The value of the UroVysion® FISH assay in the risk‐stratification of patients with “atypical urothelial cells” in urinary cytology specimens

Virk, Renu K.; Abro, Schuharazad; Ubago, Julianne M.; Pambuccian, Stefan E.; Quek, Marcus L.; Wojcik, Eva M.; Mehrotra, Swati; Chatt, Grazina; Barkan, Güliz A.

doi:10.1002/dc.23686

Cited by 26 publications

(20 citation statements)

References 77 publications

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“…Similar to the current study, Virk et al found high specificity of FISH when applied to cases diagnosed as AUS . Miki et al, however, found high specificity of FISH in their cases originally diagnosed as atypical, but extremely low specificity when using the TPS definition of AUS . It should be noted, however, that within our particular cohort no cases representative of HGUC were diagnosed as atypical.…”

Section: Discussionsupporting

confidence: 84%

“…24 Miki et al, however, found high specificity of FISH in their cases originally diagnosed as atypical, but extremely low specificity when using the TPS definition of AUS. 25 It should be noted, however, that within our particular cohort no cases representative of HGUC were diagnosed as atypical. Unlike these studies, however, we sought to evaluate the performance in the context of individual morphological features.…”

Section: Discussionmentioning

confidence: 62%

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Applying the Paris system for reporting urine cytology to challenging cytology cases

Glass

Rosca

Raab

et al. 2019

Diagnostic Cytopathology

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Background Implementing the Paris system for reporting urine cytology (TPS) can substantiate atypical diagnosis while improving standardization and risk stratification. This study evaluates its performance and reproducibility in challenging cases and examines whether focused education of morphological features can improve outcomes. Methods In our prior study, urine cytology cases diagnosed as “atypical” with surgical follow‐up were used. Cases showing poor agreement in that study were collected for this one. Representative photographs of each case were taken and distributed via online questionnaires. Participants were asked to render an initial diagnosis and evaluate the presence of several morphological features. Educational material was distributed, followed by additional questionnaires. Results Three participants evaluated 40 cases before and after educational materials. TPS diagnoses were significantly more specific (0.23 vs 0.59, P = 0.004) and more accurate (0.43 vs 0.66, P = 0.0125) than diagnoses made with our institutional system. Fewer overall cases were diagnosed as “atypical” with TPS. TPS education resulted in slightly, though not significantly, more specific diagnoses (0.25 vs 0.59, P = 0.083). Interobserver agreement decreased for nuclear‐to‐cytoplasmic (N/C) ratio, TPS diagnoses and initial diagnoses, and increased for all other features. TPS resulted in downgrading of cases with biopsy‐proven low grade urothelial neoplasm (LGUN) from “atypical” to negative for high grade urothelial carcinoma (NHGUC) (P = 0.018). Conclusions Use of TPS in challenging urine cytology cases can improve specificity, risk stratification, and diagnostic accuracy while decreasing the number of “atypical” diagnoses. Though training can help cytopathologists better apply these criteria, it is unclear how to effectively improve evaluation of N/C ratio.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 62%

Applying the Paris system for reporting urine cytology to challenging cytology cases

Glass

Rosca

Raab

et al. 2019

Diagnostic Cytopathology

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“…Therefore, accurate assessment of the N/C ratio close to cutoffs is a key training objective and should be emphasized in continuing education or training programs related to TPS. In addition, employment of ancillary tests, such as immunocytochemistry for p16 and Ki-67 or Urovysion fluorescence in situ hybridization (FISH), may help improve the risk stratification in the intermediate group [24,25]. A combination of cytomorphological assessment and ancillary testing would provide more accurate results for patient management.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Agreement for High-Grade Urothelial Cell Carcinoma in Atypical Urine Cytology: A Nationwide Survey Reveals a Tendency for Overestimation in Specimens with an N/C Ratio Approaching 0.5

Wang

Hang

Wen

et al. 2020

Cancers

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In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, p < 0.01). Three cases with an N/C ratio near 0.5 were overestimated. Poor interobserver concordance of diagnosis and TPS criteria was revealed. Compared with other cytological features, the N/C ratio assessment was quantitative and more reproducible, but a tendency to overestimate cells was noted when the N/C ratio was approximately 0.5. Continuing education programs should emphasize the accurate assessment of N/C ratio to improve the application of TPS.

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“…Even in such clinical circumstances, one should be cognizant of false-positive results, which can arise from tetraploid umbrella cells and polyomavirus cytopathic changes. 5 In a study by Virk et al, 6 the sensitivity of UroVysion was reported to be 44.6% and the false-positive rate to be 53% in equivocal urine cytology cases. In addition, it is noteworthy that in cases of equivocal urine cytology, a negative UroVysion test does not rule out low-grade or high-grade urothelial carcinoma.…”

Section: Discussionmentioning

confidence: 98%

Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology

Barkan

Tabatabai

Kurtycz

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known. Objective.— To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. Design.— A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. Results.— Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. Conclusions.— Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.

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The value of the UroVysion® FISH assay in the risk‐stratification of patients with “atypical urothelial cells” in urinary cytology specimens

Abstract: U-FISH allows risk stratification in patients with AUC. However, its usefulness is diminished by the high false-positive rate, making it important to interpret U- FISH results in the patient's clinical context. Diagn. Cytopathol. 2017;45:481-500. © 2017 Wiley Periodicals, Inc.

Cited by 26 publications

References 77 publications

Applying the Paris system for reporting urine cytology to challenging cytology cases

Applying the Paris system for reporting urine cytology to challenging cytology cases

Diagnostic Agreement for High-Grade Urothelial Cell Carcinoma in Atypical Urine Cytology: A Nationwide Survey Reveals a Tendency for Overestimation in Specimens with an N/C Ratio Approaching 0.5

Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology

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