Urine cytology suspicious for urothelial carcinoma: Prospective follow‐up of cases using cytology and urine biomarker‐based ancillary techniques

2020 ◽  
Vol 128 (7) ◽  
pp. 460-469
Author(s):  
Ruth Montalbo ◽  
Laura Izquierdo ◽  
Mercedes Ingelmo‐Torres ◽  
Pilar Galve ◽  
Manel Solé ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Urine Cytology ◽  
Urine Biomarker

scholarly journals Application of the Paris Reporting System for Urine Cytology: The Three-Year Experience of a Single Tertiary Care Institute in Thailand

2022 ◽  
pp. 1-8
Author(s):  
Bantita Phruttinarakorn ◽  
Sirithep Plumworasawat ◽  
Jitchai Kayankarnnavee ◽  
Jirasit Lualon ◽  
Atcharaporn Pongtippan
Keyword(s):  
Urothelial Carcinoma ◽  
Predictive Value ◽  
Diagnostic Category ◽  
Malignant Neoplasm ◽  
Urine Cytology ◽  
Malignant Neoplasms ◽  
Low Grade ◽  
High Grade ◽  
Sensitivity Specificity

<b><i>Introduction:</i></b> Urothelial carcinoma is one of the most common human cancers, both in Thailand and worldwide. Urine cytology is a screening tool used to detect urothelial carcinoma. The Paris System for Reporting Urinary Cytology (TPSRUC) was first published in 2016 to standardize the procedures, reporting, and management of urothelial carcinoma. Diagnostic categories include negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUCs), suspicious for HGUC (SHGUC), HGUC, low-grade urothelial neoplasm, and other malignancies. <b><i>Material and Methods:</i></b> In a retrospective review, urine cytology specimens from 2016 to 2019 were reevaluated using the TPSRUC. The risk of high-grade malignant neoplasm (ROHM) for each diagnostic category was calculated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of prediction of high-grade malignant neoplasms were evaluated for cases with histological follow-up specimens. <b><i>Results:</i></b> In total, 2,178 urine cytology specimens were evaluated, of which 456 cases had follow-up histological specimens. The ROHM in each diagnostic category was as follows: NHGUC, 17.4%; AUC, 49.9%; SHGUC, 81.2%; HGUC, 91.3%; and other malignant neoplasms, 87.5%. The sensitivity, specificity, PPV, NPV, and accuracy for high-grade malignant neoplasm prediction were 63%, 92.8%, 89%, 73.1%, and 78.5% when AUC was included as malignant in the comparison and 82.6%, 74.7%, 75.1%, 82.3%, and 78.5% when AUC was not considered malignant. <b><i>Conclusions:</i></b> TPSRUC provides reliable results that are reproducible by different interpreters and is a helpful tool for the detection of HGUC.

scholarly journals Risk Factor Analysis of Intravesical Recurrence After Laparoscopic Nephroureterectomy for Upper Tract Urothelial Carcinoma

2021 ◽  
Author(s):  
Masato Yanagi ◽  
Tsutomu Hamasaki ◽  
JunJun Akatsuka ◽  
Yuki Endo ◽  
Hayato Takeda ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Survival Rates ◽  
Urine Cytology ◽  
Rank Test ◽  
Free Survival ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Positive Urine ◽  
Laparoscopic Nephroureterectomy

Abstract Background: One of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after laparoscopic nephroureterectomy (LNU) for UTUC.Methods: Clinicopathological and surgical information were collected from the medical records of 73 patients treated with LNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after LNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoperitoneum time, was analyzed using Cox proportional hazards regression models and the Kaplan–Meier method with log-rank test.Results: During the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after LNU. The 3- and 5-year IVR-free survival rates were 76.5% and 74.3%, respectively. In the multivariate Cox regression analysis, positive preoperative urine cytology (hazard ratio [HR]: 3.55; 95% confidence interval [CI]: 1.326–11.327; p=0.011) and prolonged pneumoperitoneum time of ≥ 210 min (HR: 3.40; 95% CI: 1.271–10.692; p=0.014) were independent prognostic factors for IVR-free survival. In patients with positive urine cytology, the Kaplan–Meier method with log-rank test revealed that the 3-year and 5-years IVR free survival rates were 46.3% and 39.7%, respectively, in patients with a prolonged pneumoperitoneum time of ≥ 210 min, which was significantly lower than that in their counterparts (76% and 76%, respectively, p=0.041).Conclusions: In UTUC patients with positive urine cytology, the occurrence of IVR is highly probable when the pneumoperitoneum time of LNU is prolonged (≥ 210 min). Strict follow-up after LNU is highly recommended for these patients.

