Analysis of the Cytomorphological Features in Atypical Urine Specimens following Application of The Paris System for Reporting Urinary Cytology

2017 ◽  
Vol 62 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Ryan Glass ◽  
Lisa Rosen ◽  
Karen Chau ◽  
Sylvat Sheikh-Fayyaz ◽  
Peter Farmer ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Single Cells ◽  
Morphological Features ◽  
Urinary Cytology ◽  
Cytologic Atypia ◽  
Malignancy Risk ◽  
Risk Of Malignancy ◽  
Combined Features ◽  
Individual Features ◽  
Urine Specimens

Background: This study investigates the use of The Paris System (TPS) for Reporting Urinary Cytopathology and examines the performance of individual and combined morphological features in atypical urine cytologies. Methods: We reviewed 118 atypical cytologies with subsequent bladder biopsies for the presence of several morphological features and reclassified them into Paris System categories. The sensitivity and specificity of individual and combined features were calculated along with the risk of malignancy. Results: An elevated nuclear-to-cytoplasmic ratio was only predictive of malignancy if seen in single cells, while irregular nuclear borders, hyperchromasia, and coarse granular chromatin were predictive in single cells and in groups. Identification of coarse chromatin alone yielded a malignancy risk comparable to 2-feature combinations. The use of TPS criteria identified the specimens at a higher risk of malignancy. Conclusion: Our findings support the use of TPS criteria, suggesting that the presence of coarse chromatin is more specific than other individual features, and confirming that cytologic atypia is more worrisome in single cells than in groups.

scholarly journals Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 17 ◽  
Author(s):  
Theresa Long ◽  
Lester J. Layfield ◽  
Magda Esebua ◽  
Shellaine R. Frazier ◽  
D. Tamar Giorgadze ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Urothelial Cells ◽  
Urothelial Carcinomas ◽  
Absolute Agreement ◽  
Potential Impact ◽  
Urine Specimens

Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.

Risk of malignancy assessment for the Paris System for reporting urinary cytology

2020 ◽  
Vol 48 (12) ◽  
pp. 1194-1198
Author(s):  
Napoleon Moulavasilis ◽  
Andreas Lazaris ◽  
Ioannis Katafigiotis ◽  
Konstantinos Stravodimos ◽  
Constantine Constantinides ◽  
...  
Keyword(s):  
Urinary Cytology ◽  
Risk Of Malignancy

scholarly journals Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology

2019 ◽  
Vol 144 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Güliz A. Barkan ◽  
Z. Laura Tabatabai ◽  
Daniel F. I. Kurtycz ◽  
Vijayalakshmi Padmanabhan ◽  
Rhona J. Souers ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Practice Patterns ◽  
Low Frequency ◽  
Daily Practice ◽  
Relevant Information ◽  
Urinary Cytology ◽  
Preparation Methods ◽  
A Cell ◽  
Preparation Techniques ◽  
Urine Specimens

Context.— The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known. Objective.— To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. Design.— A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. Results.— Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. Conclusions.— Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.

Value of preoperative biopsy and radiological assessment for the diagnosis of mixed hepatocellular cholangiocarcinoma (HCC-CC).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 176-176 ◽  
Author(s):  
Mohamed Bouattour ◽  
Johanna Wassermann ◽  
Nathalie Guedj ◽  
Valerie Paradis ◽  
Chantal Dreyer ◽  
...  
Keyword(s):  
Ct Scan ◽  
Rare Variants ◽  
Liver Tumors ◽  
Morphological Features ◽  
Differentiation Markers ◽  
Surgical Specimen ◽  
Primary Liver Tumors ◽  
Preoperative Biopsy ◽  
Combined Features ◽  
Resection Specimen

