Ebook The paris system for reporting urinary cytology: Part 2
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Ebook The paris system for reporting urinary cytology: Part 2
Chapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2 TsuzukiBackgroundHistorical Review of Reporting System of Urine CytologyUrine cytology is an important test for screening and diagnosis of newly developed urothelial carcinoma (UC) and for surveillance of uc recurrence and new neoplasms. Urine cytology has been used for a long time because of its m Ebook The paris system for reporting urinary cytology: Part 2erits such as easy availability and noninvasive testing, high sensitivity, and specificity for high-grade urothelial carcinoma (HGƯC). and great effecEbook The paris system for reporting urinary cytology: Part 2
tiveness to evaluate the entire urothelial tract. With urine cytology, the high-grade malignant cells can be identified even in occult carcinoma that Chapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2newer techniques such as fluorescence in situ hybridization (FISH) for screening and diagnosis of uc. urine cytology still remains the gold standard for bladder cancer screening, especially for HGƯC.The reporting system for urine cytology has evolved over a period of time according to the changes in Ebook The paris system for reporting urinary cytology: Part 2 the histopathologic classification of uc [3]. Initially. Dr. Papanicolaou suggested a reporting system of urine cytology that included five classes [Ebook The paris system for reporting urinary cytology: Part 2
4]. Although this reporting system had a great role in diagnosing high-grade uc. the definitions or criteria for each category were somewhat unclear [Chapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2ted a new classification scheme for urine cytology [5], In this classification. HGL'C was characterized by the presence of hyperchromasia and nuclear membrane abnormalities in the malignant cells. After changes in the histopathologic classification of uc by the WHO/International Society of Urologica Ebook The paris system for reporting urinary cytology: Part 2l Pathology in 1998, the Papanicolaou Society of Cytopathology (PSC) Task Force also reported a diagnostic classification system for urine cytology siEbook The paris system for reporting urinary cytology: Part 2
milar© Springer International Publishing Switzerland 201661D.L. Rosenthal et al. (eds.). The Paris System for Reporting Urinary Cytology.nm in mn7.’O7Chapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2 and simplified categories: negative, positive. and an equivocal category, called atypical urothelial cells. For this category the authors proposed further studies to better establish criteria for subclassifying atypical specimens. The authors also addressed the incorporation of ancillary studies, s Ebook The paris system for reporting urinary cytology: Part 2uch as FISH, into urine cytology reporting, reflecting the emergence of adjunctive studies in urine cytology that continues today. The PSC also suggesEbook The paris system for reporting urinary cytology: Part 2
ted that a comment be included in the cytologic report to further classify the atypia as reactive or neoplastic. However, the criteria to separate reaChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2than LGƯN. The sensitivity of urine cytology ranges from 10 to 43.6 % for low grade to 50-85 % for HGUC: and specificity ranges from 26.3 to 88 %. depending on the type of urine sample collection and type of clinical presentation (8. 9]. Positive urine cytology is clinically meaningful. In tumor rec Ebook The paris system for reporting urinary cytology: Part 2urrence of upper urinary tract ƯC, it has been found that HGƯC recurred significantly earlier in the positive urine cytology group than in the negativEbook The paris system for reporting urinary cytology: Part 2
e urine cytology group [10]. Multivariate analysis also shows that gender, positive urine cytology, and tumor multifocality are independent risk factoChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2s independent of other clinicopathologic variables. Hence, positive urine cytology in primary upper urinary tract uc is valuable to predict prognosis, and preoperative positive urine cytology may be associated with higher prevalence of tumor recurrence [10]. Kobayashi et al. [11] have reported a rel Ebook The paris system for reporting urinary cytology: Part 2ationship between positive urine cytology anil tumor recurrence in the upper urinary tract ƯC. Positive urine cytology can be useful to predict tumorEbook The paris system for reporting urinary cytology: Part 2