scholarly journals Risk factor analysis of intravesical recurrence after retroperitoneoscopic nephroureterectomy for upper tract urothelial carcinoma

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masato Yanagi ◽  
Tsutomu Hamasaki ◽  
Jun Akatsuka ◽  
Yuki Endo ◽  
Hayato Takeda ◽  
...  
Keyword(s):  
Risk Factor ◽  
Urothelial Carcinoma ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Fisher Exact Test ◽  
Related Factors ◽  
Exact Test ◽  
Upper Tract ◽  
Positive Urine

Abstract Background One of the major concerns of patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy is intravesical recurrence (IVR). The purpose of the present study was to investigate the predictive risk factors for IVR after retroperitoneoscopic nephroureterectomy (RNU) for UTUC. Methods Clinicopathological and surgical information were collected from the medical records of 73 patients treated with RNU for non-metastatic UTUC, without a history of or concomitant bladder cancer. The association between IVR after RNU and clinicopathological and surgery-related factors, including preoperative urine cytology and pneumoretroperitoneum time, was analyzed using the Fisher exact test. Results During the median follow-up time of 39.1 months, 18 (24.7%) patients had subsequent IVR after RNU. The 1- and 3-year IVR-free survival rates were 85.9% and 76.5%, respectively. The Fisher exact test revealed that prolonged pneumoretroperitoneum time of ≥ 210 min was a risk factor for IVR in 1 year after RNU (p = 0.0358) and positive urine cytology was a risk factor for IVR in 3 years after RNU (p = 0.0352). Conclusions In UTUC, the occurrences of IVR in 1 and 3 years after RNU are highly probable when the pneumoretroperitoneum time is prolonged (≥ 210 min) and in patients with positive urine cytology, respectively. Strict follow-up after RNU is more probable recommended for these patients.

scholarly journals Diagnostic significance of dual immunocytochemical staining of p53/cytokeratin20 on liquid-based urine cytology to detect urothelial carcinoma

CytoJournal ◽  
2020 ◽  
Vol 17 ◽  
pp. 3
Author(s):  
Song-Yi Choi ◽  
Kyung-Hee Kim ◽  
Kwang-Sun Suh ◽  
Min-Kyung Yeo
Keyword(s):  
Urothelial Carcinoma ◽  
Urine Cytology ◽  
Immunocytochemical Staining ◽  
Low Grade ◽  
Cytokeratin 20 ◽  
Inexpensive Method ◽  
Diagnostic Significance ◽  
Atypical Cells ◽  
Low Sensitivity

Background: Urine cytology is a noninvasive and inexpensive method; however, it is limited in low sensitivity for detecting and monitoring urothelial carcinoma (UC). To overcome limitation of cytology, several tests using urine samples have been attempted that immunocytochemical staining is an inexpensive and easy to perform ancillary technique. Dual immunocytochemical staining for p53 and cytokeratin 20 (CK20) is assessed in liquid-based urine cytology slides. Materials and Methods: Liquid-based urine cytology samples collected between 2008 and 2013 and matched follow-up biopsy samples of high-grade UC (HGUC) (n = 44) and low-grade UC (LGUC) (n = 14) were analyzed. Results: Urine cytology showing atypical cells was subjected to dual-color immunostaining for p53 and CK20. The sensitivity of urine cytology combined with p53 and CK20 immunostaining was 77.3% in HGUC and 52.9% in LGUC. Of 20 cases diagnosed with atypia by urine cytology, 13 (65%) were positive for p53 or CK20. Dual immunocytochemical staining for p53/CK20 improved the diagnostic accuracy of urine cytology. Conclusions: The present results indicate that cytomorphology combined with p53/CK20 immunostaining is useful for the detection of HGUC and LGUC.

