A previously healthy 47-year-old Saudi male presented with a two-month history of painless gross hematuria and notable digital clubbing. The hematuria was intermittent, dark red, and unassociated with dysuria, flank pain, or systemic symptoms. Physical examination confirmed clubbing of the fingers, while vital signs and general assessment were unremarkable. Laboratory evaluation revealed mild polycythemia and borderline hypercalcemia, with otherwise normal renal and liver function. Urinalysis excluded infection or glomerular disease, and urinary cytology was negative for urothelial malignancy. Given the combination of persistent hematuria and paraneoplastic signs, imaging studies were prioritized. Renal ultrasonography identified a heterogeneous right upper pole mass, subsequently characterized by contrast-enhanced CT as a 6-cm right renal mass with heterogeneous enhancement and areas of necrosis, consistent with renal cell carcinoma (RCC), without evidence of metastasis. Multidisciplinary discussion favored radical nephrectomy, which was performed successfully with en bloc excision of the kidney, perinephric fat, and regional lymph nodes. Histopathology confirmed clear cell RCC, Fuhrman grade II, with negative margins and no lymphovascular invasion (pT1bN0M0). Postoperatively, hematuria resolved, and early regression of clubbing was observed. This case highlights the diagnostic significance of gross hematuria combined with paraneoplastic manifestations such as clubbing, emphasizing the importance of early imaging and prompt surgical intervention for localized RCC to optimize outcomes.

BackgroundMicroRNA-183 (miR-183-5p), a noncoding RNA, is upregulated in bladder carcinoma (BC). Although it has been implicated in oncogenesis, its precise regulatory effects and biological functions remain unclear. Tropomyosin-1 (TPM1) was shown to be downregulated in solid tumors and was previously identified as a novel tumor suppressor gene.ObjectivesOur study focuses on the prognostic, diagnostic, and therapeutic potential of miR-183-5p in bladder carcinoma and assess TPM1 gene targets and their modulatory functions.MethodsUrine cytology, cystectomy and transurethral resection (TUR) biopsies from 148 BC patients were collected. TPM1 protein and miR-183-5p expressions were assessed through immunohistochemistry (IHC) and real-time PCR respectively. In vitro assay investigated the effect of miR-183-5p on TPM1mRNA in bladder carcinoma cell lines, then confirmed by comparing miR-183-5p mimics in non-cancerous and urothelial carcinoma cell lines. Concomitant TPM1 gene expression was examined, and the theranostic miR-183-5p potential was evaluated. ResultsUpregulation of miR-183-5p expression in BC tissue biopsies and urine cytologies was noted, contrasting the downregulation of TPM1 protein expression in the high-grade, high-stage, lymph node metastatic BC tissues (in comparison to non-cancerous, low-grade, low-stage non-lymph node metastasizing BCs). Moreover, the miR-183-5p oncogenic influence was responsive in targeting TPM1 gene at 3′UTR region, and miR‑183‑5p.1 restricted TPM1 expression in T24 cells.ConclusionThis study provides the first illustration of the miR-183-5p–TPM1 axis in bladder carcinoma, supporting the theranostic role of miR-183-5p as an onco-miR in BC progression, diagnosis, and prognostication.

Intravesical therapy following transurethral resection of bladder tumor (TURBT) remains the standard of care for non-muscle invasive bladder cancer (NMIBC). However, the global shortage of Bacillus Calmette-Guérin (BCG) and its notable side effect profile have driven interest in alternative agents such as gemcitabine and hyperthermic intravesical chemotherapy (HIVEC), both of which have shown promising results. A total of 100 consenting patients with intermediate- and high-risk NMIBC, as per EAU 2020 risk stratification, were enrolled at a single institution between January 2021 and July 2022. Patients were electronically randomized in a 2:1:1 ratio into three groups: gemcitabine (n = 50), HIVEC (n = 25), and BCG (n = 25). Follow-up included cystoscopy and urine cytology every 3 months. Adverse events were assessed and graded using the Modified Clavien-Dindo Classification System. At 12 months, recurrence-free survival (RFS) was 94% in the gemcitabine group, 84% in the HIVEC group, and 92% in the BCG group (p = 0.675, intention-to-treat analysis). No cases of grade or stage progression were observed. Most recurrences (88.9%) occurred in the high-risk subgroup. Treatment-related side effects were significantly more frequent in the BCG group, while gemcitabine was the most well-tolerated during both induction and maintenance phases. The most common adverse events included lower urinary tract symptoms (LUTS), dysuria, and urinary tract infections (UTIs). Preliminary findings indicate that intravesical gemcitabine is non-inferior to BCG and HIVEC in terms of short-term efficacy, with a significantly better safety and tolerability profile. These results position gemcitabine as a viable alternative in the management of NMIBC. However, the study's limited sample size and short follow-up period necessitate larger, long-term studies to validate these outcomes.

