Indeterminate atypia in urinary tract cytology: Does it really matter?

Abstract

The study of atypia in urinary cytology has been ongoing for decades but most studies have focused primarily on test performance in patients with concurrent biopsies and/or limited follow‐up periods. While these data are useful, many studies fail to consider patient factors that may alter the pretest probability, which can subsequently affect test performance. An isolated diagnosis of malignancy in urinary cytology usually has a high positive predictive value and allows a urologist to conduct a rigorous workup of the patient to establish a tissue diagnosis. However, it is less certain how an atypical diagnosis impacts patient care, given that many patients have a history of bladder cancer and are already under surveillance with cystoscopy at regular screening intervals. Furthermore, a discrete negative urine cytology is unlikely to allow a patient to forego a cystoscopy procedure due to limitations in the sensitivity of urine cytology. Over the last several years, the introduction of The Paris System for Reporting Urinary Cytology (TPS) has improved the predictive value of atypical diagnoses, but additional studies are needed to evaluate the performance of these diagnoses in specific clinical situations. Such data could better inform urologists on how to manage patients with atypical diagnoses. This review discussed the diagnosis of atypia in urinary cytology and the impact of such a diagnosis in various clinical contexts.

Urinary IL‐6 and IL‐8 as predictive markers in bladder urothelial carcinoma: A pilot study

“…Ancillary tests that provide quantitative results avoid the subjectivity, variability, and uncertainty that can be introduced during any microscopic-based assessment. 43,44 In theory, a successful ancillary test could either lead to early detection and treatment of a recurrence, or, in the case of a test with a high negative predictive value, identify patients in which cystoscopy surveillance intervals could be lengthened. 10,44,45 Our study also identifies significantly different concentrations of cytokine production in LGUC and HGUC.…”

“…Although UTC is often used to detect small HGUC or flat CIS lesions not seen during cystoscopy, numerous ancillary tests have been developed to identify patients at greatest risk of recurrence. Ancillary tests that provide quantitative results avoid the subjectivity, variability, and uncertainty that can be introduced during any microscopic‐based assessment 43,44 . In theory, a successful ancillary test could either lead to early detection and treatment of a recurrence, or, in the case of a test with a high negative predictive value, identify patients in which cystoscopy surveillance intervals could be lengthened 10,44,45 .…”

“…4,5 In addition, interobserver variability can lead to inconsistency in diagnosis. [6][7][8] Because of these limitations, various ancillary tests have been developed to detect urothelial carcinoma using urine specimens. 9,10 Currently, cytokines are known to be a key a factor in numerous malignancies and to exert an important regulatory role in the tumor microenvironment (TME).…”

“…However, UTC has decreased sensitivity, especially for the detection of low‐grade urothelial neoplasms 4,5 . In addition, interobserver variability can lead to inconsistency in diagnosis 6–8 . Because of these limitations, various ancillary tests have been developed to detect urothelial carcinoma using urine specimens 9,10 …”

The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens

“…In these reports, Dr. Papanicolaou recommended that a definitive diagnosis of malignancy should be made based on the presence of "clusters" of cells with malignant features, though these features were not described in detail. Despite numerous reports over the last several decades, the literature is filled with conflicting results regarding the diagnostic meaning of UTFs in Diagnostics 2022, 12, 931 2 of 15 UTC [7][8][9][10][11][12][13]. This lack of clarity is partly due to a lack of a standardized definition for what constitutes a UTF and is further confounded by changes in the diagnostic criteria and terminology for urothelial carcinomas.…”