scholarly journals Evaluation of a triple combination of cytokeratin 20, p53 and CD44 for improving detection of urothelial carcinoma in urine cytology specimens

CytoJournal ◽  
2013 ◽  
Vol 10 ◽  
pp. 25 ◽  
Author(s):  
Brent Arville ◽  
Emily O’Rourke ◽  
Fai Chung ◽  
Mahul Amin ◽  
Shikha Bose
Keyword(s):  
Urothelial Carcinoma ◽  
Cancer Detection ◽  
Predictive Value ◽  
Urine Cytology ◽  
Low Grade ◽  
Cytokeratin 20 ◽  
Molecular Tests ◽  
Atypical Cells ◽  
Additional Value

Background: Atypical urine cytology results trigger cystoscopy or molecular tests, both of which are costly, complex and difficult to perform tests. Several immunostains are being investigated to improve cancer detection; however, cytology material is limited and restricts the use of multiple immunostains. This study was designed to determine the utility of a cocktail of three stains, cytokeratin (CK20), p53 and CD44 in urine cytology samples for improving the detection of urothelial carcinoma. Materials and Methods: Urine cytology specimens with cell blocks containing adequate cytologic material between 2005 and 2010 and subsequent follow-up biopsy and/or Urovysion test (102 cases including 29 negative, 56 atypical and 17 malignant) were included in the study and evaluated with the triple stain. Results were first validated on the positive and negative cases and then applied to the atypical cases to determine the utility in the diagnosis of urothelial carcinoma. Results: Based on the validation and published literature, two distinct immunoprofiles were defined – malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns. The malignant immunoprofile showed 88% sensitivity, 78% specificity, 74% positive predictive value (PPV) and 90% negative predictive value (NPV) for detecting urothelial carcinoma. These values improved to 95% sensitivity and 96% NPV when low-grade urothelial carcinoma cases were excluded. Summary: Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics. However Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.

Urine cytology findings in patients with biopsy‐confirmed urothelial carcinoma in situ with plasmacytoid features

2021 ◽  
Author(s):  
Meredith M. Nichols ◽  
Jordan P. Reynolds ◽  
Jesse K. McKenney ◽  
Marlo M. Nicolas ◽  
Patrick J. McIntire ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Carcinoma In Situ ◽  
Urine Cytology

scholarly journals Clinicopathological characteristics of ypT0N0 urothelial carcinoma following neoadjuvant chemotherapy and cystectomy

2019 ◽  
Vol 72 (8) ◽  
pp. 550-553 ◽  
Author(s):  
Martin J Magers ◽  
Hristos Z Kaimakliotis ◽  
Marcelo P Barboza ◽  
Elhaam Bandali ◽  
Nabil Adra ◽  
...  
Keyword(s):  
Foreign Body ◽  
Neoadjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Giant Cell ◽  
Chronic Inflammation ◽  
Morphological Features ◽  
Foreign Body Giant Cell ◽  
Cell Reaction ◽  
Variant Histology

AimsTo describe a large tertiary care academic centre’s experience with patients who achieve a complete pathological response (ie, ypT0N0) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) with emphasis on morphological features present in the RC and clinical outcome.Methods41 patients with ypT0N0 disease following transurethral resection of bladder tumour (TURBT), NAC and RC with available clinical follow-up information were analysed. Slides from all RCs were reviewed to confirm pathological stage and assess for morphological parameters (eg, foreign body giant cell reaction, dystrophic calcification, scar and fat necrosis).ResultsWith median follow-up of 32.8 months, the recurrence-free survival at 1 and 5 years was 97.4% and 93.5%, while the overall survival at 3 and 5 years was 94.2% and 88.6%, respectively. No patients died of urothelial carcinoma. Stage assigned at TURBT was 1 pTa (2%), 1 pT1 (2%), 38 pT2 (93%) and 1 pT3a (2%). 17 TURBTs demonstrated variant histology, with the majority of these being squamous (65%). The most common morphological features present at RC were scar (100%), foreign body giant cell reaction (80%), chronic inflammation within lamina propria (68%) and dystrophic calcifications (39%). Other morphological features were less common or absent.ConclusionypT0N0 disease at RC portends an excellent prognosis, regardless of stage or variant histology in the TURBT; scar, foreign body giant cell reaction, chronic inflammation and dystrophic calcifications are often present.

