Chen Longwen, He Huiying, Zarka Matthew A, Zhou Ming, Magi-Galluzzi Cristina
Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA ; Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathology, Peking University, Health Science Center, Beijing, China.
Cytojournal. 2015 Jul 28;12:17. doi: 10.4103/1742-6413.161608. eCollection 2015.
Primary upper urinary tract (UT) urothelial carcinoma (UC) is rare. UT washing cytology is often used during UT surveillance. The Johns Hopkins Hospital template (JHHT) is primarily designed to use on lower tract urine cytology and the data on applying JHHT on UT cytology is limited. We herein study the value of UT cytology in detecting UTUC using JHHT in a cohort.
One hundred UT cytologic specimens were retrieved from our database during a 10-year period (2001-2011). For each patient, the cytology specimen with the highest degree of abnormality was selected. Histologic sections of these cases were also studied.
Seventy-six cases of UT cytology had histologic follow-up by either serial (>2) endoscopic biopsies or nephroureterectomy or ureterectomy. Among them, the cytologic diagnosis of positive or suspicious for high-grade UC (HGUC) was made in 15 cases; suspicious for low-grade UC (LGUC) in 3 cases; atypical urothelial cells (AUCs) of undetermined significance in 19 cases; and negative in 39 cases. Of the 15 cases with diagnosis of positive for HGUC or AUC-HGUC (AUC-H), 10 had histologically confirmed HGUC, 1 had LGUC, and 4 had benign histology. All 3 cases of cytologically suspicious for LGUC had LGUC on concomitant histology. Among the 19 washings with AUCs with unknown significance, 7 were LGUC, 1 was HGUC, and 11 were benign on histology. Six of 39 cases with negative cytology had UC (3 low-grade and 3 high-grade) on histology. Combining positive and AUC-H for UC diagnoses, sensitivity, and specificity for detecting HGUC were 71.4% and 91.9%, while for LGUC were 21.4% and 100%, respectively.
UT washing cytology has high specificity for detecting UC, especially HGUC. Using JHHT on UT washing cytology is feasible, but the category of LGUC may need modification.
原发性上尿路（UT）尿路上皮癌（UC）较为罕见。UT冲洗细胞学检查常用于UT监测。约翰霍普金斯医院模板（JHHT）主要设计用于下尿路尿液细胞学检查，而将JHHT应用于UT细胞学检查的数据有限。我们在此研究在一个队列中使用JHHT进行UT细胞学检查在检测UTUC中的价值。
在10年期间（2001 - 2011年）从我们的数据库中检索了100份UT细胞学标本。对于每位患者，选择异常程度最高的细胞学标本。还对这些病例的组织学切片进行了研究。
76例UT细胞学病例通过连续（>2次）内镜活检或肾输尿管切除术或输尿管切除术进行了组织学随访。其中，15例细胞学诊断为高级别UC（HGUC）阳性或可疑；3例为低级别UC（LGUC）可疑；19例为意义未明的非典型尿路上皮细胞（AUC）；39例为阴性。在诊断为HGUC阳性或AUC - HGUC（AUC - H）的15例中，10例经组织学证实为HGUC，1例为LGUC，4例组织学为良性。所有3例细胞学可疑为LGUC的病例在同期组织学检查中均为LGUC。在19例意义未明的AUC冲洗液中，7例为LGUC，1例为HGUC，11例组织学为良性。39例细胞学阴性病例中有6例组织学为UC（3例低级别和3例高级别）。将UC诊断的阳性和AUC - H合并计算，检测HGUC的敏感性和特异性分别为71.4%和91.9%，而检测LGUC的敏感性和特异性分别为21.4%和100%。
UT冲洗细胞学检查在检测UC方面具有较高的特异性，尤其是HGUC。在UT冲洗细胞学检查中使用JHHT是可行的，但LGUC类别可能需要修改。
