Diagnostic terminology for urine cytology reports

Article proposes including new diagnostic subcategories ‘atypical urothelial cells of undetermined significance’ (AUC-US) and ‘cannot exclude high grade’ (AUC-H) for urine cytology reports.

E. Piaton, M. Decaussin-Petrucci, F. Mege-Lechevallier, A.-S. Advenier, M. Devonec, A. Ruffion

NOTE: It would be interesting to see how reflex molecular testing or cytology-plus molecular testing correlated with these findings as well, if available. (Unfortunately, I don’t yet have my copy of the full article to see if this was provided in the fine print. The Populist Cytologist)

Objective

We studied whether atypical, non-superficial urothelial cells (AUC) could be separated into new subcategories including AUC ‘of undetermined significance’ (AUC-US) and ‘cannot exclude high grade’’ (AUC-H) in order to help to standardize urine cytopathology reports, as it is widely accepted in the Bethesda system for gynaecological cytopathology.

Methods

We investigated whether AUC-US and AUC-H, defined by distinctive cytological criteria, might be separated with statistical significance according to actual diagnosis and follow-up data. A series of 534 cyto-histological comparisons taken in 139 patients, including 221 AUC at various steps of their clinical history was studied. There were 513 (96.1%) postcystoscopy and 469 (87.8%) ThinPrep® liquid-based specimens (95.9% and 89.1% of AUC cases, respectively). Patients viewed between 1999 and 2011 had histological control in a 0- to 6-months delay and were followed-up during an additional 5.9 ± 9.2 (0- to 56-) months period.

Results

The 221 AUC represented 0.8–2% of the specimens viewed during the study period. Among AUC-H cases, 70 out of 185 (37.8%) matched with high-grade lesions, compared with 3 of 38 (8.3%) of AUC-US cases (P = 0.0003). Conservatively treated patients with AUC-H more frequently developed high-grade lesions than those with AUC-US (54.1% versus 16.7%, P = 0.0007) with a 17.6-months mean delay. Nuclear hyperchromasia, a nuclear to cytoplasm (N/C) ratio > 0.7 and the combination of both were the more informative diagnostic criteria, all with P < 0.01.

Conclusion

We conclude that the new subcategories could help to standardize urine cytopathology reports and contribute to the patient’s management, provided it is validated by multicentric studies.
About Jana Sullinger

GYN Pathologist and Cytopathologist. Special interest in quality assessment and use of online social media in sharing educational information about cytology and quality.

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