URINE CYTOLOGY

Dubrava University Hospital
Zagreb, Croatia
URINE CYTOLOGY
Prof. KARMEN TRUTIN OSTOVIĆ, M.I.A.C.
Head of Centre of clinical cytology and cytometry
5th Annual EFCS Tutorial,
Trondheim, Norway 28th May – 1st June 2012
URINARY TRACT
• Upper urinary tract
– Kidneys
– Ureters
• Lower urinary tract
– Urinary bladder
– Urethra
• (Prostate)
•
I. EXFOLIATIVE CYTOLOGY
– URINE
• Early morning voided
• Catheterised
• Ileal conduit
•
•
– WASHING (epithelial surface)
• Urinary bladder
• Ureters left and right separately
– BRUSHING (epithelial surface)
• Ureter
• Urinary bladder
• Urethra
II. FNAC (solid and cystic lesions):
– Kidney
– Prostate
– Suprarenal glands
– Retroperitoneum (lymph nodes ...)
III. IMPRINTS
– Intraoperative tumours
Ref. Koss’ Diagnostic Cytology 2006
PROCESSING TECHNIQUES
1.
SPECIMEN COLLECTION
2.
SPECIMEN PREPARATION
3.
FIXATION
4.
STAINING
5.
ANALYSIS /EVALUATION/
6.
DIAGNOSIS
7.
ARCHIVING
1. SPECIMEN COLLECTI0N
VOIDED URINE – INSTRUCTIONS for the patients
• Give the voided urine for 3 consecutive days
•
Take one gramme of C-vitamin the night before urine analysis
•
Drink ½ litre of water 30 minutes prior to urination
•
Wash genital tract by clean-catch technique
•
Give the second morning’s voided urine at the cytology
department (do not bring urine from home!)
2. SPECIMEN PREPARATION
• Immediately preparation (the best
time is within half of an hour after
urination)
– Sediments for native microscopy
(for voided urine)
After 3 hours
– Sediments for stained cytological
slides
– Samples for ancillary tests
(cytochemistry, flow cytometry,
immunocytochemistry,FISH,PCR...)
Within 30 minutes
NATIVE URINE SEDIMENTS
• Voided urine
– 10 – 20 ml of urine is centrifuged at 3000 rpm for 5 minutes
– The supernatant is decanted from conical centrifuge tube
– A drop of sediment mixed with 0.1% of saphranine is dropped
onto the slide
CYTOSPIN SEDIMENTS
• Voided urine
– Couple of drops (depending of clarity) are cytocentrifuged at
1000 rpm for 5 min in cytocentrifuge
– 2 - 4 slides per one sample of urine are prepared for staining
3. FIXATION
4. STAINING
1.
Pappenheim staining (MGG)
–
2.
Drying on the air (2 hours)
Papanicolaou staining (PAPA)
–
Diving wet slide in 96% ethyl
alcohol (24 hours)
or
– Spraying wet slide with hair-spray
3.
Haemacolor rapid staining
– Drying on the air (1-2 min)
3
5. ANALYSIS /EVALUATION/
• Native urine analysis
– Qulitative
– Semiquantitative
• Analysis of stained slides
– Qualitative
– Semiquantitative
NATIVE URINE ANALYSIS
QUALITATIVE
a) Casts (hyaline)
b
b) Crystals (ca oxalate)
c) (Glomerular erythrocytes)
a
NATIVE URINE ANALYSIS
QUALITATIVE
a) Casts (hyaline)
b
b) Crystals (ca oxalate)
c) (Glomerular erythrocytes)
a
QUALITATIVE AND
SEMIQUANTITATIVE
Erythrocytes
1. Smooth
2. Dysmorphic
1
2
From: Chronolab, Atlas sedimenta mokraće , Split 2004.)
NATIVE URINE ANALYSIS
SEMIQUANTITATIVE
Percentage limits of erythrocytes (E)
to determine the place of bleeding
(in voided urine only)
> 70% dysmorphic E - haematuria from the upper urinary tract
> 70% smooth E - haematuria from the lower urinary tract
dysmorphic E : smooth E = 50% : 50% - mixed haematuria
ANALYSIS OF STAINED SLIDES
QUALITATIVE ANALYSIS
•
•
•
Background
Cellularity
Epithelial cells
– Urothelial cells
– Squamous cells
– Columnar cells
– Tubular renal cells
• Non-epithelial cells
– Leukocytes
– Histiocytes
– Macrophages
• Non-cellular elements
– Casts
– Crystals
– Contaminants
QUALITATIVE ANALYSIS – non-cellular elements
• Casts
• Crystals
– Normal urine:
• Hyaline c.,
• Granular c.