176 Background: Mixed tumors with hepatocellular and cholangiocarcinoma component (HCC-CC) are rare variants of primary liver tumors. In this study, we aimed to describe clinical, radiological and histopathological features of patients with resected HCC-CC. Methods: From 2000 to 2010, patients (pts) with diagnosis of mixed HCC-CC based on surgical specimen were identified from our database. Demographic, clinical, radiological and pathological data were analyzed retrospectively, along with outcome after resection. Results: Among 18 pts, 6 men (33%) and 12 women (67%) were identified. The median age was 64 years (range 38- 75). Nine pts (50%) had at least one risk factor for chronic liver disease including alcohol consumption (6), NASH (3) and HBV infection (2). Twelve (67%) and 6 pts (33%) underwent major and minor hepatic resections respectively. The positive predictive value of radiological and pathological diagnosis was reviewed. Imaging by CT scan and/or MRI suggested characteristics of HCC and CC in 5 and 6 pts respectively. In 3 pts imaging showed combined features of HCC and CC while it was atypical in 4 cases. Preoperative biopsy was performed in 10 pts and analyzed using only morphological features. Biopsy sample was non contributive in 2 cases and concluded to CC, HCC and mixed HCC-CC in 5, 2 and 1 cases respectively. This contrasted with examination of resection specimen showing evidence of HCC combined with CC phenotype. Immunostaining on resection specimens showed the presence of differentiation markers for both hepatocytes and biliairy cancer cells (CK7 +, CK19 +, anti-hepatocyte +, and glypican +). Non tumor liver analysis showed normal underlying liver, non extensive fibrosis ≤ F2, extensive fibrosis > F2 without cirrhosis and cirrhosis in 2, 3, 7 and 6 specimens respectively. With more than 6 months follow-up (range 6 -59 months) the recurrence rate was higher than 50%. Conclusions: Mixed HCC-CC are not accurately identified by preoperative biopsy using only morphological features and CT scan/MRI assessment. Following resection, mixed HCC-CC behave more like CC than HCC.

Fine-needle aspiration biopsies in the management of indeterminate follicular and Hurthle cell thyroid lesions

2009 ◽  
Vol 140 (5) ◽  
pp. 715-719 ◽  
Author(s):  
Tamara Mijović ◽  
Louise Rochon ◽  
Olguta Gologan ◽  
Michael P. Hier ◽  
Martin J. Black ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
False Negative ◽  
False Negative Rate ◽  
Diagnostic Category ◽  
Case Series ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Cytologic Atypia ◽  
Hürthle Cell ◽  
Risk Of Malignancy

Objectives: To determine the value of fine-needle aspiration biopsies (FNABs) of the thyroid and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution. Study design: Case series with chart review of preoperative FNABs of consecutive patients who underwent total thyroidectomy between 2005 and 2007. Subjects and Methods: A total of 115 cases were reviewed, and FNABs were categorized into four groups: benign, positive or suspicious for malignancy, indeterminate (follicular or Hurthle cell lesions), and nondiagnostic. Cytohistologic correlation was then established. Results: The accuracy of FNAB in detecting thyroid malignancy was 88 percent with false-negative and false-positive rates of 13 percent and 7 percent, respectively. Overall, 52 percent of the indeterminate cases were carcinomas (48 percent of follicular lesions and 62 percent of Hurthle cell lesions). In the presence of cytologic atypia, the rate of malignancy increased to 75 percent and 83 percent for the follicular and Hurthle cell lesions, respectively. Conclusions: FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Surgery should be considered for FNABs categorized as indeterminate, especially in the presence of cytologic atypia. Because of the high false-negative rate, benign FNABs require close follow-up with ultrasound examination and periodic biopsies.

scholarly journals Diagnostic accuracy of single-voided urine protein/ creatinine ratio for proteinuria assessment in children with nephrotic syndrome

2009 ◽  
Vol 49 (6) ◽  
pp. 355
Author(s):  
Devie Kristiani ◽  
Pungky Ardani Kusuma ◽  
Purnomo Suryantoro
Keyword(s):  
Nephrotic Syndrome ◽  
Sensitivity And Specificity ◽  
Good Accuracy ◽  
Urinary Protein ◽  
Diagnostic Purpose ◽  
Creatinine Ratio ◽  
Protein Excretion ◽  
Background Measurement ◽  
The Common ◽  
Urine Specimens

