Morency Elizabeth, Antic Tatjana
Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois.
Department of Pathology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, Illinois.
J Am Soc Cytopathol. 2014 Nov-Dec;3(6):295-302. doi: 10.1016/j.jasc.2014.06.002. Epub 2014 Jul 4.
The rate of atypical diagnoses in urine cytology can be high depending on the screening population. Unlike thyroid and cervical cytology, there is a lack of standardized criteria to stratify them into more clinically meaningful categories.
A set of diagnostic criteria described by Johns Hopkins Hospital (JHH) provided a tool to divide atypical urine specimens into those that were low risk and those likely to be predictive of high-grade urothelial carcinoma (HGUC). In this study, the JHH template was applied to a cohort of atypical urine cytology specimens from the University of Chicago (U of C) to compare it to existing U of C terminology and determine whether it should be formally adopted.
Sixty-eight percent of patients classified as atypical urothelial cells, favor high-grade lesion (AUC-H) were diagnosed with HGUC during the study. Correlation was noted between the JHH diagnostic categories and the U of C diagnostic categories, with 49% of patients reclassified as AUC-H being diagnosed with atypical urothelial cells, suspicious for neoplasia and 83% of cases of patients reclassified as atypical urothelial cells of unknown significance being diagnosed as atypical, urothelial cells. The JHH category of AUC-H had a higher positive predictive value for HGUC than the U of C category atypical urothelial cells, suspicious for neoplasm did (69% versus 58%, p = 0.0087). Unlike the JHH study, AUC-H showed higher correlation with HGUC in the hematuria group (90%) than in the surveillance group (66%).
JHH criteria demonstrated a higher rate of predicting HGUC than U of C diagnostic categories, supporting the adoption of these criteria at U of C.
根据筛查人群的不同，尿液细胞学中非典型诊断的比例可能会很高。与甲状腺和宫颈细胞学不同，目前缺乏将其分层为更具临床意义类别的标准化标准。
约翰霍普金斯医院（JHH）描述的一套诊断标准提供了一种工具，可将非典型尿液标本分为低风险标本和可能预测高级别尿路上皮癌（HGUC）的标本。在本研究中，将JHH模板应用于芝加哥大学（U of C）的一组非典型尿液细胞学标本，以将其与现有的U of C术语进行比较，并确定是否应正式采用该模板。
在研究期间，被归类为非典型尿路上皮细胞、倾向高级别病变（AUC-H）的患者中有68%被诊断为HGUC。注意到JHH诊断类别与U of C诊断类别之间存在相关性，重新分类为AUC-H的患者中有49%被诊断为非典型尿路上皮细胞、可疑肿瘤，重新分类为意义不明的非典型尿路上皮细胞的患者中有83%被诊断为非典型尿路上皮细胞。与U of C类别非典型尿路上皮细胞、可疑肿瘤相比，JHH的AUC-H类别对HGUC具有更高的阳性预测值（69%对58%，p = 0.0087）。与JHH研究不同，AUC-H在血尿组中与HGUC的相关性（90%）高于监测组（66%）。
JHH标准在预测HGUC方面显示出比U of C诊断类别更高的比率，支持在U of C采用这些标准。
