The merits of cytology in the workup for upper tract urothelial carcinoma - a contemporary review of a perplexing issue

Abstract

ARTICLE INFO ______________________________________________________________ ______________________Introduction: The importance of upper tract cytology for evaluating tumors is unclear. We correlated upper tract cytology with histologic findings in patients who underwent nephroureterectomy for upper tract urothelial carcinoma (UTUC) at a single tertiary care referral center. Materials and Methods: 137 patients underwent nephroureterectomy between 2004and 2012. 18 patients were excluded (benign tumors, atrophic kidneys with the remaining 119 patients serving as our study population). Upper tract cytology from the renal pelvis and/or ureter were retrospectively reviewed and analyzed with final pathology data in the remaining patients with UTUC.Results: 57% (68/119) had preoperative upper tract cytology collected. 73% (50/68) patients had abnormal cytology (positive, suspicious) with a sensitivity of 74% (which increased to 90% if atypical included), specificity of 50% and a positive predictive value of 98%. High grade tumors were more common than expected (77% high grade vs. 20% low grade). Abnormal cytology did not predict T stage or tumor grade. Interestingly, positive upper tract cytology was found in all of the UTUC CIS specimen. Conclusions: Upper tract cytology has been utilized to support the diagnosis of upper tract urothelial carcinoma. Our data demonstrates that abnormal cytology correlates well with the presence of disease but does not predict staging or grading in these respective patients.

The Paris System for reporting urinary cytology in daily practice with emphasis on ancillary testing by multiprobe FISH

“…Grade categories in cytology and histology do not always precisely predict the behaviour of UC, since aggressive low-grade UC exists. Cytological grading and categorisation of neoplastic cells from UUT can be particularly challenging, since the atypia tends to be more subtle even in neoplasms that behave aggressively 26 27. For endoscopically visible tumours in the UUT, the diagnosis of urothelial neoplasia usually suffices for further management since an excision of these tumours is aimed regardless of their grading, which is not considered as a strong prognostic factor in the UUT 28.…”

The Paris System for urine cytology in upper tract urothelial specimens: A comparative analysis with biopsy and surgical resection

“…In the literature, the false negative rate of diagnosing HGUC using UUT cytological specimens was approximately 26% using non‐TPS classification system . By contrast, the false negative rates varied wildly from 10% to as high as 31% when applying TPS to LUT cytological specimens .…”

A review of upper urinary tract cytology performance before and after the implementation of The Paris System

“…Studies have consistently demonstrated a higher accuracy rate for the detection HGUC and/ or muscle-invasive tumors (pT2-pT4) compared with LGUN and/or non-muscle invasive tumors (pTa-pT1) in UUT cytology. 22,26,29,32,33,39,45,48 However, Sverrisson et al 27 reported that abnormal UUT cytology was not predictive of tumor grade or disease stage.…”