scholarly journals Response to first line chemotherapy regimen is associated with efficacy of Immune Checkpoint Blockade Therapies in Patients with Metastatic Urothelial Carcinoma

2021 ◽  
Author(s):  
Deniz Tural ◽  
Fatih Selçukbiricik ◽  
Ömer Fatih Ölmez ◽  
Ahmet Taner Sümbül ◽  
Mustafa Erman ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Prognostic Factors ◽  
Urothelial Carcinoma ◽  
Immune Checkpoint ◽  
Clinical Benefit ◽  
Immune Checkpoint Blockade ◽  
First Line ◽  
Kaplan Meier ◽  
Line Chemotherapy

Abstract Background Atezolizumab (ATZ) has demonstrated antitumor activity in the previous studies in patients with metastatic platinum-resistant urothelial carcinoma. However, the response rate of ATZ was modest. Therefore, finding biologic or clinical biomarkers that could help to select patients who respond to the immune checkpoint blockade remains important. Patients and Methods In this study, we present the retrospective analysis of 105 patients with urothelial cancer treated with ATZ after progression on first-line chemotherapy. Data of patients were obtained from patient files and hospital records. The association between response to first-line chemotherapy and ATZ was using Fisher’s exact test. Median follow-up was calculated using the reverse Kaplan-Meier method. OS was estimated by using the Kaplan-Meier method. Results The median follow-up time was 23.5 months. Forty (74.1%) of patients who experienced clinical benefit after firs-line chemotherapy also had clinical benefit after atezolizumab, while only 14 (25.9%) of patients with initial PD after first-line chemotherapy subsequently experience clinical benefit with ATZ (p = 0.001). The median OS on ATZ of 14.8 and 3.4 months for patients with clinical benefit and progressive disease in response to first-line chemotherapy, respectively (p = 0.001). Three of the adverse prognostic factors according to the Bellmunt criteria were independent factors of short survival: liver metastases (Hazard Ratio [HR] = 1.9; p = 0.04), ECOG PS ≥ 1 (HR = 2.7; p = 0.001), and Hemoglobin level below 10 mg/dl (HR = 2.8; p < 0.001). In addition, patients with clinical benefit from first-line chemotherapy (HR = 0.39; p < 0.001) maintained a significant association with OS in multivariate analysis. Conclusions Our study demonstrated that clinical benefit from first-line chemotherapy was independent prognostic factors on OS in patients' use of ATZ as second-line treatment in metastatic bladder cancer. Furthermore, these findings are important for stratification factors for future immunotherapy study design in patients with bladder cancer who have progressed after first-line chemotherapy

scholarly journals Giant Cell Urothelial Carcinoma of Bladder

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Harshima Disvini Wijesinghe ◽  
Ajith Malalasekera
Keyword(s):  
Urothelial Carcinoma ◽  
Giant Cell ◽  
Early Stage ◽  
Giant Cells ◽  
World Health ◽  
World Health Organization Classification ◽  
Health Organization

Giant cell urothelial carcinoma is a rare variant of bladder cancer recognized by the current World Health Organization classification of urologic tumours. It is an aggressive tumour with a poor prognosis that usually presents at an advanced stage. It is characterized histologically by pleomorphic giant cells. We discuss a case of giant cell urothelial carcinoma presenting at an early stage in a previously well 62-year-old woman. Histology showed a tumour comprising pancytokeratin positive bizarre mononuclear and multi-nuclear giant cells admixed with areas of conventional urothelial carcinoma and carcinoma in situ. Three-month follow-up cystoscopy and magnetic resonance imaging showed no evidence of recurrence or pelvic lymphadenopathy.

Urinary basic fetoprotein in the diagnosis and follow-up of patients with urothelial carcinoma

Cancer ◽  
1996 ◽  
Vol 77 (8) ◽  
pp. 1529-1534
Author(s):  
Teruaki Kigure ◽  
Yukiko Wakayama ◽  
Yoshinobu Satoh ◽  
Nobuo Fujieda ◽  
Kouki Yoshida ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Basic Fetoprotein
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