LOW GRADE UROTHELIAL CARCINOMA
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Abstract:
Objectives: Urine cytology is an easy to perform non-invasive screening test forpatients who are suspected of having urinary tract malignancy. Urothelial carcinoma constitutesapproximately 90% of all primary tumors of urinary bladder.1 High-grade urothelial carcinomasare represented by well characterized cytological features. Whereas cytological features forlow-grade urothelial carcinomas show considerable overlap with features secondary to chronicinflammation, calculi, indwelling catheters or effects of intra-vesical chemotherapy.2 Thepurpose of this study is to find an appropriate set of cytological features of shed urothelial cellsthat will be useful to differentiate low-grade urothelial carcinoma cells from atypical urothelialcells secondary to non-neoplastic conditions. Study Design: Retrospective study. Setting:Charsada Teaching Hospital affiliated with Jinnah Medical College Peshawar. Period: 2010to 2015. Methods: All cases of urine and bladder washing cytology were retrieved for threediagnostic categories namely: low-grade urothelial carcinoma (LGUC), high-grade urothelialcarcinoma (HGUC), and “atypical urothelial cells”; for which histological diagnoses were alsoavailable. These cases were reviewed for cell clusters with smooth or irregular communityborders, cytoplasm texture, nucleomegaly, high nucleus to cytoplasm ratios (N/C ratio),presence of nucleoli, nuclear membrane irregularity, and chromatin texture. Results: Cellclusters with smooth borders were common in reactive changes, whereas irregular communityborders were seen in low-grade urothelial carcinomas and dyscohesive pattern was a featureof HGUC. The increase in N/C ratio ›2:1 was always associated with malignancy. The nuclearmembrane irregularity was also a strong indicator of malignancy. Cytoplasmic homogeneityand nuclear hyperchromasia were more prominent and consistently seen in high-gradeurothelial carcinomas. Conclusions: The study showed that nuclear membrane irregularity,nucleomegaly and high N/C ratio of › 2:1 were the most consistent features found in LGUC.These features can be used with high certainty to differentiate LGUC (malignant) from atypicalurothelial cells (non-neoplastic).Keywords:
Urine cytology
Urothelial Cell
Carcinoma in situ
Cytopathology
To evaluate the utility of the Johns Hopkins Hospital (JHH) template in detection of high-grade urothelial carcinoma (HGUC).A computerized search of our laboratory information system was performed for all urine cytology cases from 2009 to 2011 processed by the SurePath™. We included only cases with correlating surgical pathology within 6 months after the urinary samples were obtained. The original cytologic diagnoses were reclassified according to the JHH template, and these cytolog ic diagnoses were then correlated with the follow-up surgical pathology diagnoses.A total of 273 urine samples with histopathologic follow-up were identified. The reclassified cytologic diagnoses included negative for urothelial atypia or malignancy (NUAM) 110; atypical urothelial cells of undetermined significance (AUC-US) 83; atypical urothelial cells, cannot exclude high-grade urothelial carcinoma (AUC-H) 49; HGUC 29; and low-grade urothelial carcinoma (LGUC) 2. More than one-half of patients (58%) who had biopsy-confirmed high-grade urothelial lesions had a preceding cytologic diagnosis of AUC-H or HGUC. AUC-H and HGUC are associated with high-grade urothelial lesions in 80% and 90% of the cases and show statistical significance when compared with AUC-US or NUAM (P < 0.05).The JHH template is useful and effective in identifying patients with high-grade urothelial lesions who need to undergo cystoscopy.
Urine cytology
Atypia
Surgical pathology
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Cytopathology
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Urine cytology is an important screening tool for detection of high grade urothelial carcinoma and follow-up of patients with treated disease. Ease of procurement, cost-effectiveness, and lower turnaround time are the major advantages of the system. We aim to determine the frequency of high grade and low grade urothelial carcinoma in urine cytology specimens and to evaluate the accuracy of Paris system. A retrospective study was conducted in the Department of Pathology (Cytology), GMCH from August 2020 to July 2022 where a total of 200 cases were included. Data along with the preserved slides of urine cytology of these cases were collected from the archives and examined for the presence of urothelial carcinoma. The results were calculated in Microsoft word and excel, and p value was calculated by using the Chi- square (χ2) test of significance, P values less than 0.05 was considered statistically significant. In our study, a total of 200 cases were analysed, 169 were males and 31 were females, the male to female ratio being 5.5: 1. The most commonly affected age group was 61-70 years, the mean age being 62 years. Of the 200 urine samples examined, 12.5% cases had High Grade Urothelial Carcinoma (HGUC), 13.5% cases had atypical urothelial cells, 9% cases were suspicious for HGUC and 2% cases had Low Grade Urothelial Neoplasm. : The Paris System is a highly sensitive and rapid tool for reporting urine cytology specimens and is particularly useful in diagnosing High Grade Urothelial Carcinoma thereby helping in early management of the patients with neoplastic lesions of the urinary bladder.