Background Measurement of protein excretion is not onlyused for diagnostic purpose but also to monitor disease severityand prognosis in children with nephrotic syndrome (NS).The common method to measure proteinuria is 24-hour urinecollection. However, 24-hour urine collection is cumbersome,time consuming, and tedious. An alternative simplified methodis the measurement of protein/creatinine ratio in single-voidedurine specimens.Objective The aim of this study was to determine whether urineprotein/creatinine ratio is accurate to predict pathologic (> 100mg/m2/day) and massive proteinuria (> 1 g/m2/day).Methods Seventy single voided and 24-hour urine specimenswere collected from children aged 3-18 years. The relationshipbetween urinary protein/creatinine ratio and total daily proteinexcretion was calculated using correlation and linear regressionanalysis. Diagnostic test was conducted to estimate the accuracyof protein/creatinine ratio for the diagnosis of pathologic andmassive proteinuria in NS.Results Correlation coefficient between quantity of protein in24-hour urine specimens and protein/creatinine ratio in singlevoided urine specimens was 0.96 (R2=0.93). Both sensitivity and specificity of urinary protein/creatinine ratio were 87% in diagnosing pathologic proteinuria, whereas the sensitivity and specificity of the ratio to predict massive proteinuria were 88% and 91%, respectively.Conclusion The urinary protein/creatinine ratio in single voidedurine specimen has a good accuracy to predict pathologic andmassive proteinuria in children with NS aged 3-18 years.

scholarly journals Cytomorphologic features distinguishing Bethesda category IV thyroid lesions from parathyroid

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 10 ◽  
Author(s):  
Simon Sung ◽  
Anjali Saqi ◽  
Elizabeth M. Margolskee ◽  
John P. Crapanzano
Keyword(s):  
Single Cells ◽  
Final Diagnosis ◽  
Clinical Suspicion ◽  
Thyroid Lesion ◽  
Female Age ◽  
Parathyroid Neoplasm ◽  
Follicular Lesions ◽  
Risk Of Malignancy ◽  
Distinguishing Features ◽  
Thyroid Lesions

Background: Thyroid follicular cells share similar cytomorphological features with parathyroid. Without a clinical suspicion, the distinction between a thyroid neoplasm and an intrathyroidal parathyroid can be challenging. The aim of this study was to assess the distinguishing cytomorphological features of parathyroid (including intrathyroidal) and Bethesda category IV (Beth-IV) thyroid follicular lesions, which carry a 15%–30% risk of malignancy and are often followed up with surgical resection. Methods: A search was performed to identify “parathyroid” diagnoses in parathyroid/thyroid-designated fine-needle aspirations (FNAs) and Beth-IV thyroid FNAs (follicular and Hurthle cell), all with diagnostic confirmation through surgical pathology, immunocytochemical stains, Afirma® analysis, and/or clinical correlation. Unique cytomorphologic features were scored (0-3) or noted as present versus absent. Statistical analysis was performed using R 3.3.1 software. Results: We identified five FNA cases with clinical suspicion of parathyroid neoplasm, hyperthyroidism, or thyroid lesion that had an eventual final diagnosis of the parathyroid lesion (all female; age 20–69 years) and 12 Beth-IV diagnoses (11 female, 1 male; age 13–64 years). The following cytomorphologic features are useful distinguishing features (P value): overall pattern (0.001), single cells (0.001), cell size compared to red blood cell (0.01), nuclear irregularity (0.001), presence of nucleoli (0.001), nuclear-to-cytoplasmic ratio (0.007), and nuclear chromatin quality (0.028). Conclusions: There are cytomorphologic features that distinguish Beth-IV thyroid lesions and (intrathyroidal) parathyroid. These features can aid in rendering correct diagnoses and appropriate management.

scholarly journals Detection of Trichomonosis in Vaginal and Urine Specimens from Women by Culture and PCR

