The Johns Hopkins Hospital template for urologic cytology samples

Abstract

BACKGROUND: The most important indicator for urologic surgeons at The Johns Hopkins Hospital to have a patient undergo cystoscopy is a cytologic diagnosis of high‐grade urothelial carcinoma. The template was designed to standardize diagnostic categories so clinicians can manage their patients uniformly. The template was based in part on the Bethesda System for cervical cytology. METHODS: According to the template, reactive/inflammatory changes were included in the negative group (no urothelial atypia or malignancy identified). The category atypical urothelial cells of undetermined significance (AUC‐US) was akin to atypical squamous cells of undetermined significance (ASC‐US), as was the category of atypical urothelial cells, favor high‐grade carcinoma (AUC‐H). The categories high‐grade urothelial carcinoma (HGUC) and low‐grade urothelial carcinoma also were added. RESULTS: The Pathology Data System at the Johns Hopkins Hospital was searched for cases that met the following criteria over a period from July 1, 2007 to June 30, 2009: all cytologic specimens from the urinary tract and all surgical specimens with a diagnosis of HGUC, regardless of invasion status. All cytologic specimens were then matched with biopsies during the same period, and all surgical specimens from patients who had a cytologic diagnosis of AUC‐US or AUC‐H were retrieved for 18 months after the end of the 2‐year study period. Greater than 50% of patients who had biopsy‐confirmed HGUC had a preceding cytologic diagnosis of AUC‐H or HGUC. When patients with AUC‐US were added to the analysis, 80% of patients with HGUC had at least 1 abnormal urinary cytology result. Of those patients who had a diagnosis of AUC‐H, 38% had urothelial cancer discovered at biopsy compared with only 10% of those with an AUC‐US diagnosis. CONCLUSIONS: The authors concluded that their template is effective in targeting those patients who need to undergo cystoscopy. Cancer (Cancer Cytopathol) 2013;121:15–20 © 2012 American Cancer Society.

Urine cytology: does the number of atypical urothelial cells matter? A qualitative and quantitative study of 112 cases

“…Among those features, hyperchromasia has consistently been shown to be an independent predictor of HGUCA; however, because it has also been frequently reported in LGUCA, it makes it an essential but nondiscriminatory feature between low-grade and high-grade urothelial lesions. 6,[8][9][10][11][12] Similarly, irregular nuclear membranes, although most often reported in specimens harboring HGUCA, can also be present in LGUCA and even in certain reactive conditions, in particular stone atypia. 4,5,9 At least 3 studies, including the current one, have reported a significant association between pleomorphism and subsequent HGUCA, making it a powerful feature in assessing urine cytology specimens and in differentiating low-grade from high-grade tumors.…”

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

“…4 ), the long debated category by different authors [2][3][4][5][6][7][8][9] . In fact, our study showed Values are expressed as n (%).…”

Evaluation of Sienna Cancer Diagnostics hTERT Antibody on 500 Consecutive Urinary Tract Specimens

“…Diagnoses were made using the Johns Hopkins Template for Reporting Urinary Tract Cytology (JHHT) because the Paris System for Reporting Urinary Tract Cytology had not yet been established at JHH during this study period [20-22]. The JHHT utilized a malignant category, “high-grade urothelial carcinoma” (HGUC), a benign category, “no urothelial atypia or malignancy” (NUAM), a low-risk indeterminate category, “atypical urothelial cells of undetermined significance” (AUC-US), and a high-risk indeterminate category, “atypical urothelial cells, cannot exclude HGUC” (AUC-H).…”