Urinary cytology and bladder cancer. The cellular features of transitional cell neoplasms

Abstract

Urinary cytology is increasingly accepted as a diagnostic tool in the detection and follow‐up of patients with bladder cancer. Its potential value has been reduced, however, by the relative inexperience of most pathologists in the examination of urinary specimens, and by the lack of cellular criteria specifically reflecting the morphology of low‐grade papillary and flat lesions of bladder epithelium. The cytologic features of urothelial lesions, including papillary transitional cell carcinomas and flat urothelial dysplasias have been studied in both experimental systems and clinical situations and their application to a selected patient population is presented. Overall, the cytohistologic correlation for patients with bladder cancer was 92%. Positive cells reflecting the morphology of the tumor occurred in 62% of patients with grade I transitional cell carcinomas, and cells suspicious for malignancy were identified in an additional 14% of these individuals. Using the criteria presented, a positive cytology can correlate with a papillary grade I bladder tumor, and should not necessarily indicate the presence of another neoplasm. Dysplastic cells in cytologic specimens are often identified in patients having urothelial dysplasia as the most serious bladder lesion, but the cytologic diagnosis of dysplasia may represent an under‐interpretation of a lowgrade papillary bladder tumor. The cells of urothelial neoplasms, including low‐grade transitional cell carcinomas and dysplasias, differ morphologically both from normal and reactive/reparative elements, and can be detected in cytologic samples. The changes are often subtle and require experience and a cautious approach for accurate interpretation.

Urinary levels of urokinase‐type plasminogen activator and its receptor in the detection of bladder carcinoma

“…12 In addition, we used bladder wash-out specimens, which have been shown to yield a higher sensitivity com- pared with voided urine specimens. 3 Compared with the high sensitivity, the specificity of cytology in our study was lower than that reported previously. 14 All 10 patients who had presumed false positive urinary cytology had a past history of bladder carcinoma.…”

“…2 Its sensitivity is about 70% but decreases to 30 -50% for low-grade tumors. 3 Recently, a variety of urinary markers purported to be more sensitive than urine cytology have been investigated. 4 A common problem of these markers is that, when they demonstrate reasonable-to-good sensitivity, their specificity remains relative low.…”

The application of the Johns Hopkins Hospital Template on urine cytology

“…Over the decades, several classification schemes for reporting urine cytology have been proposed and the nomenclature has evolved in accordance with changes in the histologic classification of the bladder cancers. [1][2][3][4][5] However, unlike cervical cytology, there has not been widespread acceptance and use of any particular reporting scheme for urine cytology studies. The Johns Hopkins Hospital Template for Reporting Urine Cytology is the foundation for the newly proposed "Paris classification for reporting urine cytology" which has proposed 7 diagnostic categories for urine cytology samples, including negative for urothelial atypia or malignancy (NUAM); atypical urothelial cells of undetermined significance (AUC-US); atypical urothelial cells, cannot exclude high-grade urothelial carcinoma (AUC-H); high-grade urothelial carcinoma (HGUC); low-grade urothelial carcinoma (LGUC); other (squamous carcinoma, adenocarcinoma, etc.…”

Proteomic Strategies to Reveal Tumor Heterogeneity among Urothelial Papillomas

“…TCCs comprise more than 90% of the diagnosed bladder tumors in the Western hemisphere and are divided broadly into papillary (growing into the lumen of the bladder) and flat lesions that arise and progress through different genetic alterations (4). Bladder tumors are diagnosed routinely by cytoscopy, which give important information on multifocality, appearance, and size (5,6). Cytoscopy is essential for resection and provides valuable material for pathological observation and research purposes.…”