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.
|# 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%|