The evolving treatment landscape of muscle-invasive bladder cancer (MIBC) increasingly warrants novel trial design to evaluate perioperative strategies aimed at bladder preservation. To establish standardized outcome measures for evaluating organ preservation strategies in MIBC, the International Bladder Cancer Group (IBCG) and the Global Society of Rare Genitourinary Tumors (GSRGT) assembled an international, multidisciplinary consensus panel. The IBCG and GSRGT gathered global bladder cancer experts and patient advocates to establish a framework for risk-adapted bladder-sparing treatment approaches for MIBC. Working groups reviewed the literature and developed draft recommendations, which were discussed at a live meeting in December 2024 in Milan. This was followed by voting by the members using a modified Delphi process. Recommendations achieving ≥75% agreement during the meeting were further refined and presented. Clinical complete response (cCR) definition should encompass the absence of high-grade malignancy on pathology and malignant cells on urine cytology and no evidence of local or metastatic disease on cross-sectional imaging. Although cCR remains immature as a primary or coprimary end point in registrational trials, it could serve as a suitable end point in early-phase studies and risk-adapted investigations. Event-free survival (EFS) remains the preferred primary end point as it could reliably capture the durability of clinically meaningful benefit after omittance of surgical consolidation or chemoradiation. Given the composite nature of EFS, events should be prespecified, evaluated in an intention-to-treat approach, and meticulously collected. Continuous assessment of individual patient preferences should begin at the outset of perioperative therapy discussions, with informed decision making prioritized throughout. The consensus definition of cCR and the framework presented in this study can serve as a foundation for thorough testing of risk-adapted bladder-sparing treatment paradigms for MIBC.

Hematuria, the presence of erythrocytes in urine, is classified into two main types: macroscopic, visible to the naked eye, and microscopic hematuria not visible without a microscope. A careful medical history is the best guide for evaluation. Hematuria accompanied by proteinuria or hypertension is particularly significant in differential diagnosis. Treatment options range from regular follow-up to nephrectomy; thus, an accurate and early diagnosis is essential for managing patients with hematuria. A 52-year-old Caucasian white female presented with painless hematuria. Cystoscopy was performed following the initial ultrasound evaluation. Urine cytology and pathological findings were benign. Renal function test results were within normal limits, and there was no proteinuria. Urinary sediment analysis revealed 10–15 isomorphic erythrocytes per high-power field. Glomerulonephritis was excluded in the diagnosis. Her medical history revealed a Whipple procedure performed three years earlier. So, Doppler ultrasound was performed to assess the possibility of renal vein compression. Doppler imaging revealed that the diameter of the left renal vein was 9.5 mm before the superior mesenteric artery and 1.8 mm after it, findings consistent with Nutcracker Syndrome. As her renal function was normal and she was normotensive, clinical follow-up was recommended at six-month intervals. Nutcracker Syndrome is a rare vascular compression disorder that typically involves entrapment of the left renal vein between the aorta and superior mesenteric artery. Given the risk of unnecessary interventions, this rare condition should be considered and excluded in the differential diagnosis of hematuria.

Bridging Perspectives: Integrating urologist and cytopathologist insights of urine cytology.

