Diagnosis of Upper Tract Urothelial Carcinoma by Urinary Cytology: Evaluation of Its Efficacy and Limitations
Longwen Chen, Huiying He, Cristina Magi-Galluzzi, Ming Zhou. Mayo Clinic Arizona, Scottsdale, AZ; Cleveland Clinic, Cleveland, OH; New York University, New York, NY
Background: Primary upper urinary tract (UT) urothelial carcinoma (UC) is rare. Upper tract washing cytology is often used during UT surveillance. The diagnosis of UTUC with urinary cytology is often challenging. Reports regarding the efficacy of UT cytology are limited. We herein study the value of UT cytology in detecting UTUC in a large cohort.
Design: One hundred UT cytologic specimens were retrieved from our database during a ten-year period (2001-2011). For each patient, the cytology specimen with the highest degree of abnormality was selected. The histologic sections of these cases were also studied.
Results: Sixty-seven washings were obtained from ureter and 33 were from renal pelvis. 76 cases had histologic follow-up either by serial ureterorenoscopic biopsies or nephroureterectomy. Among them, the cytologic diagnosis of positive or suspicious for high-grade UC was made in 15 cases; suspicious for low-grade UC in 3 cases; atypical urothelial cells in 19 cases; and negative in 39 cases. Of the 15 washings with diagnosis of positive or suspicious for high-grade UC, 10 had histologically confirmed high-grade UC, 1 had low-grade UC on histology, and 4 had benign histology. All 3 cases of cytologically suspicious for low-grade UC had low grade UC on concomitant histology. Among the 19 washings with atypical urothelial cells, 7 were low-grade UC, 1 was high-grade UC; and 11 were benign on histology. Six of 39 cases with negative cytology had UC (3 low-grade and 3 high-grade) on histology. Combining positive and suspicious for UC diagnoses, sensitivity and specificity for detecting high-grade UC were 71.4% and 91.9%, while for low-grade UC were 21.4% and 100%, respectively.
Conclusions: UT washing cytology has high specificity for detecting high-grade UC. However, sensitivity for detecting UC is low, especially for low-grade UC. Practical value of UT washing cytology needs to be further evaluated in future studies.
Tuesday, March 20, 2012 9:30 AM
Poster Session III # 73, Tuesday Morning