Cytologic and cystoscopic predictors of recurrence and progression in patients with low‐grade urothelial carcinoma

Abstract

BACKGROUND:Patients with low-grade urothelial carcinoma (LGUC) are at risk of recurrence and must undergo lifelong surveillance. To date, cytology and cystoscopy are the gold standard for the detection of de novo and recurrent LGUC.The objective of the current study was is to further characterize the role of cytology and cystoscopy in determining the risk of recurrence and progression in these patients. METHODS: The authors retrospectively identified patients with LGUC who had urine cytology within 2 months of biopsy, and data were abstracted from their electronic charts. Electronic medical records were reviewed for cystoscopic findings and histologic and cytologic follow-up data over a 5-year period. Statistical analysis was performed with chi-square tests. RESULTS: In total, 76 patients were identified who had histologic follow-up material available, and 49% of those patients demonstrated progression or recurrence of urothelial carcinoma.The initial presence of multiple lesions on cystoscopy was associated with any recurrence or progression (67.7% vs 31%; P ¼ .002), tumor size >2 cm was associated with initial positive or suspicious urine cytology (23.8% vs 3.7%; P ¼ .076), and positive or suspicious initial cytology was associated with high-grade recurrence (58.3% vs 19.4%; P ¼ .009). CONCLUSIONS:Cystoscopic findings, such as the presence of multiple lesions, together with concurrent positive or suspicious urine cytology, were associated with recurrence or progression of LGUC. These findings may help to identify highrisk patients. Cancer (Cancer Cytopathol) 2013;121:398-402.

Atypical Category of the Johns Hopkins Template Has Higher Risk of Malignancy than the Paris System but the Paris System Is More Applicable for Suspicious Category

“…Ironically, while Hopkins template has categorized LGUC cases as "negative" as suggested by the authors of the Paris system, the Paris system has tended to categorize LGUC cases as AUC, SHGUC, or HGUC in this study. A study confirmed our result: after the LGUC diagnosis, subsequent cytology resulted in atypical, suspicious, or positive category in 51.9% of cases [32]. Very recently, another study subgrouped LGUC within the NHGUC category [33].…”

Effect of the Paris system for reporting urinary cytology with histologic follow‐up

“…Kiyoshima et al 23 studied the prognostic significance of preoperative cytology in low grade non‐muscle invasive bladder cancer. They followed Papanicolaou classification, 24 and classified urine cytology as follows; class I/II, class III, and class IV/V, which were equivalent to negative, atypical, and suspicious/positive, respectively, as in the study by Jackson et al 25 Jackson et al reported that patients with positive/suspicious cytology had remarkably more frequent progression to HGUC compared with those with atypical/negative cytology ( P = .009). But they did not find any significant correlation between cytology and intravesical recurrence.…”

Performance Characteristics of Urinary Tract Cytology: Observations From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytopathology

“…This wide range of accuracy is primarily due to the bland nuclear features observed in low-grade lesions, making them difficult to distinguish from instrumentation artifact or urolithiasis. [4][5][6][7][8][9][10] The sensitivity of urine cytology for detecting low-grade lesions ranges between 26% and 45%, with a specificity of up to 98%. 5,11 In contrast, cytologic samples from HGUC or carcinoma in situ show a sensitivity of 70% to 90%, with a specificity that approaches 100%.…”