Diagnostic accuracy and key cytologic features of high-grade transitional cell carcinoma in the upper urinary tract.

This study examined the diagnostic accuracy of upper urinary tract cytology and defined key cytologic criteria by logistic regression analysis for the diagnosis of high-grade transitional cell carcinoma (TCC). The upper urinary tract cytologic diagnosis was retrospectively reviewed for 153 patients, and diagnostic accuracy was calculated. Cases were scored for the presence or absence of 32 cytomorphologic criteria, and key features to distinguish high-grade TCC from benign lesions were assessed. There were two false-positive and four false-negative diagnoses of TCC. Likelihood ratios for the diagnoses of benign, atypical, suspicious, and TCC were 0.2, 1.4, 3.9, and 32.8, respectively. Regression analysis showed that the cytologic features of aniso-nucleosis, high nuclear/cytoplasmic ratio, and nuclear overlapping were important in the separation of high-grade TCC from benign lesions. We conclude that by using these criteria, the accuracy of diagnosis of high-grade TCC could be improved.