Brimo Fadi, Xu Bin, Kassouf Wassim, Ahmadi-Kaliji Babak, Charbonneau Michele, Nahal Ayoub, Kanber Yonca, Caglar Derin, Auger Manon
Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.
Department of Pathology, McGill University Health Center and McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada.
J Am Soc Cytopathol. 2015 Jul-Aug;4(4):232-238. doi: 10.1016/j.jasc.2015.01.003. Epub 2015 Jan 13.
This study presents a detailed and systematic morphological and quantitative analysis of urine cytology specimens in order to determine which qualitative and quantitative features are mostly associated with high-grade urothelial carcinoma (HGUCA).
This study included 112 urine cytology cases with a surgical follow-up within 1 year that were originally reported as "atypical," "suspicious for HGUCA," or "positive for HGUCA." The morphological characteristics as well as the number of abnormal cells were correlated with a diagnosis of HGUCA on follow-up biopsy.
Multivariate analysis showed that the presence of hyperchromatic atypical cells with nuclear-cytoplasmic ratio ≥ 0.7 was an independent predictor of HGUCA. Similarly, irregular nuclear membranes, single cells, and pleomorphism correlated with surgical outcome whereas eccentric nuclear location, prominent nucleoli, nuclear-cytoplasmic ratio between 0.5 and 0.7 did not. Cases with ≤10 atypical cells had significantly lower rates of subsequent HGUCA than did those with >10 atypical cells (58% versus 77%). Cases with ≤5 atypical cells (n = 26) showed similar prediction rates (58%) for HGUCA than did those with 6 to 10 atypical cells (n = 12).
The number of atypical urothelial cells is an important criterion that should be taken into account when assigning cases to the "positive" or the "suspicious" categories. A preliminary cutoff of 10 cells appears to be easily applicable and valid from the clinical standpoint.
本研究对尿细胞学标本进行了详细且系统的形态学和定量分析，以确定哪些定性和定量特征与高级别尿路上皮癌（HGUCA）最为相关。
本研究纳入了112例尿细胞学病例，这些病例在1年内接受了手术随访，最初报告为“非典型”、“疑似HGUCA”或“HGUCA阳性”。将形态学特征以及异常细胞数量与随访活检时的HGUCA诊断相关联。
多变量分析显示，核质比≥0.7的深染非典型细胞的存在是HGUCA的独立预测指标。同样，核膜不规则、单个细胞和多形性与手术结果相关，而核偏心定位、核仁突出、核质比在0.5至0.7之间则无关。非典型细胞≤10个的病例后续发生HGUCA的比率显著低于非典型细胞>10个的病例（58%对77%）。非典型细胞≤5个（n = 26）的病例与非典型细胞为6至10个（n = 12）的病例对HGUCA的预测率相似（58%）。
非典型尿路上皮细胞数量是在将病例归类为“阳性”或“疑似”类别时应考虑的重要标准。从临床角度来看，10个细胞的初步临界值似乎易于应用且有效。
