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Risk Prediction of Atypia in Urine Cytology: An Institutional Review
S22
Abstracts
Table 2
Voided specimens
Table 3
Bladder washes
Table 4
Ureteral washes
NPV of UTCy Indications of UCC
37 Risk Prediction of Atypia in Urine Cytology: An Institutional Review Nihar Hotchandani, MD, Hang Zhou, MD, He Wang, MD, PhD, Nirag Jhala, MD Temple University, Philadelphia, Pennsylvania Introduction: The diagnostic category of “atypical urothelial cells” is subject to higher interobserver variation than the more definitive categories. This challenging entity has been reported at widely variable incidence rates in different institutions. The objectives of the current study were as follows: 1) to determine the percentage of specimens diagnosed as atypical at our institution, 2) to study the outcomes of this diagnostic category and 3) to study the implications of the method of urine collection on the outcomes. Materials and Methods: We identified 650 urine specimens during a 4 year period (January 2011-December2014) using the laboratory information system. The specimens were categorized based on the method of collection as follows: voided, bladder washes, ureteral washes and non-specified. All specimens in the non-specified category were excluded from this study. All specimens were further categorized into benign, atypical, suspicious for malignancy, and positive for malignancy. Only the cases with a histologic follow-up were reviewed to determine the outcomes. Fisher’s exact test was used to determine statistical conclusions. Results: The distribution of cases based on type of specimen collection is shown in Table 1.The correlation for cytology and histology within each of the methodof-urine-collection categories is shown in Tables 2-4. The difference in outcomes with a negative versus atypical diagnosis was statistically significant for both voided specimens and bladder washes (pZ 0.015 and 0.049 respectively). Conclusion: Regardless of type of collection, the diagnosis of atypia is significantly more frequently associated with neoplasm on histologic samples. In voided specimens and bladder washes, these are more frequently low grade urothelial neoplasms (7 out of 10, 11 out of 15 respectively). In contrast, the diagnosis of atypia in ureteral washes is more frequently associated with high grade urothelial neoplasms.
Table 1
Type of specimen
38 The Sensitivity of Urinary Tract Cytology for High-Grade Urothelial Carcinoma Over Diagnostic Screening Intervals Mohammed Lilo, MBChB, Derek Allison, MD, Dorothy Rosenthal, MD, FIAC, Christopher VandenBussche, MD, PhD The Johns Hopkins Medical Institutions, Baltimore, Maryland
Introduction: Urinary tract (UT) cytology is an affordable, non-invasive diagnostic test for high-grade urothelial carcinoma (HGUC). The sensitivity of UT cytology relies upon the presence of well-preserved malignant cells. The method of collection may affect the quality of the specimen. This study investigated the sensitivity of UT cytology for patients being investigated for hematuria and patients under surveillance for HGUC, who were ultimately diagnosed with HGUC. Materials and Methods: Over a period of 5 years, 55 screening periods were identified in 43 patients, which resulted in a diagnosis of HGUC: 25 for hematuria and 30 for surveillance (history of HGUC). Results: The average patient age was 72 and 87% were male. A diagnosis of HGUC was made on UT cytology specimens in 44% (11/25) [hematuria] and 63% (19/30) [surveillance] prior to a positive surgical biopsy. The remaining 25 specimens required a biopsy in order to definitively diagnose HGUC. The average number of UT cytology specimens prior to a diagnosis of HGUC was 2.3 and 5.5 for the hematuria and surveillance groups, respectively. HGUC was first detected in 8 voided urines (16% positivity rate) and 3 (50% positivity rate) of wash specimens in the hematuria group. For the surveillance group, HGUC was first detected in 6 voided urines (5% positivity rate), 5 catheterized urines (33% positivity rate), and 8 wash specimens (40% positivity rate). Conclusions: Urinary wash specimens have diagnostically superior sensitivity to voided urine specimens (p<0.001) for detecting HGUC in both primary and recurrent HGUC. The earlier use of urinary wash procedures could result in an earlier diagnosis of HGUC for patients with hematuria and for patients on surveillance for HGUC recurrence.
