Cytology for the Diagnosis and Surveillance of Upper Urothelial Tract Carcinoma – A Single Cancer Center Experience
Jasreman Dhillon, Philippe E Spiess, Wade J Sexton, Julio M Pow-Sang, Barbara A Centeno. Moffitt Cancer Center, Tampa, FL
Background: Upper urinary tract (UUT) urothelial carcinoma (UC) is difficult to sample with routine biopsy devices due to the confined anatomy of the renal pelvis and ureter. This study highlights the merits of cytology for diagnosis of UUT UC.
Design: Patients with UUT cytology samples collected at our institution from 01/2009 to 12/2009 were identified from the LIS under an IRB approved protocol. Results of UUT brushings, washings, biopsies, and resection specimens were analyzed. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was calculated for cytology samples. The final diagnosis was established based on biopsy/resection specimens and clinical follow up.
Results: Thirty-four cases were retrieved (13 brushings, 31 washings) from 31 patients (22 males, 9 females). 13 patients were under surveillance for a prior UC. Table 1 shows the results for all sample types compared to the final diagnosis. Brushings were diagnostic in 12 of 13 cases (Table 2). Washings were diagnostic in all 31 cases (Table 2). For the purpose of statistical analysis, benign and atypical diagnoses were considered as negative and suspicious and malignant diagnoses were considered as positive. In our study, washings (sensitivity = 71%, specificity = 90%, PPV = 94% and NPV = 60%) yielded better results as compared to brushings (sensitivity = 60%, specificity = 50%, PPV = 86%, NPV = 20%). Calculi caused two false positives (1 brushing, 1 washing). Two HG UUTUC had only urine cytology samples which were negative. Seventeen patients had biopsies, and sixteen patients underwent nephroureterctomy/ureterectomy. Clinical follow-up was obtained on all 31 patients.
|Diagnosis||Number||Unsatisfactory||Benign||LG UC||HG UC||CIS||UC NOS|
|Diagnostic Modality||Benign||LG UC||HG UC||UC, NOS|
|Brushings - Benign/Atypical (n = 5)||1||1||3||0|
|Brushings - Positive/Suspicious (n = 7)||1||0||6||0|
|Washings - Benign/Atypical (n = 15)||9||3||3||0|
|Washings - Positive/Suspicious (n = 16)||1||1||12||2|