Utility of Urine Cytology in Genitourinary Lesions and Implication of Paris System in the Diagnosis of Urothelial Carcinoma - Five Years of Experience from a Tertiary Care Centre at North Karnataka

2021 ◽  
Vol 8 (02) ◽  
pp. 58-63
Author(s):  
Ranjana Shashidhar Ranade ◽  
Netra Prakash Kori ◽  
Vidisha Sharatchandra Athanikar
Keyword(s):  
Diagnostic Accuracy ◽  
Urothelial Carcinoma ◽  
Predictive Accuracy ◽  
Tertiary Care ◽  
Urine Cytology ◽  
Low Grade ◽  
High Grade ◽  
Tertiary Care Centre ◽  
Screening And Surveillance ◽  
Reporting Systems

BACKGROUND Urine cytology when combined with cystoscopy remains a gold standard in screening and surveillance of urothelial carcinoma. Paris system for reporting urine cytology (PSRUC) gives seven well defined diagnostic criteria. We aimed to analyse utility of urine cytology in patients with urogenital symptoms, compare existing institutional system (EIS) with PSRUC and assess the performance of both reporting systems in predicting subsequent high-grade urothelial carcinoma on histopathology. METHODS A five year retrospective study included a total of 146 urine samples from 74 patients. Each case was assigned a category according to both EIS and PSRUC system. After cyto-histological correlation, sensitivity, specificity and diagnostic accuracy of urine cytology in detecting malignancy using PSRUC and EIS were determined. Performance of urine cytology in predicting subsequent high grade urothelial carcinoma (HGUC) was assessed for both reporting systems. RESULTS PSRUC resulted in reduction in number of cases assigned to atypical category (10.5 % vs. 3.4 %) and increase in low grade carcinomas assigned to NGUC category (66 % vs. 100 %). Positive predictive value (PPV) for predicting subsequent high grade urothelial carcinoma for HGUC and SHGUC category remained the same (100 %). Sensitivity (66.67 % vs. 55.5 %), specificity (100 % vs. 85.71 %) and diagnostic accuracy (81 % vs. 68.75 %) was improved with application of PSRUC when compared to EIS. Two cases of genitourinary tuberculosis were diagnosed. CONCLUSIONS PSRUC improves predictive accuracy of subsequent high-grade urothelial carcinoma on histopathology and it ensures uniformity in reporting. Judicious use of urine cytology might aid in early diagnosis of infectious conditions like tuberculosis. KEYWORDS PSRUC, Urine Cytology, High Grade Urothelial Carcinoma

scholarly journals Clinicopathological correlation of p63 in Urothelial Carcinoma: Immunohistochemical Study

2020 ◽  
Vol 7 (6) ◽  
pp. A269-274
Author(s):  
Rupinderjit Kaur ◽  
Mridu Manjari ◽  
Sanjay Piplani
Keyword(s):  
Urothelial Carcinoma ◽  
Tertiary Care ◽  
Staining Intensity ◽  
Good Prognosis ◽  
Health Concern ◽  
Low Grade ◽  
Care Hospital ◽  
High Grade ◽  
Female Ratio ◽  
Urothelial Carcinomas

Background: Urothelial cancer (UCa) poses a significant medical and public health concern in most parts of the world and is defined as a pan- urothelial disease in which entire urothelium of the renal pelvis to the urethra can undergo malignant transformation.  Bladder tumors account for 90–95% of urothelial carcinomas and are the most common urinary tract malignancy. It is three times less common in females. Methods: The study was conducted on 40 cases of Urothelial Carcinoma received as biopsy specimens in a tertiary care hospital. There were 20 cases each of low grade and high grade and after grading these were subjected to p63 expression. Result: 78% of the patients were from 50-75 year age group with Male to Female ratio being 4:1. Painless hematuria was most common complaint. The size varied from 0.5 to 7.2 cm. For P63, 38 (95%) cases showed positive p63 expression. Of which 20 cases were low grade and 18 (90%) were high grade papillary urothelial carcinomas. Of P63 positive cases 36 cases showed moderate to strong staining intensity whereas two cases showed mild staining intensity. The p63 expression decreased with grade and invasion. Conclusion:   P63 immunoexpression decreases with increasing grade of tumor as well as with invasion thus showing that its expression is related with good prognosis.

