Efficacy of Urinary Cytology in the Detection of Tumors of the Urinary Tract

Introduction: Urological dogma dictates that washings collected from the urinary tract for cytological assessment must be performed without interference from contrast agents that may alter cellular integrity and diagnostic interpretation. In practice, the initial contrast used to outline the upper tracts is commonly discarded with subsequent saline washings sent for cytology. We hypothesize that contrast washings do not affect the morphology of urothelial carcinoma cells or the integrity of cytology interpretation.Methods: Samples obtained from (1) human bladder cell lines; (2) urine from a human xenograft bladder cancer model using UC-3 cells; and (3) patients with urothelial carcinoma were subjected to various experimental solutions (water, saline, urine, and dilutions of contrast media) for different exposure times. After exposure to various different solutions, samples underwent cytological analysis to assess morphologic and degenerative changes.Results: No cytological differences were seen when cells were exposed to ionic, hyperosmolar, or non-ionic low-osmolar contrast agents for any exposures up to five minutes. Cells exposed to mixtures of contrast agents and urine also demonstrated no evidence of degenerative change. Cells exposed to water for greater than one minute demonstrated significant hydropic degeneration impacting cytological interpretation. At 40 minutes or later, all reagents caused severe degeneration when evaluating urine samples from the mouse bladder cancer model and from patients undergoing urothelial carcinoma.Conclusions: Commonly used contrast agents have no effect on urinary cytology up to five minutes. Contrast washings of the urinary tract should not be discarded and can be sent for cytological diagnosis if fixed within this time period.

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

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0045-cp ◽

2019 ◽

Vol 144 (2) ◽

pp. 172-176 ◽

Cited By ~ 4

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.

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Significance of Urinary Cytology in the Early Detection of Transitional Cell Cancer of the Upper Urinary Tract

The Journal of Urology ◽

10.1016/s0022-5347(17)59010-2 ◽

1976 ◽

Vol 116 (6) ◽

pp. 781-783 ◽

Cited By ~ 76

Author(s):

Horst Zincke ◽

Juan J. Aguilo ◽

George M. Farrow ◽

David C. Utz ◽

Ansar U. Khan

Keyword(s):

Urinary Tract ◽

Early Detection ◽

Cell Cancer ◽

Transitional Cell ◽

Upper Urinary Tract ◽

Urinary Cytology ◽

Transitional Cell Cancer

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Impact of Initial Computed Tomography Findings on Management of Atypical Urinary Cytology of the Upper Urinary Tract

Urologia Internationalis ◽

10.1159/000512978 ◽

2021 ◽

pp. 1-5

Author(s):

Kotaro Takemura ◽

Taketo Kawai ◽

Yusuke Sato ◽

Jimpei Miyakawa ◽

Satoru Taguchi ◽

...

Keyword(s):

Computed Tomography ◽

Urinary Tract ◽

Upper Urinary Tract ◽

Wall Thickening ◽

Urinary Cytology ◽

Class Iii ◽

Ct Findings ◽

Retrograde Ureteropyelography ◽

Tumor Like Lesions

Introduction: Management of patients with atypical urinary cytology (class III) of the upper urinary tract is often complicated because some patients develop upper urinary tract urothelial carcinoma (UTUC). Here, we aimed to help define the optimal management of these patients. Methods: We investigated 31 patients who underwent retrograde ureteropyelography (RP) and were diagnosed with atypical findings of upper urinary tract cytology. Results: UTUC was revealed in 17 of 31 patients during the follow-up period of 1 year or longer. Tumor-like lesions and wall thickening in the upper urinary tract on initial computed tomography (CT) were significant predictors of UTUC (p = 0.0002 and p = 0.012, respectively). All 11 patients with tumor-like lesions and 3 of 8 patients with wall thickening on initial CT underwent nephroureterectomy, and UTUC was confirmed histologically. Moreover, 3 of 12 patients with hydronephrosis only or with normal findings later went on to develop UTUC. Repeated RP performed within 6 months from the initial RP was able to distinguish patients with UTUC from those without, even in individuals with normal CT findings. Discussion/Conclusion: Repeated RP based on initial CT findings is recommended in patients with atypical urinary cytology of the upper urinary tract. Nephroureterectomy without repeated RP may be warranted in patients with tumor-like lesions on initial CT findings.

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