Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
Cancer Cytopathol. 2013 Jan;121(1):21-8. doi: 10.1002/cncy.21254. Epub 2012 Nov 28.
Urine cytology represents a major portion of testing volume in many cytopathology laboratories.
The authors previously reported a template designed to standardize urothelial diagnostic categories to enable clinicians to uniformly manage their patients. In this study, they examined the common cytomorphologic features observed in specimens diagnosed with atypical urothelial cells, cannot exclude high-grade urothelial carcinoma (AUC-H), which prove most predictive of high-grade urothelial carcinoma (HGUC).
The most common morphologic features observed in the AUC-H specimens were hyperchromasia, irregular nuclear borders, increased nucleus-to-cytoplasm ratio, and anisonucleosis. Of the 58 patients who had specimens diagnosed with AUC-H, 95% ultimately were diagnosed with HGUC on follow-up biopsy over the study period. The small number of patients who had AUC-H with non-HGUC follow-up did not allow for a statistical comparison to determine the predictive ability of the selected criteria for HGUC. Next, the authors used the same features to examine a subset of urine samples that were diagnosed with atypical urothelial cells of unknown significance (AUC-US) in an attempt to improve the predictive value of this clinically frustrating category. A blind review was performed of 290 urine specimens from 217 patients. In contrast to the AUC-H specimen cohort, the majority of specimens with AUC-US did not contain atypical cells with the 4 common morphologic features. All 4 features significantly predicted HGUC in surveillance patients, but not in patients with hematuria.
Hyperchromasia was the strongest predictor of HGUC by far in patients who were undergoing surveillance (odds ratio, 9.81). Hyperchromasia remained statistically significant in multivariate analysis, indicating its predictive strength even in the absence of other features.
尿液细胞学检查代表了许多细胞病理学实验室检测量的主要部分。
作者之前报告了一个模板，旨在将尿路上皮诊断类别标准化，使临床医生能够统一管理他们的患者。在这项研究中，他们检查了在诊断为非典型尿路上皮细胞、不能排除高级别尿路上皮癌（AUC-H）的标本中观察到的常见细胞学特征，这些特征最能预测高级别尿路上皮癌（HGUC）。
在 AUC-H 标本中观察到的最常见的形态学特征是核深染、核边界不规则、核浆比增加和核大小不均。在研究期间，58 例诊断为 AUC-H 的患者中，95%的患者最终在随访活检中被诊断为 HGUC。AUC-H 伴非 HGUC 随访的患者数量较少，无法进行统计学比较，以确定所选 HGUC 预测标准的预测能力。接下来，作者使用相同的特征检查了一组尿液样本，这些样本在诊断为意义不明的非典型尿路上皮细胞（AUC-US）时被诊断为非典型尿路上皮细胞，试图提高这一临床上令人沮丧的类别。对 217 例患者的 290 份尿液标本进行了盲法复查。与 AUC-H 标本队列相比，大多数 AUC-US 标本不含有具有 4 种常见形态学特征的非典型细胞。所有 4 种特征在监测患者中均显著预测 HGUC，但在血尿患者中则不然。
迄今为止，在接受监测的患者中，深染是预测 HGUC 的最强指标（优势比为 9.81）。在多变量分析中，深染仍然具有统计学意义，表明即使在没有其他特征的情况下，其预测强度仍然很高。
