Kapur Umesh, Venkataraman Girish, Wojcik Eva M
Department of Pathology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
Cancer. 2008 Aug 25;114(4):270-4. doi: 10.1002/cncr.23656.
Urine cytology plays an important role in monitoring patients with a history of urothelial carcinoma. Because it is difficult to reliably discriminate artifacts induced by instrumentation, inflammation, or therapy those of from malignant cells, many of these specimens are categorized as atypical. The objective of the current study was to study the prevalence and significance of atypical urine cytology with regard to the effect of instrumentation and prior biopsy.
All urine cytology cases seen during a 4-year period (2001-2004) with a diagnosis of atypical urothelial cells (AU) were obtained from the cytopathology computer database. In all cases with available surgical follow-up, the following data were extracted: total number and type of urine specimen, the primary histologic diagnosis, and follow-up histologic diagnosis.
In all, 1653 voided and 3502 instrumented urine specimens were examined. A diagnosis of AU was rendered in 115 (6.9%) of the voided urine specimens and in 277 (7.9%) of the instrumented specimens. Follow-up histology was available in 70 cases, including 55 instrumented and 15 voided urine specimens. A nonbenign follow-up diagnosis was observed in 18 of 55 (32.7%) cases in the instrumented group and in 7 of 15 (46.6%) cases in the voided group. Voided urine was marginally associated with a worse subsequent biopsy diagnosis (Pexact Monte Carlo = .09)
An AU diagnosis is more predictive of a subsequent adverse biopsy diagnosis in voided urine specimens compared with instrumented urines. In the absence of a benchmark for the atypia rate, it is prudent to keep the atypia rate low to keep it more meaningful. This important category should be used by the pathologist to convey concern and recognize the difficulty in interpretation of specimens that may require close follow-up.
尿细胞学检查在监测尿路上皮癌病史患者中发挥着重要作用。由于难以可靠地区分由器械操作、炎症或治疗引起的假象与恶性细胞所致的假象，许多此类标本被归类为非典型。本研究的目的是探讨非典型尿细胞学检查在器械操作和既往活检影响方面的患病率及意义。
从细胞病理学计算机数据库中获取2001年至2004年4年间所有诊断为非典型尿路上皮细胞（AU）的尿细胞学病例。在所有有手术随访资料的病例中，提取以下数据：尿标本的总数和类型、原发性组织学诊断以及随访组织学诊断。
共检查了1653份自然排尿尿标本和3502份经器械采集的尿标本。自然排尿尿标本中有115份（6.9%）诊断为AU，经器械采集的标本中有277份（7.9%）诊断为AU。70例有随访组织学结果，包括55份经器械采集的尿标本和15份自然排尿尿标本。经器械采集组的55例中有18例（32.7%）随访诊断为非良性，自然排尿组的15例中有7例（46.6%）随访诊断为非良性。自然排尿与随后较差的活检诊断有轻微关联（精确蒙特卡罗检验P = 0.09）。
与经器械采集的尿液相比，自然排尿尿标本中AU诊断对随后不良活检诊断的预测性更强。在缺乏非典型率基准的情况下，谨慎地保持较低的非典型率使其更具意义。病理学家应利用这一重要类别来表达关注，并认识到对可能需要密切随访的标本进行解读的困难。