– Pathological:
• Erythrocyte c.
• Leukocyte c.
• Epithelial c.
• Waxy c.
• Mixed cell c.
• Contaminants
QUALITATIVE ANALYSIS – non-cellular elements
• Casts
• Crystals
– Normal urine:
• Hyaline c.,
• Granular c.
– Pathological:
• Erythrocyte c.
• Leukocyte c.
• Epithelial c.
• Waxy c.
• Mixed cell c.
• Contaminants
– Normal urine:
• Uric acid
• Ca oxalate
• Triple phosphatase
– Pathological:
• Cystine
• Tyrosine
• Leucine
• Bilirubin
• Drugs (laxative, sulfa
drugs...)
QUALITATIVE ANALYSIS – non-cellular elements
• Casts
• Crystals
– Normal urine:
• Hyaline c.,
• Granular c.
– Pathological:
• Erythrocyte c.
• Leukocyte c.
• Epithelial c.
• Waxy c.
• Mixed cell c.
• Contaminants
– Normal urine:
• Uric acid
• Ca oxalate
• Triple phosphatase
– Pathological:
• Cystine
• Tyrosine
• Leucine
• Bilirubin,
• Drugs (laxative, sulfa
drugs...)
- Powder
- Alternaria
- Cotton
- Corpora
Amylacea
- Mucus
- Fibrin
- Lubricant
QUALITATIVE ANALYSIS
NON-CELLULAR ELEMENTS
QUALITATIVE ANALYSIS
NON-CELLULAR ELEMENTS
Uric acid crystal
Drugs crystal
Granular cast
and lubricant
Alternaria
Enterobius vermicularis
Powder
From: Bardales RH: Practical Urologic
Cytopathology, Oxford 2002
QUALITATIVE ANALYSIS
Epithelial cells
• Urothelial (transitional) cells
• Pelvis
• Ureters
• Urinary bladder
• Urethra
• Non-cornifying squamous cells
• Trigone of bladder (female)
• Urethra
• Columnar cells
• Trigone of bladder
• Urethra (male)
• Renal tubular cells
• Kidney
UROTHELIAL CELLS
•
•
Variation in shape
1
a)
2
Cell shape depends upon bladder
extension
a) Distended transitional cells
b) Non-distended
3
1
b)
•
Variation in size
•
They shed singly (1) or in clusters (2,3)
1. Superficial (umbrella, luminal) cell
2. Intermediate (piriform) cells
3. Basal (deep) cells
2
3
3
2
1
Ref. Koss’ Diagnostic Cytology 2006
EPITHELIAL CELLS
1.
2.
3.
4.
5.
Urothelial superficial (umbrella) cells
– Mononucleated
– Multinucleated
• 2,10 or more nuclei of variable sizes
Urothelial intermediate and basal cells
– Rare in voided urine
(usually after instrumentation)
Squamous cells
– Cells from trigone and urethra respond to
hormonal changes in both sexes
– Be careful: difficult differentiation from
contaminant squamous cells
(use catheterised urine!)
