Urothelial Carcinoma Either Arising in the Renal Pelvis or Upper Urinary Tract: A Retrospective Analysis and Cytological-Histological Correlation of a Consecutive Series
S Hooda, AV Parwani. University of Pittsburgh, Pittsburgh, PA
Background: Although cytology of washings from upper urinary tract are used for the early detection and surveillance of urothelial carcinoma from renal pelvis/upper tract, there is paucity of information on the outcomes of cytologic-histologic discrepancies. We obtained histologic follow-up on a series of upper tract urinary cytologic specimens from a single institution to determine the diagnostic discrepancy frequency and outcomes.
Design: We performed a retrospective analysis of 50 consecutive patients with urothelial carcinoma either arising in the renal pelvis or involving the renal pelvis/upper urinary tract.We searched the laboratory information system (LIS) (Copath plus) for cytologic examination of urinary samples/genitourinary washings of these patients. The cytology and histology reports were reviewed and follow-up was obtained.
Results: The cytology specimens included genitourinary washings, voided urine samples and instrumented urine specimens. Most of the patients had 2-3 cytologic specimens. Of the cases included in the study, 40 cases were high grade urothelial carcinoma and 10 cases were low grade urothelial carcinoma. The cytologic examination of high grade urothelial carcinoma was concordant with histologic results in 24 (60%) of cases,7 (17%) cases were negative or reactive atypical cells and 9 (22%) cases were classified as “atypical urothelial cells, not further classified” Among the low grade urothelial carcinomas, the cytologic examination was concordant in 3 (30%) of the cases. 1 case was reported as high grade urothelial carcinoma, 1 case was reactive while the remaining 5 (50%) cases were reported as atypical without further classification.
Conclusions: The sensitivity of GU washings to sample upper urinary tract, targeting the renal pelvis lesions is 60%. The cytological diagnosis of “atypical not further classified category” is rendered in a large percentage of cases, several of which were neoplastic on follow-up. It may be useful to classify these further on cytology as either favor reactive or neoplastic to improve specificity of this diagnostic modality. As expected, the concordance among cytologic examination and histologic examination is much higher in high grade urothelial carcinoma than in low grade urothelial carcinoma.
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 101, Tuesday Morning