Abstract Introduction/Objective Cytologists are currently permitted to independently sign out negative Pap smear cases due to their specialized training and demonstrated accuracy. Expanding this role to include negative urine cytology cases could enhance workflow efficiency and reduce pathologists’ workloads. This study investigates the diagnostic concurrence between cytologists and pathologists for urine cytology cases to evaluate this potential role expansion. Methods/Case Report A retrospective review of urine cytology cases from January 2023 to May 2024 was conducted in our institution. Cytopathologist’s final diagnosis was compared with the initial cytologist screening diagnosis. Specimens analyzed included voided urine, catheterized urine, and bladder irrigations, all categorized according to the Paris System for Reporting Urinary Cytology. We defined the classification of concurrence into three levels: Concur, Minor (one-level difference), and Major (more than two levels difference) disagreements in order to help us understand the extent of diagnostic variation and the reliability of cytologists’ independent assessments. Data was organized and analyzed using Microsoft Excel. Results Out of the 3,716 cases reviewed, 3,671 were included in the final analysis after excluding 45 cases due to unsatisfactory samples. There were 3116 cases with a diagnosis of negative for high grade urothelial carcinoma (NGHUC), 415 atypical urothelial carcinoma (AUC), and 140 suspicious for high-grade urothelial carcinoma (SHGUC) and high-grade urothelial carcinoma (HGUC). There were 367 minor and 3 major discrepancies. The overall concurrence rate between cytologists and pathologists was 89.92% (3,301 cases in agreement). Discrepant cases totaled 10.07% (n = 370), comprising 9.9% (n = 367) minor disagreements and 0.08% (n = 3) major disagreements. For the 3,116 cases signed out as NGHUC, the concurrence rate between cytologists and pathologists was 95.32%, demonstrating high diagnostic agreement. Only 1 out of 3116 negative urine diagnosis had a major discrepancy. Conclusion A high agreement rate for negative urine cytology cases suggests cytologists can independently diagnose these cases using the Paris system, with proper quality control. This is consistent with existing literature. Such a shift could streamline the diagnostic process, reduce workload for pathologists, and maintain high levels of diagnostic accuracy in clinical practice. Further research is needed to compare these rates and consider logistical and legal factors.

Abstract Introduction/Objective Cytologists are currently permitted to independently sign out negative Pap smear cases due to their specialized training and demonstrated accuracy. Expanding this role to include negative urine cytology cases could enhance workflow efficiency and reduce pathologists’ workloads. This study investigates the diagnostic concurrence between cytologists and pathologists for urine cytology cases to evaluate this potential role expansion. Methods/Case Report A retrospective review of urine cytology cases from January 2023 to May 2024 was conducted in our institution. Cytopathologist’s final diagnosis was compared with the initial cytologist screening diagnosis. Specimens analyzed included voided urine, catheterized urine, and bladder irrigations, all categorized according to the Paris System for Reporting Urinary Cytology. We defined the classification of concurrence into three levels: Concur, Minor (one-level difference), and Major (more than two levels difference) disagreements in order to help us understand the extent of diagnostic variation and the reliability of cytologists’ independent assessments. Data was organized and analyzed using Microsoft Excel. Results Out of the 3,716 cases reviewed, 3,671 were included in the final analysis after excluding 45 cases due to unsatisfactory samples. There were 3116 cases with a diagnosis of negative for high grade urothelial carcinoma (NGHUC), 415 atypical urothelial carcinoma (AUC), and 140 suspicious for high-grade urothelial carcinoma (SHGUC) and high-grade urothelial carcinoma (HGUC). There were 367 minor and 3 major discrepancies. The overall concurrence rate between cytologists and pathologists was 89.92% (3,301 cases in agreement). Discrepant cases totaled 10.07% (n = 370), comprising 9.9% (n = 367) minor disagreements and 0.08% (n = 3) major disagreements. For the 3,116 cases signed out as NGHUC, the concurrence rate between cytologists and pathologists was 95.32%, demonstrating high diagnostic agreement. Only 1 out of 3116 negative urine diagnosis had a major discrepancy. Conclusion A high agreement rate for negative urine cytology cases suggests cytologists can independently diagnose these cases using the Paris system, with proper quality control. This is consistent with existing literature. Such a shift could streamline the diagnostic process, reduce workload for pathologists, and maintain high levels of diagnostic accuracy in clinical practice. Further research is needed to compare these rates and consider logistical and legal factors.