Abstracts
Table 2
Voided specimens
Table 3
Bladder washes
Table 4
Ureteral washes
NPV of UTCy Indications of UCC
37 Risk Prediction of Atypia in Urine Cytology: An Institutional Review Nihar Hotchandani, MD, Hang Zhou, MD, He Wang, MD, PhD, Nirag Jhala, MD Temple University, Philadelphia, Pennsylvania Introduction: The diagnostic category of “atypical urothelial cells” is subject to higher interobserver variation than the more definitive categories. This challenging entity has been reported at widely variable incidence rates in different institutions. The objectives of the current study were as follows: 1) to determine the percentage of specimens diagnosed as atypical at our institution, 2) to study the outcomes of this diagnostic category and 3) to study the implications of the method of urine collection on the outcomes. Materials and Methods: We identified 650 urine specimens during a 4 year period (January 2011-December2014) using the laboratory information system. The specimens were categorized based on the method of collection as follows: voided, bladder washes, ureteral washes and non-specified. All specimens in the non-specified category were excluded from this study. All specimens were further categorized into benign, atypical, suspicious for malignancy, and positive for malignancy. Only the cases with a histologic follow-up were reviewed to determine the outcomes. Fisher’s exact test was used to determine statistical conclusions. Results: The distribution of cases based on type of specimen collection is shown in Table 1.The correlation for cytology and histology within each of the methodof-urine-collection categories is shown in Tables 2-4. The difference in outcomes with a negative versus atypical diagnosis was statistically significant for both voided specimens and bladder washes (pZ 0.015 and 0.049 respectively). Conclusion: Regardless of type of collection, the diagnosis of atypia is significantly more frequently associated with neoplasm on histologic samples. In voided specimens and bladder washes, these are more frequently low grade urothelial neoplasms (7 out of 10, 11 out of 15 respectively). In contrast, the diagnosis of atypia in ureteral washes is more frequently associated with high grade urothelial neoplasms.
Table 1
Type of specimen
38 The Sensitivity of Urinary Tract Cytology for High-Grade Urothelial Carcinoma Over Diagnostic Screening Intervals Mohammed Lilo, MBChB, Derek Allison, MD, Dorothy Rosenthal, MD, FIAC, Christopher VandenBussche, MD, PhD The Johns Hopkins Medical Institutions, Baltimore, Maryland
Introduction: Urinary tract (UT) cytology is an affordable, non-invasive diagnostic test for high-grade urothelial carcinoma (HGUC). The sensitivity of UT cytology relies upon the presence of well-preserved malignant cells. The method of collection may affect the quality of the specimen. This study investigated the sensitivity of UT cytology for patients being investigated for hematuria and patients under surveillance for HGUC, who were ultimately diagnosed with HGUC. Materials and Methods: Over a period of 5 years, 55 screening periods were identified in 43 patients, which resulted in a diagnosis of HGUC: 25 for hematuria and 30 for surveillance (history of HGUC). Results: The average patient age was 72 and 87% were male. A diagnosis of HGUC was made on UT cytology specimens in 44% (11/25) [hematuria] and 63% (19/30) [surveillance] prior to a positive surgical biopsy. The remaining 25 specimens required a biopsy in order to definitively diagnose HGUC. The average number of UT cytology specimens prior to a diagnosis of HGUC was 2.3 and 5.5 for the hematuria and surveillance groups, respectively. HGUC was first detected in 8 voided urines (16% positivity rate) and 3 (50% positivity rate) of wash specimens in the hematuria group. For the surveillance group, HGUC was first detected in 6 voided urines (5% positivity rate), 5 catheterized urines (33% positivity rate), and 8 wash specimens (40% positivity rate). Conclusions: Urinary wash specimens have diagnostically superior sensitivity to voided urine specimens (p<0.001) for detecting HGUC in both primary and recurrent HGUC. The earlier use of urinary wash procedures could result in an earlier diagnosis of HGUC for patients with hematuria and for patients on surveillance for HGUC recurrence.