Columnar cells
– Rare in voided urine
Renal tubular cells
– Rare in voided urine
(<10 cells/10 high-power fields)
– Often naked nuclei (very fragile cells)
– Different in shape and size
1
2
RENAL TUBULAR CELLS
MEDULLA
CORTEX
•
•
•
•
•
•
15 – 60 µm
Oval or round cells
Usually single
Ill-defined cytoplasm
Granular cytoplasm
Pyknotic nucleus
•
•
•
•
•
•
15 – 60 µm
Cuboid or cylindric cells
Single or in clusters
Well-defined cytoplasm
Fine granular cytoplasm
Nucleus is not pyknotic
ANALYSIS OF STAINED SLIDES
QUALITATIVE
•
•
•
Background
Cellularity
Epithelial cells
– Urothelial cells
– Squamous cells
– Columnar cells
– Tubular renal cells
• Non-epithelial cells
– Leukocytes
– Histiocytes
– Macrophages
• Non-cellular elements
– Casts
– Crystals
– Contaminants
QUALITATIVE AND SEMIQUANTITATIVE
•
Erythrocytes
1. Glomerular
2. Non-glomerular
QUALITATIVE AND SEMIQUANTITATIVE ANALYSIS
Erythrocytes
Non-glomerular
a) Spiked forms
b) Discoid forms
a
c
(like normal E but
larger)
c) Creased forms with
Mercedes star pattern
in central zone or
obliquely (cap shape)
d)
b
Double-rim forms
d
From: Rathert P.et al: Urinary Cytology, 1993
QUALITATIVE AND SEMIQUANTITATIVE
ANALYSIS
Erythrocytes
Glomerular
4
2
1. Ring forms (doughnut E)
3
3
1
2. Vesicular forms
3. Combination of vesicular and
ring forms
4. Ruined forms (grotesque
shape)
2
1
STAINED SLIDES – semiquantitative analysis
Percentage limits of glomerular erythrocytes (E)
(synonims: G1 dysmorphic E or G1 erythrocytes (Tomita M)
to point the damage of glomerulus
(in voided urine only)
• < 20% glomerular E - no glomerulopathia
• 20 - 50% glomerular E – possible glomerulopathia
• 50 - 75% glomerular E – possible glomerulonephritis
• > 80% glomerular E - glomerulonephritis
CYTOLOGY OF THE URINE
• NORMAL URINE
• PATHOLOGICAL LESIONS
NORMAL VOIDED URINE
•
FEW EPITHELIAL CELLS
–
–
–
–
•
Urothelial
Squamous cells
Columnar cells
Tubular renal cells
FEW NON-EPITHELIAL CELLS
– Erythrocytes (nonglomerular)
– Leukocytes
• Neutrophiiic granulocytes
• Lymphocytes
•
•
NON-CELLULAR ELEMENTS (OCCASI0NAL)
– Hyaline and finely granular casts
– Corpora amylacea (male)
CONTAMINATION
– Female (from vagina and vulva)
1.Squamous cells
2.Doderlein bacillus
– Male
3. Seminal vesicle cells
 Be careful: similar to malignant cells!
4. Spermatozoa
1, 2
4
3
CYTOLOGY OF THE URINE
PATHOLOGICAL LESIONS (VOIDED URINE)
• BENIGN LESIONS
•
•
•
•
•
Infections
Inflammatory conditions
Haematuria
Urolithiasis
PREMALIGNANT LESIONS
• Squamous metaplasia
• Dyskariosis
• SUSPICIOUS FOR MALIGNANCY
• NON-CLASSIFIED LESIONS
• Reactive changes
• Polymorphia
• Atypia
• TUMOURS
– Urothelial tumours
– Papillary tumours
• Non-papillary
– Non-urothelial tumours
• Squamous
• Adenocarcinoma
– Metastatic tumours
• INADEQUATE
HAEMATURIA
 Essential
 Phisiological
 Ill effects to anticoagulation therapy and radiation
 Systemic disease (Mb. Bechterew, hemophilia, leukaemia)
• Lower urinary tract
• Upper urinary tract
(more than 70% smooth E)
(more than 70% dysmorphic E)
–
–
–
–
–
–
–
–
–
Kidney neoplasm
Acute glomerulonephritis
Tuberculosis
Tumours of ureters
Pyelonephritis
Nephrolithiasis
Cistyc kidney
Trauma of kidney
Infarct of kidney
–
–
–
–
–
–
–
–
Tumors of bladder
Tumors of urethra
Hemorrhagic cystitis
Cystitis
Bladder lithiasis
Diverticulum
Urethritis
Trauma of urethra
ERYTHROCYTES
NATIVE
SEDIMENT
STAINED
SMEARS
DYSMORPHIC
GLOMERULAR
SMOOTH
NON-GLOMERULAR
GLOMERULONEPHRITIS
• >80% glomerular
erythrocytes
• Numerous renal tubular
cells
• Lots of casts
– Erythrocytic
– Coarsely granular
• Urothelial cells (often
reactive)
GLOMERULONEPHRITIS
•Be careful:
use high magnification for
analysis of erythrocytes,
do not misdiagnose ruined
forms of GE with damaged
erythrocytes – ruined forms
have intact memebrane!