A man in his 50s with an intellectual disability underwent a cystostomy for neurogenic bladder, followed by regular catheter exchange. Eighteen years later, the patient developed hematuria. Computed tomography and cystoscopy revealed a bladder tumor despite negative urinary cytology. Transurethral resection of the tumor confirmed the diagnosis of squamous cell carcinoma. Radical cystectomy was performed due to muscle invasion. Histopathological analysis revealed a pT3aN1M0 squamous cell carcinoma. No adjuvant therapy was administered, and the patient has remained recurrence-free for seven years postoperatively.

To evaluate diagnostic practices in the United Kingdom (UK) prior to radical nephroureterectomy (RNU) for suspected upper tract urothelial carcinoma (UTUC) and assess their impact on early oncological outcomes. The audit examined compliance post-operative intravesical Mitomycin C (MMC) instillation and adjuvant chemotherapy for ≥pT2 disease. This national audit, by the British Association of Urological Surgeons (BAUS), invited all NHS hospitals performing RNU for non-metastatic UTUC. Retrospective anonymised data were collected. Outcomes included time from imaging to RNU, use of MMC, adjuvant chemotherapy, bladder recurrence, surgical margins, extravesical metastasis, and final histology. Statistical analysis used Mann-Whitney U, Chi-square/Fisher's exact test, and multivariate logistic regression. A total of 877 patients who underwent RNU across 70 hospitals were analysed (median 10 cases per hospital). Diagnostic ureteroscopy (d-URS) was performed in 61.3% of cases, delaying RNU by a median of 53 days (130 vs 77 days; P < 0.01). Voided urine cytology was recorded in 34.3%. Among patients with high-grade and/or ≥ pT1 disease, 89% had positive cytology. MMC was administered in 45.1% of ≥pT2 cases and adjuvant chemotherapy in 46%. Bladder recurrence was significantly higher in patients undergoing d-URS (26.6% vs 12.3%; P < 0.01), as were positive margins in ≥pT2 tumours (24% vs 14%; P = 0.03). Although not statistically significant, d-URS was associated with more metastases (27.2% vs 19.2%) and fewer non-UTUC diagnoses (5.5% vs 8.6%). Multivariate analysis showed that d-URS independently predicted bladder recurrence and margin positivity in ≥pT2 disease. Our audit showed that d-URS is associated with significant treatment delays, increased rates of metachronous bladder cancer recurrence, and higher surgical positive margin rates in patients with ≥pT2 disease. Compliance with MMC therapy and adjuvant chemotherapy was low. This national audit highlights the need for risk-stratified diagnostic pathways, multidisciplinary expertise, and establishment of quality performance indicators to improve care and outcomes in UTUC management in the UK.

On April 22, 2024, the U.S. FDA granted regular approval to nogapendekin alfa inbakicept-pmln (N-803) with Bacillus Calmette-Guerin (BCG) for the treatment of adult patients with BCG-unresponsive non-muscle-invasive bladder cancer with carcinoma in situ, with or without papillary tumors. Substantial evidence of effectiveness for this application was obtained from cohort A of the single-arm, multicenter QUILT-3.032 trial. Patients received N-803 400 μg administered intravesically with TICE BCG once a week for 6 weeks as induction therapy, a second induction course if complete response (CR) was not achieved at month 3, and maintenance N-803 with BCG weekly for 3 weeks at months 4, 7, 10, 13, and 19 (for a total of 15 maintenance doses). The major efficacy outcome measures were CR at any time [as defined by negative results for cystoscopy [with transurethral resection of bladder tumor (TURBT)/biopsies as applicable] per local investigator assessment and urine cytology] and duration of response. The CR rate in the 77-patient efficacy population, per FDA review, was 62% [95% confidence interval (CI), 51%-73%]. Of the 48 patients with a CR, 28 (58%; 95% CI, 26%-55%) and 19 (40%; 95% CI, 16%-36%) maintained a response for ≥12 months and ≥24 months, respectively. The most common adverse reactions were increased creatinine, dysuria, hematuria, urinary frequency, urinary urgency, and urinary tract infection. This article summarizes the data and FDA thought process supporting the approval of N-803 with BCG.

