Upper urinary tract washings outperform voided urine specimens to detect upper tract high‐grade urothelial carcinoma

Zhang, M. Lisa; Rosenthal, Dorothy L.; VandenBussche, Christopher J.

doi:10.1002/dc.23746

Cited by 24 publications

(14 citation statements)

References 17 publications

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Section: Diagnostic Rates Of Tps Categories In Uut Cytologymentioning

confidence: 99%

“…Among them, the reported rates of negative for HGUC (NHGUC), atypical urothelial cells (AUC), SHGUC, and HGUC ranged from 0% to 39%, 13% to 37%, 10% to 36%, and 16% to 62%, respectively (Table 3). 14,48,[54][55][56][57][58][59] However, only 3 studies compared the frequency of comparable diagnostic categories pre-and post-TPS. 54,56,57 In these studies, pre-TPS cases with previously rendered final diagnoses were re-reviewed and reclassified using TPS criteria.…”

Section: Diagnostic Rates Of Tps Categories In Uut Cytologymentioning

confidence: 99%

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A review of upper urinary tract cytology performance before and after the implementation of The Paris System

Zhang

Miki

Hang

et al. 2020

Cancer Cytopathology

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Urinary cytology (UC) is one of the primary diagnostic modalities used for the screening and surveillance of urothelial carcinoma. Despite its widespread use, UC has suffered from a lack of standardized or reproducible criteria and wide interobserver variability, particularly of the designation of atypical urothelial cells. The Paris System for Reporting Urinary Cytology (TPS), published in 2016, aimed to provide a standardized approach for evaluating UC by creating diagnostic categories with specific cytomorphologic criteria. Recent studies have primarily investigated the application of TPS on lower urinary tract specimens and have mostly shown that TPS implementation has improved the performance of UC specimens. Only a few studies have reported the impact of TPS on upper urinary tract (UUT) cytology. Additionally, there is uncertainty as to which cytological features are most predictive of high‐grade urothelial carcinoma (HGUC) in the UUT. This review summarizes the literature regarding the utility and performance of UUT cytology and highlights findings before and after the implementation of TPS.

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Section: Diagnostic Rates Of Tps Categories In Uut Cytologymentioning

confidence: 99%

Section: Diagnostic Rates Of Tps Categories In Uut Cytologymentioning

confidence: 99%

A review of upper urinary tract cytology performance before and after the implementation of The Paris System

Zhang

Miki

Hang

et al. 2020

Cancer Cytopathology

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“…Although voided urine cytology (VUC) has been shown to be a convenient method of diagnosing high‐grade urothelial carcinoma (HGUC) in the lower urinary tract, diagnosing upper urinary tract HGUCs by VUC is limited by poor cellular preservation and mechanical distortion . Additionally, the increased technical difficulty in visualizing and accessing potential tumors in the upper urinary tract in comparison to those arising in the lower urinary tract also makes acquisition of diagnostic material by biopsy more difficult .…”

Section: Introductionmentioning

confidence: 99%

The utility of upper urinary tract urine cytology before and after application of the Paris system

Simon

Skala

Magers

et al. 2018

Diagnostic Cytopathology

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Background The Paris System (TPS) introduced diagnostic criteria for urine cytology to improve reproducibility among pathologists. Thus far, most cytology studies have investigated application of TPS on lower urinary tract specimens. Also, it is unclear which cytologic features are most predictive of malignancy, particularly in the upper urinary tract. We evaluate concordance rates of preoperative upper urinary tract cytology specimens before and after application of TPS criteria with surgical resections and assess cytologic features associated with malignancy. Design 54 resections with high‐ and low‐grade urothelial carcinoma (HGUC, LGUC) from 2000‐2016 with available preoperative cytology (n = 61) were identified. Cytology was re‐reviewed to evaluate cytologic features and provide diagnoses before and after TPS implementation. Results The most common cytologic features associated with HGUC were N:C ratios ≥0.7 (88%), hyperchromasia (83%), coarse chromatin distribution (67%), and nuclear pleomorphism in cell clusters (65%). Application of TPS criteria resulted in 10 diagnostic downgrades and 6 diagnostic upgrades. After TPS criteria were applied, the sensitivity of a positive diagnosis decreased from 29% to 19%. The morphologic feature most consistently associated with a downgrade from positive to suspicious was a lack of marked nuclear contour irregularities in atypical urothelial cells. Conclusion Using strict TPS criteria in upper urinary tract cytology specimens may decrease the frequency of positive diagnoses with a concurrent increase in suspicious diagnoses. These findings may indicate that different morphologic features, particularly markedly irregular nuclear contours, may have different predictive values for HGUC in upper urinary tract cytology specimens compared with those from the lower urinary tract.

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“…In general, the modalities for early diagnosis and follow-up of bladder cancer include cystoscopy and urine cytology [ 4 ]. Cystoscopy is considered the gold standard for the initial diagnosis and staging of bladder cancer, which should be confirmed by histological examination of biopsy specimens [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the NMP22 BladderChek test for detecting bladder cancer: a systematic review and meta-analysis

et al. 2017

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BackgroundWe examined the usefulness of the nuclear matrix protein 22 (NMP22) BladderChek test for detecting bladder cancer.Materials and MethodsA literature search was performed using PubMed, Embase, the Cochrane Library, and Web of Science. The diagnostic accuracy of the NMP22 BladderChek test was evaluated via pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under curve (AUC). Inter-study heterogeneity was explored using meta-regression and subgroup analyses.ResultsWe included 23 studies in the systematic review and 19 in the quantitative meta-analysis. Overall sensitivity and specificity were 56% (52–59%) and 88% (87–89%), respectively; pooled PLR and NLR were 4.36 (3.02–6.29) and 0.51 (0.40–0.66), respectively; DOR was 9.29 (5.55–15.55) with an AUC of 0.8295. The mean sensitivity for Ta, T1, ≥ T2, Tis, G1, G2, and G3 disease was 13.68%, 29.49%, 74.03%, 34.62%, 44.16%, 56.25%, and 67.34%, respectively.ConclusionsThe NMP22 BladderChek test shows good discrimination ability for detecting bladder cancer and a high-specificity algorithm that can be used for early detection to rule out patients with higher bladder cancer risk. It also has better potential for screening higher-grade and higher-stage tumors, and better diagnostic performance in Asians.

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Upper urinary tract washings outperform voided urine specimens to detect upper tract high‐grade urothelial carcinoma

Cited by 24 publications

References 17 publications

A review of upper urinary tract cytology performance before and after the implementation of The Paris System

A review of upper urinary tract cytology performance before and after the implementation of The Paris System

The utility of upper urinary tract urine cytology before and after application of the Paris system

Evaluation of the NMP22 BladderChek test for detecting bladder cancer: a systematic review and meta-analysis

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