Comparative Evaluation of ProEx C and ImmunoCyt/uCyt Assays in Atypical Urine Cytology

2014 ◽  
Vol 138 (9) ◽  
pp. 1215-1222 ◽  
Author(s):  
Maria E. Vergara-Lluri ◽  
Eugenia Hu ◽  
Jian-Yu Rao ◽  
Mary Levin ◽  
Sophia K. Apple ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Topoisomerase Ii ◽  
High Sensitivity ◽  
Urine Cytology ◽  
Urothelial Cell ◽  
Low Grade ◽  
Nuclear Staining ◽  
High Grade ◽  
Surgical Biopsy ◽  
Papillary Urothelial Carcinoma

Context.—Detection of urothelial carcinoma by urine cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of urothelial carcinoma. ProEx C is an assay targeting expression of topoisomerase II-α and the minichromosome maintenance protein-2 and is used to assist in diagnoses of gynecologic specimens. Objective.—To evaluate the utility of ProEx C and uCyt in atypical urine cytology. Design.—Sixty-eight specimens with a diagnosis of atypical urine cytology, concurrent uCyt testing, and surgical biopsy follow-up were included. Slides were restained with ProEx C. ProEx C was recorded as positive when nuclear staining was seen in at least one morphologically atypical urothelial cell. The uCyt was scored as positive if at least one morphologically atypical urothelial cell showed positive fluorescence staining. Thirteen cases (19%) had benign histologic diagnoses, 18 (26%) had low-grade papillary urothelial carcinoma, and 37 (54%) had high-grade urothelial carcinoma. Results.—The overall sensitivity was 85% for ProEx C, 85% for uCyt, and 93% for the combination of the 2 assays. The overall specificity was 69% for ProEx C, 31% for uCyt, and 23% for the combination of the 2 tests. In predicting high-grade urothelial carcinoma, sensitivity was 92% for ProEx C, 86% for uCyt, and 92% for both tests. In predicting low-grade papillary urothelial carcinoma, sensitivity was best with the combination of the 2 tests at 94%. Conclusion.—ProEx C has superior specificity to uCyt. The combination of the 2 tests yielded high sensitivity not only for high-grade urothelial carcinoma but also for low-grade papillary urothelial carcinoma.

scholarly journals Paris System Has A Higher Cytohistologic Correlation And Reproducibility Than Traditional Urine Cytology Method

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S94-S94
Author(s):  
R P Mendoza ◽  
T Haidary ◽  
R Gupta
Keyword(s):  
Urothelial Carcinoma ◽  
Traditional Method ◽  
Urine Cytology ◽  
Low Grade ◽  
High Grade ◽  
Cytologic Diagnosis ◽  
Histologic Diagnosis ◽  
Negative Results ◽  
The Mean ◽  
Cytology Result

Abstract Introduction/Objective The major limitation of urine cytology is the lack of consensus regarding the terminology and diagnostic criteria that should be used for urothelial atypia. The main goal of the newly proposed Paris System for Reporting Urine Cytology is to concentrate primarily on the detection of high grade urothelial carcinoma while minimizing the detection of low grade lesions. This study aimed to apply the criteria and categories of the Paris system in retrospectively collected urine cytology specimens and assess histologic correlation and reproducibility. Methods Two senior pathologists independently reviewed retrospectively collected urine cytology specimens strictly following the Paris system criteria for categorization. Cytologic diagnosis were compared with previous cytology result and histologic diagnosis. Results A total of 67 patients were included in the study. The mean age is 65.8 years (36-89 years), majority were males (73.1%) and African American (89.6%). Urine cytology using traditional method showed mostly atypical results (58.2%), followed by reactive (26.9%), high-grade urothelial carcinoma (11.9%) and suspicious (3.0%). On the other hand, the Paris system had more negative results (62.7%), followed by atypical (19.4%), high-grade urothelial carcinoma (11.9%) and lastly suspicious (6.0%). All of negative cases (18 out of 18) and majority of HGUC cases (7 out of 8) were concordant between the two cytology methods. Traditional urine cytology method only yielded 71.4% histologic concordance, while 100% Paris system results were concordant with bladder histology. Majority of the atypical cases using traditional method were converted to negative, and a few atypical cases were converted to suspicious and high-grade. All results using Paris system were concordant between two general pathologists. Conclusion Using the Paris system in analyzing urine cytology resulted to higher cytohistologic concordance than traditional method. Majority of atypical cases from traditional method were converted to more definitive categories. The cytopathologic analyses from two general pathologists applying the criteria of Paris system had superior reproducibility. Applying the Paris system, therefore, can significantly improve the performance of urine cytopathology.

