McCroskey Zulfia, Bahar Burak, Hu Zhihong, Wojcik Eva M, Barkan Güliz A
Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois.
Department of Pathology, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois.
J Am Soc Cytopathol. 2015 Jul-Aug;4(4):183-189. doi: 10.1016/j.jasc.2014.11.002. Epub 2014 Nov 7.
The diagnosis "atypical urothelial cells (AUC)" remains an unresolved problem, making many urologists dissatisfied and confused about the management strategy on these cases. To date, a few inspiring attempts were made to subclassify AUC into "atypical urothelial cells of undetermined significance" (AUC-US) and "atypical urothelial cells cannot exclude high grade" (AUC-H). The aim of our study was to investigate the most predictive for high-grade urothelial carcinoma (HGUC) cytomorphologic parameters and whether the proposed classification can be implemented in our institution.
The electronic medical record system was searched for cytology specimens that were diagnosed as AUC from January 1, 2005 to March 1, 2013 and their relative clinical-pathological follow-up. All specimens were reviewed by an experienced cytopathologist by using 20 published "most predictive" for HGUC criteria.
A total of 162 AUC specimens were reclassified into 3 groups: AUC-H (n = 45), AUC-US (n = 51), and "negative for malignancy" (n = 66). The reclassification of AUC-H and "negative for malignancy" had 79% sensitivity, 77% specificity, 60% positive predictive value, and 89% negative predictive value to histologically proven HGUC diagnosis.
Our study demonstrated a good correlation between the presence of "HGUC-predictive" cytologic criteria and the final biopsy-proven HGUC in cytologic cases originally diagnosed as "atypical urothelial cells present." We identified 2 of the most predictive for HGUC on follow-up cytomorphologic parameters such as increased nuclear-cytoplasmic ratio >0.7 and coarse chromatin (16 abnormal cells per slide in average). These parameters, along with positive fluorescent in situ hybridization results can help during cytologic evaluation of urine specimens.
“非典型尿路上皮细胞（AUC）”的诊断仍是一个未解决的问题，这使得许多泌尿科医生对这些病例的管理策略感到不满和困惑。迄今为止，人们进行了一些鼓舞人心的尝试，将AUC细分为“意义未明的非典型尿路上皮细胞”（AUC-US）和“不能排除高级别病变的非典型尿路上皮细胞”（AUC-H）。我们研究的目的是调查对高级别尿路上皮癌（HGUC）最具预测性的细胞形态学参数，以及所提出的分类是否能在我们机构中实施。
在电子病历系统中搜索2005年1月1日至2013年3月1日期间诊断为AUC的细胞学标本及其相关的临床病理随访资料。所有标本均由一位经验丰富的细胞病理学家根据20条已发表的针对HGUC的“最具预测性”标准进行复查。
总共162份AUC标本被重新分类为3组：AUC-H（n = 45）、AUC-US（n = 51）和“恶性阴性”（n = 66）。AUC-H和“恶性阴性”的重新分类对经组织学证实的HGUC诊断具有79%的敏感性、77%的特异性、60%的阳性预测值和89%的阴性预测值。
我们的研究表明，在最初诊断为“存在非典型尿路上皮细胞”的细胞学病例中，“HGUC预测性”细胞学标准的存在与最终经活检证实的HGUC之间存在良好的相关性。我们在随访细胞形态学参数中确定了2个对HGUC最具预测性的指标，如核质比增加>0.7和染色质粗糙（每张玻片平均16个异常细胞）。这些参数，连同荧光原位杂交阳性结果，有助于尿液标本的细胞学评估。
