The application of the Johns Hopkins Hospital Template on urine cytology

Wu, Howard H.; Redelman, Megan; Chen, Shaoxiong; Grignon, David J.; Cramer, Harvey

doi:10.1002/dc.23257

Cited by 12 publications

(30 citation statements)

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“…There are some authors that use subcategories of atypia [4,[6][7][8] . However, Bostwick and Hossain [5] , in a very comprehensive study, found no use in stratifying urothelial cell atypia for diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

et al. 2016

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The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. Objectives: To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Materials and Methods: Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. Results: When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Conclusions: Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required.

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Section: Discussionmentioning

confidence: 99%

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

et al. 2016

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“…Samples classified as AUC-H, while unable to be definitively called high-grade urothelial carcinoma (HGUC), typically contain features highly predictive of HGUC, i.e., hyperchromasia, anisonucleosis, coarse clumped chromatin, irregular nuclear borders, and an increased nuclear-to-cytoplasmic (N/C) ratio [5] . Studies have tested these criteria and have found them to be easily reproducible and predictive of high-grade (HG) carcinoma in cytologic specimens [6,7] .…”

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confidence: 99%

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

et al. 2017

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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.

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“…The urine cytologic diagnoses of AUC‐H and HGUC are highly associated with high‐grade urothelial lesions . In our previous study, greater than one‐half of patients (58%) who had biopsy‐confirmed high‐grade urothelial lesions had a preceding cytologic diagnosis of AUC‐H or HGUC .…”

Section: Discussionmentioning

confidence: 83%

“…The goal of urinary cytology is to identify HGUC. In addition to its well‐defined cytologic features (such as hyperchromasia; a high nuclear:cytoplasmic ratio; an irregular nuclear membrane; anisonucleosis; and irregular, coarse, clumpy chromatin), HGUC also frequently demonstrates apoptosis with pyknotic nuclei and karyorrhexis in association with urinary cytologic examination of urothelial carcinoma . Apoptosis was observed more often in HGUC than low‐grade urothelial neoplasms in a small study of malignant atypical cells in urinary cytology .…”

Section: Discussionmentioning

confidence: 99%

“…Urologists continue to rely on urinary cytology as a first‐line screening test, and the cytologic diagnosis of high‐grade urothelial carcinoma (HGUC) is the most important indication for a patient to undergo cystoscopy. The most common and diagnostic cytologic features characteristic of a diagnosis of HGUC are hyperchromasia; a high nuclear:cytoplasmic ratio; an irregular nuclear membrane; irregular, coarse, clumpy chromatin; and anisonucleosis . The less frequently observed cytologic features include India ink nuclei (single cells with deep black and structureless nuclei), micronucleus, and cell cannibalism .…”

Section: Introductionmentioning

confidence: 99%

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High apoptotic index in urine cytology is associated with high‐grade urothelial carcinoma

Yang

Chen

Cramer

et al. 2016

Cancer Cytopathology

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BACKGROUND:The significance of apoptosis and its association with high-grade urothelial carcinoma (HGUC) in urine cytology has yet to be determined. METHODS: A computerized search of the study laboratory information system was performed over a 3-year period for all urine cytology specimens processed using the SurePath liquid-based preparation technique. Only those cases with correlating surgical pathology obtained within 6 months after the urine cytologic samples were included in the current study. Cases from ileal conduit samples were excluded. A semiquantitative numerical scoring system (apoptotic index) was used to assess the amount of pyknosis or karyorrhexis, with 0 indicating none, 1 indicating < 10 per 10 high-power fields, 2 indicating 10 to 30 per 10 high-power fields, and 3 indicating > 30 per 10 highpower fields. Statistical analysis using the Pearson chi-square test was performed. RESULTS: A total of 228 cases including 105 benign cases, 79 cases of HGUC, and 44 cases of low-grade urothelial carcinoma (LGUC) diagnosed on follow-up surgical pathology were selected. A score of 0 was observed in 70 benign, 11 HGUC, and 8 LGUC cases; a score of 1 was observed in 31 benign, 21 HGUC, and 23 LGUC cases; a score of 2 was observed in 3 benign, 27 HGUC, and 9 LGUC cases; and a score of 3 was observed in 1 benign, 20 HGUC, and 4 LGUC cases. CONCLUSIONS: Excluding ileal conduit urine specimens, the finding of a high apoptotic index (score 2) with the presence of pyknosis or karyorrhexis in 10 per 10 high-power fields in the urine cytology appears to be significantly associated with HGUC (P<.05). Cancer Cytopathol 2016;124:546-51.

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The application of the Johns Hopkins Hospital Template on urine cytology

Abstract: Background: To evaluate the utility of the Johns Hopkins Hospital Template in detection of

Cited by 12 publications

References 12 publications

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

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

High apoptotic index in urine cytology is associated with high‐grade urothelial carcinoma

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