The clinicopathologic correlates of cellular atypia in urinary cytology of ileal neobladders.

OBJECTIVE

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.

STUDY DESIGN

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.

RESULTS

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).

CONCLUSION

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.