigation one of them was found to have carcinoma in situ (CIS) and one to have a transitional cell carcinoma. Three had false-positive urine cytology results. A bladder tumour or CIS was detected in 0.6% of the population tested. The cost per cancer diagnosed was GB pound 2020. Urine cytology is a simple noninvasive way of assisting accurate diagnosis of men who have LUTS in the absence of haematuria.

Ureteroscopic evaluation in renal transplant recipients.

Percutaneous access and antegrade intervention have been the gold standard for the management of renal and ureteral complications in the renal transplant patient. We reviewed 540 consecutive renal allografts performed between July 1991 and September 1996 to determine the feasibility and morbidity of diagnostic and therapeutic ureteroscopy in renal allograft ureters. Of these, 14 patients (2.5%) had indications for endoscopic intervention of the allograft ureter. Four patients had obstructive ureteral calculi, three had migrated double-pigtail stents, three had persistent suspicious urinary cytology findings necessitating diagnostic ureteroscopy, three had persistent funguria, and one had multiple ureteral filling defects seen on retrograde ureteropyelography. Ureteropyeloscopy was successful in 93% of the patients. A diagnosis was made in all cases, including the one unsuccessful ureteroscopy, as this patient had allograft ureteral necrosis preventing passage of the endoscope into the renal pelvis. All of the migrated stents could be seen, and all but one was retrieved. Two of the patients with persistent funguria did have renal fungal balls, which were removed endoscopically, and the other case yielded a urothelial biopsy positive for fungus. All of the ureteral calculi were removed endoscopically. The only complication was ureteral perforation, which occurred in the patient with ureteral necrosis. Transplant ureteral endoscopy is a technically challenging intervention, but both diagnostic and therapeutic ureteroscopy can be performed with acceptable outcomes and minimal morbidity. One should consider ureteroscopy as an alternative to percutaneous and antegrade modalities, as these methods carry significant morbidity.

The Use of Urine Cytology for Diagnosing Bladder Cancer in Spinal Cord Injured Patients

The diagnosis of bladder cancer in spinal cord injured patients is complicated by inflammatory changes caused by long-term indwelling catheters, which make cystoscopic followup difficult. We evaluated cytology as an aid in diagnosing bladder cancer in spinal cord injured patients. The charts of 208 spinal cord injured patients were reviewed retrospectively from January 1988 to July 1995 to define the value of cytology in the diagnosis of bladder cancer in this population. In all patients at least 1 urine cytology study was done less than 3 months before bladder biopsy. We examined 272 bladder biopsies (several patients underwent more than 1 biopsy at least 1 year apart) with 1 to 6 cytology studies done before biopsy. Cytology results were classified as negative-no malignant cells, inflammation or benign urothelial cells, reactive-atypia or atypical reactive and suspicious-atypical suspicious, keratinizing squamous metaplasia, suspicious for cancer, cancer or dysplastic. A total of 960 cytology specimens was obtained before the 272 biopsies (average 3 before each biopsy). Of 17 patients with cancer 12 had at least 1 prior suspicious urine cytology result. The sensitivity and specificity of cytology were 71 and 97%, respectively, when evaluating only patients with suspicious findings. The high sensitivity and specificity of multiple cytology studies in this population suggest that cytology is a useful adjunct to improve the detection of bladder cancer in spinal cord injured patients with chronic (longer than 5 years) indwelling catheters. We recommend a minimum of yearly cytology in all high risk spinal cord injured patients with subsequent biopsies in all patients with any suspicious finding.

Predictive value of DNA measurements in bladder washings. Comparison of flow cytometry, image cytophotometry, and cytology in patients with a past history of urothelial tumors

Comparative DNA ploidy measurements were carried out by flow cytometry and by image analysis on cells in 71 bladder washing specimens from 50 patients with past histories of bladder tumors. Among the specimens classified as diploid or questionable by flow cytometry, 14 showed the presence of aneuploid DNA values documented by image analysis. In 18 of the 50 patients, recurrent tumors were observed during a relatively brief period of follow-up. In 15 of them the DNA pattern was aneuploid and in three it was questionable. In nine of the 15 patients, both methods of DNA analysis disclosed aneuploidy, but in six patients aneuploidy was detected by image analysis only. A combination of DNA aneuploidy, whether observed by flow cytometry, image analysis, or both, and of positive or suspicious urine cytology is highly predictive of recurrence of high grade bladder tumors. Image analysis of DNA content in bladder washings adds information of clinical value above and beyond that obtained by flow cytometry.

Falsely Positive Urinary Cytology: Pathologist’s Error or Preclinical Cancer?

The reluctance to accept urinary cytology as a diagnostic procedure in urologic cancer has been partially owing to a relatively high incidence of falsely positive results. The recent recognition of bladder cancer as a field change and the identification of urothelial dysplasia support the contention that these cytologic findings represent early neoplasia rather than laboratory errors. Of 64 patients with positive or suspicious urinary cytology short-term histologic confirmation could not be obtained in 10. Of these 10 patients review of the clinical and pathologic material was possible in 9 and significant urologic abnormalities were found in 7. Among patients with bladder cancer there were no falsely negative reports. Urinary cytology is a reliable procedure in the diagnosis of urologic malignancies. Unconfirmed positive results require careful examination and followup.