12 The major diagnostic categories that we use at our laboratory are presented in Table 7-1. Cytology is useful to detect carcinoma in situ or marked chronic inflammation (i.e. Frequently, the request form arrives with no clinical details, which can lead to misinterpretation of the changes by the reporting cytopathologist. The test commonly checks for infection, inflammatory disease of the urinary tract, cancer, or precancerous conditions. The hypercellular specimen contains abundant mixed inflammatory cells including neutrophils, lymphocytes, and histiocytes. These tissues must be treated with strong acids or other chemicals to remove the minerals so that the tissue becomes soft enough to be thinly sectioned (sliced). We use cookies to help provide and enhance our service and tailor content and ads. Karen S. Gustafson, Douglas P. Clark, in Cell and Tissue Based Molecular Pathology, 2009. The bladder tumor may be palpable on rectal examination. Urine cytology is a test to screen a patient’s urine for cancer cells. The cytoplasm contains degenerative vacuoles. The American Cancer Society estimated that there would be more than 60,000 new cases of bladder cancer in the United States in the 2006. Fresh urine cytology on voided urine may reveal clumps of epithelial cells associated with RBCs and few WBCs. A cytology report recorded as suspicious is not considered as diagnostic of cancer and unless supported by a positive biopsy (as reported on a pathology report) or by a clinical impression of cancer, these cases should not be abstracted. Patients with uncomplicated HC do not normally have significant BK viraemia (i.e. Distinction between sloughed neoplastic cells and inflammatory urothelial cell changes may be difficult. Sarah McAchran, ... Sandip Vasavada, in Neuromodulation, 2009. Introduction. Urine cytology is, at best, only moderately sensitive in detecting bladder cancer. Urine collection: cytology. The current 5th edition AJCC staging system, introduced in 1997, is provided in Fig. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Negative. Bladder wall trabeculation may help to confirm a clinical suspicion of bladder outlet obstruction or neurogenic pathology. Urine cytology examination is used as a diagnostic measure in the diagnosis of cancer and urinary tract infection. Low-grade UCs are detected less reliably by cytology, as compared to high-grade UCs.34,35,39-41 Finally, the sensitivity of urine cytology is reduced in patients who have been treated with radiation or chemotherapy.35 Molecular cytogenetic analysis using the fluorescence in situ hybridization (FISH) method shows promise in improving on the sensitivity of cytology. Turnaround time is defined as the usual number of days from the date of pickup of a specimen for Technique I (routine): One hour after collection of discarded specimen, have patient void and save the specimen. Bladder cancer - current status. Because of the absence of staining in a wet preparation, these are better limited to examination for crystals and RBCs. URINE CYTOLOGY KIPRONO FELIX H31/2244/2011 UNIVERSITY OF NAIROBI S U P E R V I S E D B Y D R N D U N G ’ U 25TH JULY 2 0 1 4 2. It is also possible that the specific patterns of aneuploidy or deletion may correlate with recurrence or progression. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. The bladder tumor antigen test (V-BTA Test; Polymedco, Cortlandt Manor, N.Y.) detects the presence of tumor antigens in urine. What is urine cytology ? The basic evaluation should include a medical and social history, physical examination with additional tests, and a urinalysis (Urinary Incontinence Guideline Panel, 1992). Commercially available assays for two tumour markers present in urine have been approved by the United States Food and Drug Administration (FDA) for the detection of recurrent bladder cancer. When cytology results show cancer, often a biopsy is also done to be sure before treatment is started. Low-grade papillary transitional cell or urothelial carcinomas may not be diagnosed by cytologic examination. Walk-ins are also welcome. Non-invasive methods such as urine cytology detection of polyomavirus infected uroepithelial cells (decoy cells) or detection of polyomavirus in urine by electron microscopy, though sensitive, are non-specific and have poor positive predictive values. This is one of many tools used to diagnose cancers in the urinary tract, including bladder, kidney, prostate, ureter and urethra cancers. It has a high negative predictive value (98.6%), but its positive predictive value is poor (31%) (Billet et al., 2002; Henry et al., 2003). Urine cytology is, at best, only moderately sensitive in detecting bladder cancer. Ship specimen immediately to the laboratory. Unlike thyroid and cervical cytology, there is a lack of standardized criteria to stratify them into more clinically meaningful categories. 1. All patients should undergo a thorough history and physical examination, including rectal exam and pelvic exam in women. This problem is compounded by increasing workload pressures on pathology laboratories, which prevents follow up of each abnormal urine specimen. Most UCs are low-grade papillary UCs (70% to 80%) that tend to recur but rarely progress to muscle-invasive UCs. Unlike cervical cytology, there has not been widespread acceptance and use of any particular reporting scheme for urine cytology studies. In some patients, urine cytology is positive for tumour cells, but the diagnosis is usually established by cystoscopic evaluation. (Note: Specimens prepared with fixatives that contain 50% ethyl alcohol, eg, Saccomanno fixative, are not acceptable for microbiology testing.) Antibodies to polyomaviruses can be measured using haemagglutination inhibition (HAI) and enzyme-linked immunosorbent assay (ELISA). Hematuria and inflammation present. Other sites besides the bladder can be the source of the malignant cells; a primary tumor of the ureters, kidneys, prostate, and other contiguous organs must be considered.15,47. Some investigators report finding no false-positive results in their studies34,42; others describe