scholarly journals Application of the Paris Reporting System for Urine Cytology: The Three-Year Experience of a Single Tertiary Care Institute in Thailand

2022 ◽  
pp. 1-8
Author(s):  
Bantita Phruttinarakorn ◽  
Sirithep Plumworasawat ◽  
Jitchai Kayankarnnavee ◽  
Jirasit Lualon ◽  
Atcharaporn Pongtippan
Keyword(s):  
Urothelial Carcinoma ◽  
Predictive Value ◽  
Diagnostic Category ◽  
Malignant Neoplasm ◽  
Urine Cytology ◽  
Malignant Neoplasms ◽  
Low Grade ◽  
High Grade ◽  
Sensitivity Specificity

<b><i>Introduction:</i></b> Urothelial carcinoma is one of the most common human cancers, both in Thailand and worldwide. Urine cytology is a screening tool used to detect urothelial carcinoma. The Paris System for Reporting Urinary Cytology (TPSRUC) was first published in 2016 to standardize the procedures, reporting, and management of urothelial carcinoma. Diagnostic categories include negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUCs), suspicious for HGUC (SHGUC), HGUC, low-grade urothelial neoplasm, and other malignancies. <b><i>Material and Methods:</i></b> In a retrospective review, urine cytology specimens from 2016 to 2019 were reevaluated using the TPSRUC. The risk of high-grade malignant neoplasm (ROHM) for each diagnostic category was calculated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of prediction of high-grade malignant neoplasms were evaluated for cases with histological follow-up specimens. <b><i>Results:</i></b> In total, 2,178 urine cytology specimens were evaluated, of which 456 cases had follow-up histological specimens. The ROHM in each diagnostic category was as follows: NHGUC, 17.4%; AUC, 49.9%; SHGUC, 81.2%; HGUC, 91.3%; and other malignant neoplasms, 87.5%. The sensitivity, specificity, PPV, NPV, and accuracy for high-grade malignant neoplasm prediction were 63%, 92.8%, 89%, 73.1%, and 78.5% when AUC was included as malignant in the comparison and 82.6%, 74.7%, 75.1%, 82.3%, and 78.5% when AUC was not considered malignant. <b><i>Conclusions:</i></b> TPSRUC provides reliable results that are reproducible by different interpreters and is a helpful tool for the detection of HGUC.

High-Grade Urothelial Carcinoma on Urine Cytology Resembling Umbrella Cells

2017 ◽  
Vol 62 (1) ◽  
pp. 62-67 ◽  
Author(s):  
Andrew A. Renshaw ◽  
Edwin W. Gould
Keyword(s):  
Urothelial Carcinoma ◽  
Malignant Cell ◽  
Urine Cytology ◽  
Low Grade ◽  
High Grade ◽  
Malignant Cells ◽  
Abundant Cytoplasm ◽  
Abnormal Cells ◽  
Rare Cells ◽  
Umbrella Cells

Context: High-grade urothelial carcinoma (UC) cells have many appearances on urine cytology, but according to The Paris System, they can be easily distinguished from umbrella cells. Objective: We aimed to define the incidence and appearance of high-grade UC cells that resemble umbrella cells in Cytospin preparations on urine cytology. Results: Cytospin preparations from 331 cases with biopsy follow-up (230 benign/low-grade and 101 malignant [22 carcinoma in situ, 52 papillary, 19 invasive UC, 8 other] cases) were reviewed. A total of 18 cases with malignant cells resembling umbrella cells were identified (17.8% of the malignant cases) and were the only type of malignant cell in 3% of the cases. Two patterns were identified. Tumor cells were either identifiable by at least 20 abnormal cells which were large, had abundant cytoplasm but an elevated nuclear-to-cytoplasmic ratio, and markedly enlarged, round-to-elongated nucleoli, or else rare cells with abundant cytoplasm but obviously malignant nuclei. Cells without nucleoli or obviously malignant nuclei were not specific. Conclusions: Malignant cells resembling umbrella cells can be seen in up to 17% of urine cytology specimens.

