- Volume 15 Issue 5
DOI QR Code
Clinical Value of Dividing False Positive Urine Cytology Findings into Three Categories: Atypical, Indeterminate, and Suspicious of Malignancy
- Matsumoto, Kazumasa (Department of Urology, Kitasato University School of Medicine) ;
- Ikeda, Masaomi (Department of Urology, Kitasato University School of Medicine) ;
- Hirayama, Takahiro (Department of Urology, Kitasato University School of Medicine) ;
- Nishi, Morihiro (Department of Urology, Kitasato University School of Medicine) ;
- Fujita, Tetsuo (Department of Urology, Kitasato University School of Medicine) ;
- Hattori, Manabu (Department of Clinical Cytology, Kitasato University School of Allied Health Sciences) ;
- Sato, Yuichi (Department of Molecular Diagnostics, Kitasato University School of Allied Health Sciences) ;
- Ohbu, Makoto (Department of Pathology, Kitasato University School of Allied Health Sciences) ;
- Iwam, Masatsugu (Department of Urology, Kitasato University School of Medicine)
- Published : 2014.03.01
Background: 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. Materials and Methods: 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. Results: 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. Conclusions: 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.
- Whisnant RE, Bastacky SI, Ohori NP (2003). Cytologic diagnosis of low-grade papillary urothelial neoplasms (low malignant potential and low-grade carcinoma) in the context of the 1998 WHO/ISUP classification. Diagn Cytopathol, 28, 186-90. https://doi.org/10.1002/dc.10263
- Raitanen MP, Aine RA, Kaasinen ES, et al (2002). Suspicious urine cytology (class III) in patients with bladder cancer: should it be considered as negative or positive? Scand J Urol Nephrol, 36, 213-7. https://doi.org/10.1080/003655902320131901
- Sternberg I, Rona R, Olsfanger S, et al (2011). The clinical significance of class III (suspicious) urine cytology. Cytopathology, 22, 329-33. https://doi.org/10.1111/j.1365-2303.2010.00827.x
- Sullivan PS, Chan JB, Levin MR, Rao J (2010). Urine cytology and adjunct markers for detection and surveillance of bladder cancer. Am J Transl Res, 2, 412-40.
- Turco P, Houssami N, Bulgaresi P, et al (2011). Is conventional urinary cytology still reliable for diagnosis of primary bladder carcinoma? Accuracy based on data linkage of a consecutive clinical series and cancer registry. Acta Cytol, 55, 193-6. https://doi.org/10.1159/000320861
- Kanagawa Urological Research Group (2012). A 2-week maintenance regimen of intravesical instillation of bacillus Calmette-Guerin is safe, adherent and effective in patients with non-muscle-invasive bladder cancer: a prospective, multicenter phase II clinical trial. Jpn J Clin Oncol, 42, 813-9. https://doi.org/10.1093/jjco/hys097
- Brimo F, Vollmer RT, Case B, et al (2009). Accuracy of urine cytology and the significance of an atypical category. Am J Clin Pathol, 132, 785-93. https://doi.org/10.1309/AJCPPRZLG9KT9AXL
- Cibas ES, Ducatman BS (2009). In "Cytopathology Diagnostic Principles and Clinical Correlates", Saunders Elsevier, Philadelphia, PA.
- Deshpande V, McKee GT (2005). Analysis of atypical urine cytology in a tertiary care center. Cancer, 105, 468-75. https://doi.org/10.1002/cncr.21317
- Kapur U, Venkataraman G, Wojcik EM (2008). Diagnostic significance of ‘atypia' in instrumented versus voided urine specimens. Cancer, 114, 270-4. https://doi.org/10.1002/cncr.23656
- Mokhtar GA, Al-Dousari M, Al-Ghamedi D (2010). Diagnostic significance of atypical category in the voided urine samples: A retrospective study in a tertiary care center. Urol Ann, 2, 100-6. https://doi.org/10.4103/0974-7796.68857
- Muus Ubago J, Mehta V, Wojcik EM, Barkan GA (2013). Evaluation of atypical urine cytology progression to malignancy. Cancer Cytopathol, 121, 387-91. https://doi.org/10.1002/cncy.21278
- Nabi G, Greene D, O'Donnell MO (2004). Suspicious urinary cytology with negative evaluation for malignancy in the diagnostic investigation of haematuria: how to follow up? J Clin Pathol, 57, 365-8. https://doi.org/10.1136/jcp.2003.009696
- Powsner SM, Costa J, Homer RJ (2000). Clinicians are from Mars and pathologists are from Venus. Arch Pathol Lab Med, 124, 1040-6.
- Raab SS, Grzybicki DM, Vrbin CM, Geisinger KR (2007). Urine cytology discrepancies: frequency, causes, and outcomes. Am J Clin Pathol, 127, 946-53. https://doi.org/10.1309/XUVXFXMFPL7TELCE
- Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM (1999). The accuracy of urinary cytology in daily practice. Cancer, 87, 118-28. https://doi.org/10.1002/(SICI)1097-0142(19990625)87:3<118::AID-CNCR4>3.0.CO;2-N
- Bhatia A, Dey P, Kakkar N, et al (2006). Malignant atypical cell in urine cytology: a diagnostic dilemma. Cytojournal, 3, 28. https://doi.org/10.1186/1742-6413-3-28