rates ranging from 1.3% to 15%.38,43,44 False-positive results occur in patients with bladder stones,45 human polyomavirus infection,46 and chemotherapy.39 A positive cytologic result in the face of a negative biopsy result does not necessarily mean that the cytologic diagnosis is false. Urine cytology – general considerations Cytologic features of neoplasms involving the urinary tract Review of the urine cytology reporting systems Ancillary … URINE CYTOLOGY 2. Process. H.A. Objectives: We assessed the performance of urine cytology using the Paris System for Reporting Urine Cytology (PSRUC) in comparison to our current system. Y1 - 2014/11/1. T1 - Atypical urine cytology and the Johns Hopkins Hospital template. Urine Cytology Urine and Bladder Washings. Cytologic examination of urine is performed in screening programs of asymptomatic but high-risk patients for case finding, in the diagnostic evaluation of symptomatic patients, and in the follow-up and monitoring of patients with known and treated disease. The pathophysiology of neurogenic bladders, as seen in patients with multiple sclerosis and spinal cord injury, can change with time and disease progression. 1– 5 It is also used rather indiscriminately to screen for lower grade lesions, although sensitivity is low in this setting. Accurate cytological assessment of urine and communication of results allow for optimal management pathways for patients. Combatting Modern Slavery and Human Trafficking Statement. In addition, UCs often contain numeric chromosomal alterations (aneuploidy), as well as amplification and overexpression of specific oncogenes, which correlate with increased risk of progression and aggressive behavior. Ideally at least three mid-morning or random specimens should be submitted for examination. First, sensitivity is higher (37% to 89%) when suspicious diagnoses are included with positive diagnoses.34,35 Second, the sensitivity increases when more than one specimen is examined; tumor cells may be absent from one urine specimen but present in subsequent specimens.34,36,37 For this reason, it has been recommended that at least three specimens per patient be examined.38 Third, the sensitivity of urine cytology is highly dependent on the grade of the bladder tumor. Send labeled specimen to the laboratory immediately. Urine cytology is therefore an important primary method of diagnosing urothelial tumors, and in combination with cytoscopy and biopsy, it is used as an adjunct.2–7, From: Comprehensive Cytopathology (Third Edition), 2008, Andrew A. Renshaw, in Cytology (Third Edition), 2009. To detect bladder cancer. Degenerative urothelial cells present. Failure to detect antibody to JCV nearly always excludes a diagnosis of PML. • ~ 76,900 new cases in 2016 in the USA • ~ 16,390 deaths due to bladder cancer • 4thmost common ca in men and 9 in women (1 in 44 people) • 9thmost common cause of cancer death (F>M) • ~ 75% non-muscle invasive bladder cancers (superficial bladder cancers), Ta, Tis, T1 • ~ 30% - 70% - recurrence • ~ 5% - … After obtaining urine, the catheter is rigorously moved back and forth while applying negative pressure. urine cytology; cytospin; demand management; Exfoliative cytospin cytology of urine is an established sensitive and specific investigation in the diagnosis of carcinoma in situ and of primary and recurrent high grade transitional cell carcinoma of the bladder. 09/03/2020 by Staff. Several variables affect the sensitivity of urine cytology. The Papanicolaou classification of cells for the detection of malignancy ("Pap" smear) used in the past is as follows: Recurrence of UCs in such patients is common (50% to 80%), and some low-grade tumors will recur as high-grade UCs. Fig. Most of these patients were expected to present with superficial urothelial carcinomas (UCs) that are treated by transurethral resection of the tumor. 12/07/2020 by Staff. Hematuria and inflammation present. The reported sensitivity of urine cytology for UCs varies tremendously in the literature. 1. Background. Thoracic radiographs are examined for signs of metastasis. My urologist stated degenerative cels are normal in urine. Cells can also be extracted by inserting needles into growths or diseased areas or tissues—such as with a fine-needle aspiration cytology … Urine cytology after BCG therapy had a sensitivity of 56% and a specificity of 56% for cancer recurrence; when combined with cystoscopy, the results were 88% and 82%, respectively, obviating the need for routine biopsy in many patients. A... Urinary Tract. Urine cytology is only one of many tests used to confirm cancer, but it is particularly good for diagnosing larger-cell and rapidly reproducing cancers because those very properties make them easier to … All Rights Reserved. Often, there are technical reasons for delays in reporting results. Criteria useful for the classification of urine cytology as positive are discussed but are not a major emphasis of their report. The diagnosis of plasmocytoma was made, confirming the urine cytology diagnosis. Appointments must be made at least two hours in advance. A urine cytology test alone can't diagnose cancer. Urine cytology should be considered in patients who present with refractory symptoms of dysuria, urgency or frequency as both bladder cancer and bladder carcinoma in situ may present with irritative bladder symptoms without hematuria (Siegel, 2005). An introduction to cytopathology is in the cytopathology article. Further assessment will depend upon the variables thought to be controlling the voiding. Urine cytology is the examination of cells in urine under a microscope. Low-grade tumors missed by cytology are papillary lesions readily visualized with the help of a cystoscope and thus earmarked for biopsy.48,49 For high-grade UCs, however, particularly carcinoma in situ (CIS), which is more difficult to detect by cystoscopy, urine cytology provides a high degree of diagnostic accuracy. Haemagglutination inhibition ( HAI ) and enzyme-linked immunosorbent assay ( ELISA ), Regenstrief Institute, Inc. and Logical. 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