Urothelial carcinoma with squamous differentiation (UCSD) carries adverse outcomes, yet cytological recognition is challenging because keratinized atypical squamous cells (ASCs) often show deceptively low nuclear-to-cytoplasmic ratios. A size-based ASC classification anchored to neutrophils was evaluated as a biological internal reference. All cytology specimens were prepared with the ThinPrep liquid-based cytology system. Seventeen urine cytology specimens from histologically confirmed UCSD and 79 cytologically benign (BE) specimens with squamous cells were retrospectively reviewed. ASCs with orangeophilic cytoplasm were subclassified by nuclear size relative to the adjacent neutrophils: ASC-S (small nuclei; >1× neutrophil) and ASC-L (large nuclei; >2× neutrophil). Counts were obtained from five high-power fields. UCSD was stratified by the extent of squamous differentiation (<50% vs.≥50%). No ASC-S/L was identified in BE specimens, whereas either subtype was present in 15 of the 17 UCSD cases, which yielded a cohort-level sensitivity of 88% and specificity of 100% for UCSD detection (95% CI, 65.7%-96.7% and 95.4%-100%, respectively). ASC-S was more prevalent than ASC-L, and was observed across Paris System categories-including atypical urothelial cells (AUCs)-whereas ASC-L appeared mainly in suspicious for high-grade urothelial carcinoma/high-grade urothelial carcinoma. ASC-S counts tended to increase with greater histological squamous differentiation, and were detectable even when tissue involvement was <50%. Neutrophil-calibrated ASC classification provides an objective, biologically grounded framework that aligns cytology with histology in UCSD. Reporting ASC-S/L-particularly ASC-S in equivocal (AUC) specimens-may facilitate earlier recognition of squamous differentiation and inform subsequent tissue evaluation. Prospective, multi-institutional validation with interobserver agreement and receiver operating characteristic-based thresholds is warranted.

BackgroundBladder cancer (BCa) represents the most common malignancy of the urinary system, characterized by a high recurrence rate, with approximately 61% of patients experiencing recurrence within 1 year post-surgery. Current monitoring methods, such as cystoscopy and urine cytology, are constrained by low sensitivity and patient discomfort. This study employed multi-omics data to investigate the role of OLFML3 in BCa recurrence, with the aim of enhancing the accuracy of recurrence prediction and improving clinical management.MethodsThis study utilized RNA sequencing (RNA-seq) data and clinical information from The Cancer Genome Atlas (TCGA) to analyze patients with BCa, stratifying them into relapse and non-relapse groups. Weighted gene co-expression network analysis (WGCNA) was performed to identify gene modules associated with 1-year BCa recurrence. Subsequently, univariate Cox regression and least absolute shrinkage and selection operator (LASSO) Cox regression analyses were conducted to select eight prognostic genes, and a risk model was developed and validated in both TCGA and Gene Expression Omnibus (GEO) datasets. Additionally, single-cell RNA sequencing (scRNA-seq) data from Guangdong Provincial Second People’s Hospital were analyzed to evaluate gene expression across high and low tumor stromal BCa subtypes and explore the relationship between the expression of these eight genes and clinical features. A deep learning model based on the ResNet50 architecture was developed to predict OLFML3 expression in hematoxylin and eosin-stained images. Statistical analysis was performed using R software (version 4.4.2), with significance set at P<0.05.ResultsWGCNA identified gene modules associated with BCa recurrence, with the red module exhibiting a significantly positive correlation with recurrence status. Through univariate and LASSO Cox regression analyses, we selected eight prognosis-related genes. Kaplan-Meier survival analysis demonstrated that these genes effectively differentiated between high- and low-risk groups, with statistically significant survival differences observed in both TCGA and GEO datasets. Further Kaplan-Meier survival analysis of each of the eight genes indicated that high OLFML3 expression was associated with lower survival rates. scRNA-seq revealed differential expression of OLFML3 between high and low tumor stromal subtypes, suggesting that OLFML3 may be a key gene associated with 1-year BCa recurrence. High OLFML3 expression also correlated with BCa invasiveness, grade, and stage. Using a deep learning model based on BCa pathological features, we constructed a random forest (RF) model that successfully predicted high and low OLFML3 expression levels, providing novel insights for the clinical prognosis of BCa recurrence within 1 year.ConclusionsMulti-omics approaches effectively identified the OLFML3 gene as a critical factor potentially associated with 1-year BCa recurrence. Furthermore, a deep learning model based on pathological features was developed to predict OLFML3 expression. Further research is warranted to elucidate its role in BCa recurrence within 1 year.