• Perform semiquantitative
analysis on 4 different parts of
sediment
•The cytological diagnosis
should be confirmed by
electron microscopic (EM)
analysis
FOCAL SEGMENTAL NECROTISING
GLOMERULONEPHRITIS
• IgA nephropathy
– IgA positive
•
Immune deposits in
mesangial cells
UROLITHIASIS
• Calculi may be present in all urinary
tract (the most common in pelvis and
bladder)
• Polymorfism of urothelial cells
– Dyskaryosis (dysplasia)
– Reactive urothelial cells, usually
umbrella
• Squamous metaplasia
• Numerous erythrocytes (non-glomerular)
(native urine analysis of erythrocytes)
• Many leukocytes
• Crystals
– Calcium oxalate
– Uric acid
Haematuria
• Cytologist (cytopathologist) - at the crossroad
suggesting to the patient to go to:
– Nephrologist:
• Dysmorphic E >70%
• Glomerular E >20%
– Urologist (usually):
• Smooth E >70%
• Non-glomerular E
– Nephrologist and urologist:
• 50% smooth E and 50% dysmorphic E
• Non-glomerular E
– Biopsy:
• >50% glomerular E
INFECTIONS
• Increased exfoliation of cells
• Non-specific morphological changes of
epithelial cells (bacterial)
• Specific morphological changes of epithelial
cells (viral – DNA viruses)
• Identification of:
– Parasites
– Fungal spores and hyphal forms
(microbiological identification)
– Bacteria (microbiological identification)
BACTERIAL INFECTION
1. Reactive urothelial cells
– Enlargement of the cell
– Enlargement of the
nucleus
– Enlargement of the
nucleolus
– Nuclear-cytoplasmic
ratio is normal
– Prominent nucleolus
1
1
1
1
Inflammation?
Inflammation? No - Urothelial carcinoma
VIRAL INFECTIONS
POLYOMA VIRUS
•
In immunosuppressed patients and renal
allograft recipients after reactivation of virus
1. Inclusion stage
–
Single, centrally located irregular
hyperchromatic nucleus with large
homogeneous, basophilic intranuclear
inclusions
1
2. Postinclusion stage
–
•
•
Enlarged nucleus with “empty”, pale
appearance with distinct network of
chromatin filaments – “fishnet-stocking”
pattern
Immunocytochemistry: antigen to SV40 virus
Be careful: “decoy cells” are similar
to malignant cells
1
2
PARASITIC INFECTIONS
Trichomonas (TV)
– Rare (urethritis, cystitis)
– Marked acute inflammation
•
•
•
•
•
Numerous neutrophilic granulocytes
Squamous metaplastic cells
Few urothelial cells
Erythrocytes
Necrosis is absent
– A light gray, pear-shaped
protozoan with dark eccentric
nucleus
– Be careful: do not misdiagnose
trichomonas as destroyed cell
MALAKOPLAKIA
•
•
•
•
•
•
Uncommon granulomatous cystitis
or urethritis or ureteritis
Affects middle-aged female
A yellow plaque with central depression
Lots of cells
– Histiocytes with single or multiple
Michaelis-Gutmann bodies (PAS
and iron-positive)
– Few plasma cells, macrophages
– Reactive urothelial cells
The background is granular with
nectrotic debris
Be careful: not misdiagnose with
engulfed erythrocytes within macrophage
DYSKARYOSIS
•
•
•
•
Synonims:
– Atypical urothelial cells
– Dysplasia
It is the putative precursor of ca in situ and
invasive urothelial carcinoma (occurs in 15 %
of the patients within 5 years after detection)
Cytollogically follow up every 3 – 6 months
Dyskaryotic cells
– Increased uniform basal cells
– Irregular hyperchromatic nucleus
– Slight shape variation of the nucleus
– Slightly increased nuclear-cytoplasmic
ratio
– Scanty cytoplasm
– Single cells or in papillay clusters
• Be careful: do not misdiagnose dyskariotic
cells with single basal urothelial cells – use
highe magnification
WHO CLASSIFICATION OF TUMOURS (2004)
•
UROTHELIAL TUMOURS
•
Infiltrating urothelial carcinoma
–
–
–
–
–
–
–
–
–
–
–
•
Non-invasive urothelial neoplasias
–
–
–
–
•
With squamous differentiation
With glandular differentiation
With trophoblastic differentiation
Nested
Microcystic
Micropapillary
Lymphoepithelioma-like
Lymphoma-like
Plamsacytoid
Giant cell
Undifferentiated
Urothelial ca in situ
Non-invasive papillary ca high grade
Non-invasive papillary ca low grade
Urothelial papilloma
•
•
•
•
•
•
•
•
•
•
•
SQUAMOUS NEOPLASMS
–
–
–
Squamous cell carcinoma
Verrucous carcinoma
Squamous papilloma
•
HAEMATOPOIETIC AND LYMPHOID TUMOURS
•
•
Lymphoma
Plasmacytoma
•
•
•
GLANDULAR NEOPLASMS
Adenocarcinoma
– Enteric
– Mucinous
– Signet-ring cell
– Clear cell
Villous adenoma
NEUROENDOCRINE TUMOURS
Small cell carcinoma
Carcinoid
Paraganglioma
MELANOCYTIC TUMOURS
Malignant melanoma
Nevus
MESENCHYMAL TUMOURS
– Rhabdomyosarcoma
– Leiomyosarcoma
– Angiosarcoma
– Osteosarcoma
– Malignangt fibous histiocytoma
– Lleiomyoma
– Haemangioma.....