progression. Zieger et al. have reported that positive urine cytology is associated with tumor progression in patients with stage Ta ưc 112]. Another Chapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2 cytology [13]. Koga et al. [14] described the progression rates of positive urine cytology group and negative urine cytology group, with 5-year cumulative incidences of 20 % and 2 %. respectively.The Importance of Tumor Grade as a Prognostic FactorTumor grade is a strong prognostic factor. Tumor gr Ebook The paris system for reporting urinary cytology: Part 2ade has a higher predictive value of tumor progression and mortality than tumor stage. The prognosis of urothelial tumors is influenced by grade thanEbook The paris system for reporting urinary cytology: Part 2
by stage if the tumors are the same6 High-Grade Urothelial Carcinoma (HGƯC)63grade. HGL’C generally has a worse prognosis than LGƯN, regardless of staChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2 37 % and 40 %. respectively in patients (/1 = 85) with Ta HGƯC [16]. This suggests that tumor grade is highly correlated to recurrence, progression, and cancer-specific mortality.The Cytologic Characteristics of HGƯCThe cytomorphologic characteristics of HGƯC have historically been described as fol Ebook The paris system for reporting urinary cytology: Part 2lows: High nuclear to cytoplasmic (N/C) ratio, nuclear pleomorphism, nuclear margin irregularity, and hyperchroinasia [4. 5, 17], Chromatin abnormalitEbook The paris system for reporting urinary cytology: Part 2
ies such as coarse clumping or homogenous chromatin pattern are also present. Comet. India-ink (single cells with deep black structureless nuclei) andChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2tures, prominent nucleoli, isolated malignant cells and extensive necrosis are also characteristic features of HGUC in urine cytology specimens, with necrosis being an indicator for invasive disease 119].DefinitionHistologic Definition of HGVCIn the 2(X)4 WHO classification. HGUC has papillary struc Ebook The paris system for reporting urinary cytology: Part 2tures lined by tumor cells that are disorderly arranged and are cytologically malignant [20]. All tumors identical to grade 3 in the 1973 WHO classifiEbook The paris system for reporting urinary cytology: Part 2
cation, and some tumors of grade 2 in that classification belong to HGƯC in the 2004 WHO classification [20]. The papillary fronds are frequently fuseChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2morphic nuclei with prominent nucleoli, if present, show loss of polarity and frequent mitoses. Carcinoma in situ (CIS) is frequently observed in the surrounding mucosa.Histologic Definition of Carcinoma In SituCIS is grossly a fiat lesion and composed of high-grade carcinoma cells which are cytolog Ebook The paris system for reporting urinary cytology: Part 2ically malignant [20]. The morphologic criteria of CIS require the presence of severe cytologic pleomorphism. Full-thickness maturation arrest is64M.TEbook The paris system for reporting urinary cytology: Part 2
. Siddiqui el al.not absolutely needed. The tumor cells arc disorganized with loss of polarity and cohesiveness. The malignant cells are generally larChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2itotic figures arc frequently present.Cytologic Definition of HGUCUrine cytology cannot distinguish invasive HGUC from noninvasive HGUC or CIS. However, the background in CTS is reported to be clean without blood, abundant inflammation, and cell debris [21. 22|. The malignant cells usually display a Ebook The paris system for reporting urinary cytology: Part 2n N/C ratio that is 0.7 or greater, Ĩ.C.. nucleus occupying more than 70 % of the cytoplasm. and demonstrate nuclear hyperchromasia. irregular nuclearEbook The paris system for reporting urinary cytology: Part 2
membranes, and coarse chromatin (Figs. 6.1.6.2. 6.3. 6.4, 6.5. 6.6. 6.7. and 6.8) [21.22]. According to The Paris System consensus, a cellular cytoloChapter 6High-Grade Urothelial Carcinoma (HGUC)Mom in T. Siddiqui, Guido Fadda, Jee-Young Han. Christopher L. Owens, z. Laura Tahatabai. and Tovonori Ebook The paris system for reporting urinary cytology: Part 2t may contribute to the minimal number of abnormal cells required for a more definitive diagnosis of malignancy. For example, upper urinary tract instrumented specimens will require at least ten abnormal cells.Fig. 6.1 High-grade urothelial carcinoma, (a) High-grade urothelial carcinoma (IlGl.'C). T Ebook The paris system for reporting urinary cytology: Part 2he sample is hyperccllular showing numerous tumor cells lhal demonstrate pleomorphism and necrosis in lhe background Í Voided urine. SP. low mag.). tEbook The paris system for reporting urinary cytology: Part 2
bl High-grade urothelial carcinoma (HGUC). rhe sample was full of these abnormal cells with high N/C ratios and prominent nuclear profiles. The totalGọi ngay
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