Diagnostic Accuracy of the Oncuria-Detect Multiplex Immunoassay in Detecting Upper Tract Urothelial Carcinoma.

Abstract Background Emergency department (ED) patients often present with acute onset, severe symptoms, and complex conditions, posing significant challenges for rapid and accurate diagnostic testing. Urothelial carcinoma cancer (UC), in the early stage, frequently manifests with painless hematuria, and less patients have microscopic hematuria, which is easily overlooked. The “gold standard” of UC is TURB (Transurethral resection) combined with histopathological examination, performed in the pathology department. Traditional Urine cytology can be another option for diagnosis but is time-consuming and extremely complicated, being often separated from routine urinalysis, which is not conducive to short turnaround time and rapid diagnosis. Studies have shown that abnormal/malignant urothelial cells can be identified through urine sediment analysis. The Sysmex UF-3000 urine analyzer novel parameter Atyp.C (atypical cells) offers a rapid, easy operated (without centrifuge and dying) and non-invasive way for routine detecting atypical cells in urine, providing a new approach for UC screening. Methods Patient data were collected from the electronic records of HIS and LIS. Complete blood count (CBC), urine dry chemistry, urine sediment analysis, centrifuged microscopy, and stained microscopy were performed in the emergency laboratory using Sysmex XN9000 and Sysmex UF3000 instruments and other instruments. Both diagnostic and research parameters are available on Sysmex Laboman 4.2 software. Also being as an ISO 15189 accredited laboratory, we evaluated and reviewed this special case in accordance with the laboratory*s quality documentation, then made specific improvement. Results A 62-year-old DM patient suffered from 1-month hypochondriac pain after travel, with low fever. Initial tests revealed a complete blood cell count (CBC) of 10.32×10?/L, urine appeared gross hematuria visible on naked eye, dry chemistry analysis occult blood 2+, and 12-14 red blood cells per high-power field (HPF) on microscopy after centrifuging. Patient was initially diagnosed with urinary tract infection and treated with antibiotics. Four hours later, ultrasound detected a cystic mass in the ureter, then followed sediment analysis showed red blood cells 35 /µL, white blood cells 40.6 /µL. besides these diagnostic parameters, the instrument reported atypical cells (2.7/µL ) under the heading of “research parameters.” Presence of atypical cells was confirmed by the manual microscopy. Later the patient had transurethral resection and the pathology report confirmed a urothelial carcinoma. Conclusion The application of novel and standardized laboratory techniques is essential for earlier diagnosis and precision therapeutic of UC. The Atyp.C parameter of the Sysmex UF-3000, combined with clinical indicators (e.g., hematuria, abdominal pain), effectively aids in early screening and diagnosis of UC. Compared to traditional methods, Sysmex UF-3000 offers rapid and non-invasive detection way, significantly improves emergency testing efficiency and reduces the risk of missed diagnoses. As an ISO 15189 accredited laboratory, we evaluated and reviewed this special case in accordance with the laboratory*s quality documentation, then made specific improvement, which is, any abnormal indication on important research parameters, like Atyp.C, should be documented and reported for clinician’s reference and better medical assistance.