Urine cytology
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Introduction: Urine cytology used for diagnosing high-grade urothelial carcinoma (HGUC), but plagued by low sensitivity and wide inter-observer variability mainly ascribed to the lack of an established template of reporting. We assessed the performance of urine cytology by comparing the Paris System with our current institutional system. This study is developed to identify the prevalence of various cytological categories and their association with a subsequent diagnosis of high-grade urothelial carcinoma. Materials and Methods: A total of seventy four urine cytological specimens were studied which have follow up biopsy with histological correlation was done to categorize: benign, atypical urothelial cells (AUCs), suspicious for high-grade urothelial carcinoma (SHGUC), and high-grade urothelial carcinoma (HGUC). Original cytological diagnoses were recorded. Results: Males outnumbered females with a mean age of 57.4 years (range 21-86) (46 M and 28 F) with no statistical significance among the age groups and between male and female genders. By applying TPS, number of cases assigned to AUC category are very few (7 cases out of 74 with 9.45. Using the TPS resulted in a higher number of low-grade carcinomas assigned to the benign rather than the AUC category. LGUN category includes all low grade urothelial neoplasms of urinary tract, such as LGUC and PUN of uncertain malignant potential. According to institute diagnosis categories for urine cytology, there were 2 cases shown negatives, 16 cases shown Atypical/suspicious, 21 cases shown LG papillomas, and 35 cases shown HGUC. In negative group; out of 2 cases, 2 cases were papilloma. In HGUC group, out of 35 cases, 27 cases were turned out to be HGUC with 77.14%. In HGUC group, out of 35 cases, 8 cases were turned out to be LGUP with 29.62%. Conclusion: The TPS seems to improve the performance of urine cytology by limiting the AUC category to cases that are more strongly associated with HGUC. This is the first inclusive a
Urine cytology
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Carcinoma in situ
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Urine cytology
Urothelial Cell
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We performed a urine cytology analysis of a pharmacologically induced diuresis for the diagnosis of upper tract urothelial carcinoma. To evaluate the diagnostic value of cytology of pharmacologically forced diuresis, an initial cohort of 77 consecutive patients with primary upper tract urothelial carcinoma treated via radical surgery was enrolled. To evaluate pharmacologically forced diuresis cytology as a follow-up procedure, a second cohort of 1250 patients who underwent a radical cystectomy for bladder cancer was selected. In the first cohort, the sensitivity of cytology of pharmacologically forced diuresis in patients with invasive, high-grade, low-grade, and concomitant carcinoma in situ was 8%, 9%, 0%, and 14%, respectively. In the second cohort, cytology of pharmacologically forced diuresis was positive in 30/689 (4.3%) patients, in whom upper urinary tract recurrence was present in 21/30 (70%) of cases, and urethral recurrence was present in 8/30 (26%) of cases. As a follow-up tool, cytology of pharmacologically forced diuresis showed a sensitivity, specificity, and positive and negative predictive values of 60%, 99%, 70%, and 98%, respectively. Overall, as a diagnostic tool, the sensitivity of cytology of pharmacologically forced diuresis is slightly better in patients with invasive upper tract urothelial carcinoma and concomitant carcinoma in situ. As a follow-up method, positive cytology of pharmacologically forced diuresis is strongly related to cancer recurrence and can reveal urethral recurrence. Cytology of pharmacologically forced diuresis might be useful in cases with contraindications for imaging or when achieving endoscopic access to the upper urinary tract is difficult.
Urine cytology
Concomitant
Carcinoma in situ
Upper urinary tract
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Urine cytology
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69, lines 5 and 9 of the second paragraph, left column.Line 5 should read, "group showed rare ECs.
Cytopathology
Urine cytology
Value (mathematics)
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