METASTATIC TUMOURS
MISCELLANEOUS TUMOURS
Carcinoma of glands
UROTHELIAL TUMOURS
• 95 % of bladder tumours are urothelial carcinoma
– Per se
– In combination with squamous or glandular
differentiation
• In the time of initial diagnosis
– 75% of the patients have noninvasive urothelial
carcinoma
– 20% have invasive carcinoma
– 5% have metastatic disease
• 60% of tumours are recurrent
• Most of carcinoma are papillary and multifocal
– Be careful: after biopsy, if histological diagnosis
is benign, it does not mean that patient has no
carcinoma if cytological diagnosis is malignant!
UROTHELIAL TUMOURS
• Papillary tumours
– Papilloma
– Papillary tumor grade I (papillary neoplasm of low malignant
potential)
– Papillary carcinoma grade II (papillary carcinoma, low grade)
– Papillary carcinoma grade III (papillary carcinoma, high
grade)
• Nonpapillary tumours
– Flat carcinoma in situ
– Invasive carcinoma
UROTHELIAL TUMOURS
• Papillary tumours
– Papilloma
– Papillary tumor grade I (papillary neoplasm of low malignant
potential)
– Papillary carcinoma grade II (papillary carcinoma, low grade)
– Papillary carcinoma grade III (papillary carcinoma, high
grade)
• Nonpapillary tumours
– Flat carcinoma in situ
– Invasive carcinoma
Papillary tumours
Papilloma
• Increased number of benign
urothelial cells and erythrocytes
• The diagnosis is
histological
• Note: when there are lots of reactive
cells and papillary clusters of
dyskaryotic cells in sediment,
cytological diagnosis of possible
papilloma can be put but biopsy is
recommanded
Papillary tumours
Papillary tumour grade I
(papillary neoplasm of low malignant potential - PUNLMP)
•
•
•
•
•
The background is clean
Dyskaryotic cells in three-dimensional
clusters
Lots of reactive urothelial cells
Malignant urothelial cells
– In papillary clusters (can suggest the
diagnosis)
– Nuclear-cytoplasmic ratio is slightly high
– Cytoplasm is thin and semitransparent
– Nuclei are round or oval with powdery
chromatin, uniform “pencil-drawn”
nuclear contours and small nucleoli
Cell blocks of urinary sediment enables the
diagnosis – immunocytochemistry (CK20)
Suspicious lesions
•
•
Cytology of the urinary sediment
does not lend itself to the
diagnosis – dg. is usually
suspicious
Pathohistology
–
PUNLMP-s (papillary urothelial
neoplasm of low malignant
potential)
Papillary tumours
Papillary carcinoma grade II
(papillary carcinoma, low-grade)
• Few small clusters and single markly
atypical or frankly malignant cells
– Enlarged cells
– Slightly irregular nuclear contour
– Moderate hypechromasia with reduced
nuclear transparency
– Prominent nucleoli
– Homogeneous cytoplasm
– Moderate increased the
nuclear-cytoplasmic ratio
Papillary tumours
Papillary carcinoma grade II (low-grade)
•Cytological diagnosis can be: atypical or suspicious or
probably malignant low-grade papillary carcinoma
•FISH (fluorescent in situ hybridization) can help
•DNA pattern analysis can help – aneuploid DNA is strongly suggestive of carcinoma
Flow cytometry (FCM)
– DNA analysis (ploidy and proliferative activity)
• Discriminates high-grade (aneuploid) and low-grade
(diploid) urothelial tumours
• It and detects urothelial carcinoma 12 to 18 months earlier
than cystoscopy
– Be careful: FCM requires large number of abnormal cells to
give the accurate value (45% of voided urine give satisfactory
result)
Papillary tumours
Papillary carcinoma grade III (high grade)
• Background
may be
bloody,
but necrosis is
absent
• Cellularity
is high
with numerous tight
clusters and single
malignant cells
Papillary tumours
Papillary carcinoma grade III
(papillary carcinoma, high grade)
• Pleomorphic malignant cells
– Larger than normal
– The cytoplasm ranges from
homogeneous and scant to
vacuolated and abundant
– Variable nuclear-cytoplasmic ratio