Abstract Background The traditional approach to screening for urothelial cancer in patients employs urine cytology, but the detection of lesions in the upper urinary tract is suboptimal. In patients with suspected upper tract urothelial carcinoma (UTUC), the American Urological Association recommends instrumented sampling of urine for cytological examinations, but such invasive examinations are costly and potentially traumatic. This study reviews the possible role of ancillary tests on voided urine to diagnose upper tract urothelial carcinoma. Methods We executed a Pubmed search using the MESH terms Carcinoma, Transitional Cell, Biomarkers Tumor, DNA Methylation, Urine, Urologic Neoplasms, and Ureteral Neoplasms. Studies of ancillary tests (Epigenetic, sequencing, and immunoassay-based) on voided samples for the diagnosis of upper tract UC were included. We reviewed the performance data of the ancillary tests. Results We identified 11 qualifying upper tract-focused studies ranging from 22 to 402 urine samples. There were 7 tests reliant on evaluating DNA methylation, 1 test employing sequencing for mutation detection, and 3 immunoassay-based tests. Overall sensitivity ranged from 55.4 to 96% (mean = 82.3), and specificity from 68 to 100% (mean = 90.9). Conclusion Non-invasive detection of UTUC may be assisted by ancillary tests utilizing PCR, immunoassays, or epigenetic techniques. DNA methylation techniques show high sensitivity and appear to be frequently studied. The validation of the role of non-invasive ancillary tests in larger prospective studies is desirable due to the potential benefits from the minimization of upper tract instrumentation and lowered costs.

Impact of the 2022 Paris System on diagnostic accuracy and estimating the risk of high-grade malignancy in urine cytology.

Roles for epigenetic and other biomarkers in upper tract urothelial carcinoma diagnosis and surveillance.

Introduction: Urine cytology is a noninvasive and widely used approach for the early detection of urothelial carcinoma (UC), but its diagnostic accuracy is limited, particularly for low-grade lesions. This study aimed to develop a novel artificial intelligence (AI)-based framework for risk stratification of UC from whole-slide images (WSIs), offering a promising solution to enhance the diagnostic accuracy of urine cytology. Methods: A total of 385 urine cytology slides were included and stratified into three diagnostic groups based on cytological evaluation: negative for high-grade urothelial carcinoma (NHGUC), low risk (including atypical urothelial cells and low-grade urothelial carcinoma [LGUC]), and high risk (including suspicious for high-grade urothelial carcinoma and high-grade urothelial carcinoma). Following digitization into WSIs, expert pathologists conducted detailed cell-level annotation. Cell detection and segmentation were performed using RTMDet and DuckNet, and the extracted features were aggregated into slide-level representations for training and evaluation of classification models. Results: Support vector machine demonstrated the highest overall performance among the classifiers, with an accuracy of 79%, recall of 79%, and a specificity of 90%. The model demonstrated strong classification performance across three risk stratifications. The high-risk group achieved a sensitivity of 73.1% and specificity of 90.2%, while the low-risk group showed a sensitivity of 81.8% and specificity of 89.1%. Precision-recall curves indicated that the NHGUC group achieved the highest average precision, reaching 0.93, followed by the high-risk group at 0.85 and the low-risk group at 0.82. ROC analysis further demonstrated strong discriminative capability for three risk groups, with the area under the curve measured at 0.95 for NHGUC and 0.91 for both the low-risk and High-risk groups. Conclusion: The proposed AI-assisted framework shows robust and interpretable performance in stratifying UC cytological categories from WSIs. It holds strong potential as a supportive tool in urine cytology, especially in assisting with the diagnosis of high-risk UC cases.

ABSTRACTIntroductionWe present a case of carcinoma in situ (CIS) of the bilateral upper urinary tract (UUT) in which long‐term complete remission was achieved through retrograde perfusion of Bacillus Calmette–Guérin (BCG) via open‐ended ureteral catheters following the failure of endoluminal therapy using double‐J stents.Case PresentationA 52‐year‐old male patient was diagnosed with CIS of the bilateral UUT and bladder. Intravesical BCG instillation using double‐J stents failed to eradicate persistently positive catheter urine cytology from the bilateral UUT. Since the patient strongly desired kidney‐sparing treatment, retrograde BCG perfusion via open‐ended ureteral catheter was performed. This treatment resulted in durable complete remission lasting 3 years.ConclusionsRetrograde BCG treatment via double‐J stent may result in suboptimal efficacy due to limited drug exposure to the UUT urothelium. In cases in which kidney‐sparing treatment is required, retrograde BCG perfusion via open‐ended ureteral catheters may be considered a viable therapeutic option.