2000 ◽  
Vol 38 (10) ◽  
pp. 3585-3588 ◽  
Author(s):  
Lisa F. Lawing ◽  
Spencer R. Hedges ◽  
Jane R. Schwebke
Keyword(s):  
Sexually Transmitted Diseases ◽  
Sensitivity And Specificity ◽  
Trichomonas Vaginalis ◽  
Dna Amplification ◽  
Sexually Transmitted ◽  
Specific Pcr ◽  
Virus Acquisition ◽  
Immunodeficiency Virus ◽  
Culture Positive ◽  
Urine Specimens

Vaginal trichomonosis is a highly prevalent infection which has been associated with human immunodeficiency virus acquisition and preterm birth. Culture is the current “gold standard” for diagnosis. As urine-based testing using DNA amplification techniques becomes more widely used for other sexually transmitted diseases (STDs) such as gonorrhea and chlamydia, a similar technique for trichomonosis would be highly desirable. Women attending an STD clinic for a new complaint were screened for Trichomonas vaginalis by wet-preparation (wet-prep) microscopy and culture and for the presence of T. vaginalis DNA by specific PCR of vaginal and urine specimens. The presence of trichomonosis was defined as the detection of T. vaginalis by direct microscopy and/or culture from either vaginal samples or urine. The overall prevalence of trichomonosis in the population was 28% (53 of 190). The sensitivity and specificity of PCR using vaginal samples were 89 and 97%, respectively. Seventy-four percent (38 of 51) of women who had a vaginal wet prep or vaginal culture positive for trichomonads had microscopic and/or culture evidence of the organisms in the urine. Two women were positive for trichomonads by wet prep or culture only in the urine. The sensitivity and specificity of PCR using urine specimens were 64 and 100%, respectively. These results indicate that the exclusive use of urine-based detection of T. vaginalis is not appropriate in women. PCR-based detection of T. vaginalis using vaginal specimens may provide an alternative to culture.

scholarly journals Detecting proteinuria: A comparison of diagnostic tests

2011 ◽  
Vol 51 (1) ◽  
pp. 17
Author(s):  
Jeanida Mauliddina ◽  
Rosmayanti Siregar ◽  
Oke Rina Ramayani ◽  
Rafita Ramayati ◽  
Rusdidjas Rusdidjas
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
High Sensitivity ◽  
Cross Sectional Study ◽  
Common Symptom ◽  
Sulfosalicylic Acid ◽  
Cross Sectional ◽  
Renal Disorders ◽  
Acid Test ◽  
Urine Specimens

Background Proteinuria is a condition when protein is found in urine, a common symptom in children with renal disorders. Proteinuria can also be found in nonnal children and in those with non-renal disorders. A high sensitivity test is needed to detect proteinuria. Spectrophotometry has been used as a standard to detect proteinuria, however, it is expensive and not readily available in health clinics. We tested the use of20% sulfosalicylic add to detect proteinuria, and compared it to spectrophotometry. The sulfosalicylic add test is inexpensive, rapid, and easily performed in primary community health centers.Objective To compare 2 0 % sulfosalicylic acid test t o spectrophotometry as a diagnostic test for proteinuria.Methods We conducted a cross-sectional study in Adam Malik Hospital from September 2009 until December 2009. Inclusion criteria were children aged 3 to 18 years who experienced kidney disease. We collected 24 hour urine specimens from 55 children by consecutive sampling. Urine specimens were tested for proteinuria by 20% sulfosalicylic acid test and spectrophotometry.Results Sensitivity and specificity of 20% sulfosalicylic acid test compared to spectrophotometry were 88.1 % and 69.2%, respectively, with a positive predictive value and a negative predictive value of 90.2% and 64.3%, respectively.Conclusion The sulfosalicylic acid test had low sensitivity and specificity for detecting proteinuria, but it was more practical and less expensive compared to spectrophotometry.

Sign in / Sign up

Export Citation Format

Share Document