Department of Pathology and Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
James Buchanan Brady Urological Institute, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Diagn Cytopathol. 2022 Apr;50(4):176-183. doi: 10.1002/dc.24912. Epub 2021 Dec 6.
The study of atypia in urinary cytology has been ongoing for decades but most studies have focused primarily on test performance in patients with concurrent biopsies and/or limited follow-up periods. While these data are useful, many studies fail to consider patient factors that may alter the pretest probability, which can subsequently affect test performance. An isolated diagnosis of malignancy in urinary cytology usually has a high positive predictive value and allows a urologist to conduct a rigorous workup of the patient to establish a tissue diagnosis. However, it is less certain how an atypical diagnosis impacts patient care, given that many patients have a history of bladder cancer and are already under surveillance with cystoscopy at regular screening intervals. Furthermore, a discrete negative urine cytology is unlikely to allow a patient to forego a cystoscopy procedure due to limitations in the sensitivity of urine cytology. Over the last several years, the introduction of The Paris System for Reporting Urinary Cytology (TPS) has improved the predictive value of atypical diagnoses, but additional studies are needed to evaluate the performance of these diagnoses in specific clinical situations. Such data could better inform urologists on how to manage patients with atypical diagnoses. This review discussed the diagnosis of atypia in urinary cytology and the impact of such a diagnosis in various clinical contexts.
对尿细胞学非典型性的研究已经进行了几十年，但大多数研究主要集中在有活检和/或有限随访期的患者的检测性能上。虽然这些数据很有用，但许多研究未能考虑可能改变术前概率的患者因素，这可能会影响检测性能。尿细胞学中孤立的恶性肿瘤诊断通常具有较高的阳性预测值，可让泌尿科医生对患者进行严格的检查，以建立组织诊断。然而，鉴于许多患者有膀胱癌病史，并且已经在定期筛查间隔内通过膀胱镜进行监测，因此，非典型诊断如何影响患者的护理还不太确定。此外，由于尿细胞学的敏感性有限，离散的阴性尿细胞学不太可能使患者避免进行膀胱镜检查。在过去几年中，巴黎尿细胞学报告系统（TPS）的引入提高了非典型诊断的预测值，但需要进一步的研究来评估这些诊断在特定临床情况下的性能。这些数据可以更好地为泌尿科医生提供如何管理非典型诊断患者的信息。本文讨论了尿细胞学中非典型性的诊断以及这种诊断在各种临床环境中的影响。
