Cimino-Mathews Ashley, Ali Syed Z
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Acta Cytol. 2011;55(5):449-54. doi: 10.1159/000329867. Epub 2011 Oct 8.
Ileal neobladders (INBs) are routinely created in patients following cystectomy for urothelial carcinoma (UC). Patients are screened by urinary cytology for tumor recurrence. However, the diagnosis of urothelial atypia remains a nonstandardized category in INB specimens and has never been studied before.
The cytopathology archives from the Johns Hopkins Hospital were searched over a period of 19 years for specimens from patients with INB and atypical urine cytology. Follow-up surgical pathology results and clinical data were reviewed.
A total of 620 urine specimens were identified from patients with INB, 77 of which (12.4%) were diagnosed as 'atypical'. Of the 51 patients who were followed up, only 3 developed a concordant local recurrence (5.9% positive predictive value), defined as biopsy-proven recurrence within 1 year of atypical cytology. The recurrent patients had more diagnoses of 'atypical cells suspicious for carcinoma' than nonrecurrent patients (66 vs. 11.4%; p > 0.10).
A diagnosis of urothelial atypia in patients with INB is made as frequently as in patients with native bladders but with a lower positive predictive value (5.9 vs. 12%) for subsequent histologic diagnosis of UC. This suggests that the diagnosis of urothelial atypia in INB may have less clinical significance than in native bladders.
对于因尿路上皮癌（UC）行膀胱全切术的患者，常规创建回肠新膀胱（INB）。通过尿液细胞学检查对患者进行肿瘤复发筛查。然而，在INB标本中尿路上皮异型性的诊断仍是一个未标准化的类别，且此前从未被研究过。
对约翰霍普金斯医院19年间的细胞病理学档案进行检索，查找INB患者且尿液细胞学检查不典型的标本。回顾随访手术病理结果及临床数据。
共识别出620例INB患者的尿液标本，其中77例（12.4%）被诊断为“不典型”。在51例接受随访的患者中，仅3例出现一致的局部复发（阳性预测值为5.9%），定义为在不典型细胞学检查后1年内经活检证实的复发。复发患者中“可疑癌细胞的不典型细胞”诊断比未复发患者更多（66%对11.4%；p>0.10）。
INB患者尿路上皮异型性的诊断频率与天然膀胱患者相同，但对随后UC组织学诊断的阳性预测值较低（5.9%对12%）。这表明INB中尿路上皮异型性的诊断可能比天然膀胱中的临床意义更小。