scholarly journals Clinicopathological Study of Extranodal Marginal Zone Lymphoma in a Tertiary Care Centre in North Kerala

2021 ◽  
Vol 8 (11) ◽  
pp. 584-587
Author(s):  
Shima Kannadas ◽  
Rajeevan Kunnaruvath
Keyword(s):  
B Cell ◽  
Marginal Zone ◽  
Strong Association ◽  
Tertiary Care ◽  
Autoimmune Disorders ◽  
Marginal Zone Lymphoma ◽  
Low Grade ◽  
High Grade ◽  
Care Centre ◽  
Tertiary Care Centre

BACKGROUND Extranodal marginal zone lymphomas are rare groups of B cell lymphomas that arise in mucosa associated lymphoid tissues of various sites. Strong association with autoimmunity and certain infections are its distinct features. Diagnosis is by histology with immunophenotyping alongside ruling out other low-grade lymphomas. In this study we wanted to analyse MALTomas with regard to their clinical features, relation to autoimmunity, histological and immunohistochemical profile. METHODS This is a descriptive study conducted from 2013 to 2018 at a tertiary care centre in North Kerala. Study sample included all cases of extranodal lymphomas obtained retrospectively from 2013 to 2017 and prospectively from 2017 to 2018. Blocks of all specimens were cut and stained with haematoxylin and eosin (H & E) and immunohistochemical markers. RESULTS Out of the 15 cases we analysed, the most common sites of involvement were gastrointestinal tract (40 %) followed by thyroid (27 %). Thyroid, which is a rarer site for MALT lymphoma, is detected as one of the frequent sites in this study. In our study, stomach was one of the less common site affected which is in contrast to other studies. Associated autoimmune disorder was detected in 20 % of cases. 46 % of cases show features of transformation to high grade lymphoma. CONCLUSIONS This study analysed the features of MALT lymphomas in different sites and found a strong association with autoimmune disorders. Rarer sites like thyroid were found to be more frequently involved and common sites like stomach was detected in only small percentage of cases. Although most cases are indolent low-grade lymphomas, possibility of transformation to a high-grade B cell lymphoma should always be considered when dealing with these cases. Utility of immunohistochemistry in ruling out other small cell lymphomas is also well demonstrated in this study. KEYWORDS Extranodal Marginal Zone Lymphoma, MALToma, Autoimmune Disorders, Immunohistochemistry

The Added Value of Inflow-Based Vascular-Space-Occupancy and Diffusion-Weighted Imaging in Preoperative Grading of Gliomas

2021 ◽  
pp. 1-8
Author(s):  
Haimei Cao ◽  
Xiang Xiao ◽  
Jun Hua ◽  
Guanglong Huang ◽  
Wenle He ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Diffusion Weighted Imaging ◽  
Low Grade ◽  
High Grade ◽  
Mr Images ◽  
Vascular Space ◽  
Diffusion Weighted ◽  
High Grade Gliomas ◽  
And Diffusion

Objectives: The present study aimed to study whether combined inflow-based vascular-space-occupancy (iVASO) MR imaging (MRI) and diffusion-weighted imaging (DWI) improve the diagnostic accuracy in the preoperative grading of gliomas. Methods: Fifty-one patients with histopathologically confirmed diffuse gliomas underwent preoperative structural MRI, iVASO, and DWI. We performed 2 qualitative consensus reviews: (1) structural MR images alone and (2) structural MR images with iVASO and DWI. Relative arteriolar cerebral blood volume (rCBVa) and minimum apparent diffusion coefficient (mADC) were compared between low-grade and high-grade gliomas. Receiver operating characteristic (ROC) curve analysis was performed to compare the tumor grading efficiency of rCBVa, mADC, and the combination of the two parameters. Results: Two observers diagnosed accurate tumor grade in 40 of 51 (78.4%) patients in the first review and in 46 of 51 (90.2%) in the second review. Both rCBVa and mADC showed significant differences between low-grade and high-grade gliomas. ROC analysis gave a threshold value of 1.52 for rCBVa and 0.85 × 10−3 mm2/s for mADC to provide a sensitivity and specificity of 88.0 and 81.2% and 100.0 and 68.7%, respectively. The area under the ROC curve (AUC) was 0.87 and 0.85 for rCBVa and mADC, respectively. The combination of rCBVa and mADC values increased the AUC to 0.92. Conclusion: The combined application of iVASO and DWI may improve the diagnostic accuracy of glioma grading.