– Pleomorphic hyperchromatic nuclei
with prominent nucleoli
– Chromatin is clumped, irregular or
vesicular
– Nuclear contour is irregular
– “Cannibalism”
• The diagnosis is cytological
Nonpapillary tumours
Flat carcinoma in situ
•
Background is without necrosis, there are
few erythrocytes and inflammatory cells
•
Cellularity is variable
– Usually monotonous population of
medium-sized or small malignant
urothelial cells in small clusters or single
– Ocasional a few larger or bizzare
malignant cells may occur
– Pleomorphic cells with scanty basophilic
cytoplasm in one third of the patients
dif.dg. High grade ca
Nuclei are large, hyperchromatic with
irregular contours and chromatin is coarse
and irregular or pyknotic
Markedly increased nuclear-cytoplasmic ratio
•
•
The diagnosis is cytological
Nonpapillary tumours - Flat carcinoma in situ
The cytological diagnosis of ca in situ may remain unconfirmed for
many years in the absence of an aggresive approach to bladder
biopsies
Nonpapillary tumours
Invasive nonpapillary carcinoma
• It is a high grade carcinoma
•
•
•
•
The prognosis is poor and the 5-year
survival is less than 50% even with
therapy
Background is dirty
– Marked inflammation
– Marked bleeding
– Marked necrosis
Pleomorphic cells
– Variable sizes
– Variable nuclear-cytoplasmic ratio
– Anaplastic nuclei with irregular
chromatin and large, irregular
nucleoli
Squamous or glandular differentiation
is common
Nonpapillary tumours
Invasive nonpapillary carcinoma
The diagnosis is cytological
Metastatic tumours I.
• Directly spread from adjacent organs
– Squamous carcinoma of the
uterine cervix
– Endometrial carcinoma of the
uterine corpus in postmenopausel
females
– Colorectal carcinoma
• Immunocytochemistry: positive CEA
– Adenocarcinoma of the prostate
• Immunocytochemistry: positive PSA
• Implantation from the upper urinary tract
– Hypernephroma
• Fairly large cells with finely
vacuolated and granular cytoplasm
• Cytochemistry: PAS, PAS
with amylase digestion and
oil-red or Sudan III positive
PAS with amylase digestion
Metastatic tumours II.
Lymphatic or hyematogenous spread from distant sites
1. Melanoma
– Pigment in malignant cells
• Immunocytochemistry:
positive HMB-45, S-100, Melan
2. Carcinoma
– Small cell ca (lung) – dif. dg. small cell
undifferentiated urinary carcinoma
• Immunocytochemistry:
positive TTF1
3. Haematolymphoid malignancies
(lymphoma, leukemia, multiple myeloma)
– Flow cytometry - immunophenotyping
• Monoclonality
3
DIAGNOSTIC VALUE OF URINE CYTOLOGY
EXAMINATION
• Diagnostic accuracy of urine cytology of bladder carcinoma
diagnosis ranges between 26% and 100%
– Low and variable for low grade papillary neoplasms (accurate
in 1/3 of the cases)
– Highly accurate for high-grade tumours including invasive
carcinoma and carcinoma in situ (accurate in ¾ of the cases)
• False-positive diagnosis range from 1.3% to 11.9% high specificity
• False-negative diagnosis range from 23% to 38% low sensitivity
BIOMARKERS AND ANCILLARY TESTS FOR
UROTHELIAL CARCINOMA
They have a potential role in the
improvement of screening and
detection of bladder carcinoma
because they have
better sensitivity than conventional cytology
CONCLUSION
Urinary cytology
• Is the only nonivasive method
for detecting carcinoma in urinary tract
• Has better specificity but lower sensitivity than ancillary
tests and biomarkers
• Remains the gold standard for the detection of urothelial
carcinoma especially for the lesions inaccessible to
cystoscopy or biopsy and those that are invisible by
radiology and cystoscopy like dysplasia and flat tumours
• Needs consensus of cytological classification system
“DUBRAVA” UNIVERSITY HOSPITAL, ZAGREB, CROATIA
CENTRE OF CLINICAL CYTOLOGY AND CYTOMETRY
Thank you
EUROPEAN CONGRESS OF CYTOLOGY
CAVTAT - CROATIA - 2012