Deshpande Vikram, McKee Grace T
Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Cancer. 2005 Dec 25;105(6):468-75. doi: 10.1002/cncr.21317.
Voided urine cytology continues to play a paramount role in the surveillance of transitional cell neoplasms and as a screening modality in certain high-risk situations. Although a significant number of samples are diagnosed as atypical, there is little known about the outcome of these patients. In addition, the significance of transitional cell fragments in voided urine samples is uncertain. The objective of the current study was to evaluate retrospectively a large series of voided urine specimens that were reported as atypical. Standard cytomorphologic parameters were used with the aim of refining the atypical category.
The authors studied 201 consecutive voided urine samples from 1995 that were evaluated by liquid-based cytology for the following features: specimen cellularity, the presence and number of cell clusters, and the architecture of the cell fragments. In addition, cells were examined for the following cytologic features: high nuclear-to-cytoplasmic ratios, nuclear membrane irregularities, hyperchromasia, India-ink nuclei, and chromatin pattern. Cytoplasmic features were evaluated but were limited significantly by poor preservation. Only specimens with a biopsy or cystoscopy and/or from patients who were followed for > 5 years were analyzed further.
In total, 23.4% of specimens showed transitional cell carcinoma (TCC) on biopsy, including 20 Grade 1 TCCs and 21 Grade 2 TCCs. Specimen cellularity, cluster numbers, nuclear membrane abnormalities, hyperchromasia, and India-ink nuclei were associated significantly with TCC. Twenty-six specimens (18.9%) were associated with renal calculi.
The atypical category contained a significant proportion of low-grade TCCs. Transitional cell clusters in voided urine are relevant clinically. The clinical picture, including the previous history of TCC and the presence of urinary calculi, provides valuable information when evaluating voided urine cytology. These features and careful attention to India-ink nuclei and nuclear membrane abnormalities could help make the "atypical" category a more meaningful group.
排尿细胞学检查在移行细胞肿瘤的监测以及某些高危情况下的筛查方式中仍起着至关重要的作用。尽管大量样本被诊断为非典型，但对这些患者的预后了解甚少。此外，排尿样本中移行细胞碎片的意义尚不确定。本研究的目的是回顾性评估大量报告为非典型的排尿标本。使用标准的细胞形态学参数以细化非典型类别。
作者研究了1995年连续的201份排尿样本，这些样本通过液基细胞学检查评估以下特征：标本细胞密度、细胞簇的存在和数量以及细胞碎片的结构。此外，检查细胞的以下细胞学特征：高核质比、核膜不规则、核深染、印戒核和染色质模式。对细胞质特征进行了评估，但由于保存不佳而受到显著限制。仅对有活检或膀胱镜检查和/或随访超过5年的患者的标本进行进一步分析。
总体而言，23.4%的标本在活检时显示移行细胞癌（TCC），包括20例1级TCC和21例2级TCC。标本细胞密度、细胞簇数量、核膜异常、核深染和印戒核与TCC显著相关。26份标本（18.9%）与肾结石有关。
非典型类别中包含相当比例的低级别TCC。排尿中的移行细胞簇具有临床相关性。临床情况，包括既往TCC病史和尿路结石的存在，在评估排尿细胞学检查时提供了有价值的信息。这些特征以及对印戒核和核膜异常的仔细关注有助于使“非典型”类别成为一个更有意义的组。