scholarly journals Expression of Semaphorin 3A in Malignant and Normal Bladder Tissue: Immunohistochemistry Staining and Morphometric Evaluation

Biology ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 109
Author(s):  
Ilan Bejar ◽  
Jacob Rubinstein ◽  
Jacob Bejar ◽  
Edmond Sabo ◽  
Hilla K Sheffer ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Carcinoma In Situ ◽  
Urothelial Cancer ◽  
Basal Layer ◽  
Low Grade ◽  
High Grade ◽  
Bladder Tissue ◽  
Normal Bladder ◽  
Normal Bladder Tissue

Introduction: Our previous studies showed elevated levels of Semaphorin3a (Sema3A) in the urine of patients with urothelial cancer compared to healthy patients. The aim of this study was to analyze the extent of Sema3A expression in normal and malignant urothelial tissue using immune-staining microscopic and morphometric analysis. Materials and Methods: Fifty-seven paraffin-embedded bladder samples were retrieved from our pathology archive and analyzed: 14 samples of normal urothelium, 21 samples containing low-grade urothelial carcinoma, 13 samples of patients with high-grade urothelial carcinoma, 7 samples containing muscle invasive urothelial carcinoma, and 2 samples with pure urothelial carcinoma in situ. All samples were immunostained with anti Sema3A antibodies. The area of tissue stained with Sema3A and its intensity were analyzed using computerized morphometry and compared between the samples’ groups. Results: In normal bladder tissue, very light Sema3A staining was demonstrated on the mucosal basal layer and completely disappeared on the apical layer. In low-grade tumor samples, cells in the basal layer of the mucosa were also lightly stained with Sema3A, but Seama3A expression intensified upon moving apically, reaching its highest level on apical cells exfoliating to the urine. In high grade urothelial tumors, Seama3A staining was intense in the entire thickness of the mucosa. In samples containing carcinoma in situ, staining intensity was high and homogenous in all the neoplastic cells. Conclusions: Sema3A may be serve as a potential non-invasive marker of urothelial cancer.

scholarly journals Effectiveness of contrast-enhanced ultrasound for detecting the staging and grading of bladder cancer: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xinyue Ge ◽  
Zhong-Kai Lan ◽  
Jing Chen ◽  
Shang-Yong Zhu
Keyword(s):  
Bladder Cancer ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Cochrane Library ◽  
Forest Plot ◽  
Low Grade ◽  
High Grade ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced

Aim: The study retrospectively analysed the accuracy of preoperative contrast-enhanced ultrasound (CEUS) in differenti-ating stage Ta-T1 or low-grade bladder cancer (BC) from stage T2 or high-grade bladder cancer. Material and methods: We systematically searched the literature indexed in PubMed, Embase, and the Cochrane Library for original diagnostic articles of bladder cancer. The diagnostic accuracy of CEUS was compared with cystoscopy and/or transurethral resection of bladder tumors (TURBT). The bivariate logistic regression model was used for data pooling, couple forest plot, diagnostic odds ratio (DOR) and summary receiver operating characteristic (SROC). Results: Five studies met the selection criteria; the overall number of reported bladder cancers patients were 436. The pooled-sensitivity (P-SEN), pooled-specificity (P-SPE), pooled-positive likelihood ratio (PLR+), pooled-negative likelihood ratio (PLR−), DOR, and area under the SROC curve were 94.0% (95%CI: 85%–98%), 90% (95%CI: 83%–95%), 9.5 (95%CI: 5.1–17.6), 0.06 (95%CI: 0.02–0.17), 147 (95%CI: 35–612) and 97% (95% CI: 95%–98%) respectively. Conclusion: CEUS reaches a high efficiency in discriminating Ta-T1 or low-grade bladder cancer from stage T2 or high-grade bladder cancer. It can be a promising method in patients to distinguish T staging and grading of bladder cancer because of its high sensitivity, specificity and diagnostic accuracy.

scholarly journals Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 17 ◽  
Author(s):  
Theresa Long ◽  
Lester J. Layfield ◽  
Magda Esebua ◽  
Shellaine R. Frazier ◽  
D. Tamar Giorgadze ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Urothelial Cells ◽  
Urothelial Carcinomas ◽  
Absolute Agreement ◽  
Potential Impact ◽  
Urine Specimens

Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.

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