[406] Evaluation of Atypical Urine Cytology Progression to Malignancy: An Eleven-Year Retrospective Review

Julianne Muus Ubago, Eva M Wojcik, Guliz A Barkan. Loyola University Medical Center, Maywood, IL

Background: In urine cytology, the diagnosis of atypia is subjective and clinical management based on these results can be difficult to determine. In this study, we determined the percentage of atypical urine diagnoses that progressed to positive cytology or surgical pathology results over an eleven year period.
Design: In a retrospective review of urinary tract specimens at our institution, we identified 1320 atypical urine cytology diagnoses from 851 patients performed from January 2000 through December 2010. We then reviewed all subsequent pathology reports to determine which patients developed positive cytology/surgical pathology diagnoses. In total, 4106 cytology and surgical pathology specimen reports were reviewed.
Results: At our institution, 8.1% (1320 of 16299) of urine cytology specimens were diagnosed as atypical during the eleven year period. Overall, 271 of 1320 initial atypical urine specimens (21%) progressed to positive cytology or surgical pathology results, with a mean time to progression of 155 days and median time of 43 days. The mean patient age at first atypical cytology diagnosis was 66 years (range 15 to 99 years) consisting of 604 male and 247 female patients.
Of the cases that progressed to malignancy, 118 were high grade (HG) (including high grade urothelial carcinoma, carcinoma in situ, invasive carcinoma, and urothelial metastasis) and 92 were low grade urothelial carcinoma (LG). Furthermore, 17 were found to be other primary cancers/metastasis (9 prostate, 7 renal clear cell, and 1 lung) and 44 cases had positive cytology results with no positive surgical pathology follow-up.

Rate of Atypia in Urinary Tract Specimens and Progression to Malignancy

	# Atypical (n)	% Atypical	# Progressed to Positive (n, %)	# Progressed to LG Urothelial Carcinoma (n)	% LG	# Progressed to HG Urothelial Carcinoma (n)	% HG
Bladder Barbotage/Washing	869	8.9%	189 / 22%	74	39%	81	43%
Voided Urine	291	8.7%	41 / 14%	12	29%	17	41%
Upper Tract Urine	82	3.8%	31 / 38%	5	16%	17	55%
Urinary Diversion	60	16%	7 / 12%	0	0%	2	29%
Catheterized Urine	18	5.2%	3 / 17%	1	33%	1	33%
Total	1320	8.1%	271 / 21%	92	34%	118	44%

Conclusions: The rate of atypia in urine specimens at our institution is 8.1%. Of the specimen types, atypia was most commonly seen in urinary diversion specimens (16%) and the least common in upper tract cytology (3.8%). When diagnosed as atypical, upper tract specimens had the highest percentage of progression to high grade carcinoma. Therefore we postulate that the diagnosis of atypia in this specimen group has higher clinical significance and should be more aggressively managed.
Category: Cytopathology

Tuesday, March 20, 2012 11:45 AM

Platform Session: Section F, Tuesday Morning