• The Korean Journal of Cytopathology
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• v.17 no.1
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• pp.1-17
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• 2006

Urine cytology is the most useful technique for detecting either primary or recurrent neoplasms in the urinary tract. Although urine cytology is the traditional method of detecting these neoplasms, its diagnostic accuracy has been underevaluated because of low sensitivity. The cytologic interpretation of urinary samples is not an easy task, even with some expertise in this area, for many reasons. In low-grade urothelial carcinoma, no reliable or reproducible diagnostic cytologic criteria can be provided because of the lack of obvious cytologic features of malignancy, which is one of the main factors lowering its diagnostic accuracy. Many diagnostic markers have been developed recently to enhance its diagnostic yield, but the results have not been satisfactory. However, urine cytology plays a role in detecting high-grade urothelial carcinoma or its precursor lesions. It still shows higher specificity than any of the newly developed urine markers. Understanding the nature of urine samples and the nature of neoplasms of the urinary tract, recognizing their cytologic features fully, and using cytologic findings under appropriate conditions in conjunction with a detailed clinical history would make urine cytology a very valuable diagnostic tool.

• The Korean Journal of Cytopathology
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• v.17 no.1
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• pp.18-26
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• 2006

Transitional cell carcinoma of the urinary bladder is common in the genitourinary tract. The gold standard for the diagnosis of bladder cancer has been cystoscopy, along with urine cytology. Cystoscopy is an invasive and relatively expensive technique. By comparison, urine cytology is easy to perform and specific for a diagnosis of bladder cancer, although less sensitive, especially in low-grade tumors. For this reason, there has been a need for superior noninvasive technology to increase our confidence in being able to detect bladder cancer. There are many reports of the various urinary tests that are available to facilitate the diagnosis. In this article, I reviewed the literature on urinary markers and tests that may be clinically useful, including fluorescence in situ hybridization, uCyt+/Immunocyte, the $BTA^{(R)}$ test, the NMP 22TM, the $FDP^{(R)}$ test, the telomerase activity test, the HA and HAse tests, and flow cytometry. Most of these tests have a higher sensitivity and specificity than cytology. However, urine cytology has the highest specificity, especially in individuals with a high-grade tumor. We conclude that no urinary markers or tests can replace the role of cystoscopy along with cytology in the diagnosis of transitional cell carcinoma of the bladder. However, some markers could be used adjunctively to increase the diagnostic accuracy during screening or during the postoperative follow-up examination of patients with bladder cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.5
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• pp.2251-2255
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• 2014

Background: The aim of this study was to evaluate 10 years of false positive urine cytology records, along with follow-up histologic and cytologic data, to determine the significance of suspicious urine cytology findings. Materials and Methods: We retrospectively reviewed records of urine samples harvested between January 2002 and December 2012 from voided and catheterized urine from the bladder. Among the 21,283 urine samples obtained during this period, we located 1,090 eligible false positive findings for patients being evaluated for the purpose of confirming urothelial carcinoma (UC). These findings were divided into three categories: atypical, indeterminate, and suspicious of malignancy. Results: Of the 1,090 samples classified as false positive, 444 (40.7%) were categorized as atypical, 367 (33.7%) as indeterminate, and 279 (25.6%) as suspicious of malignancy. Patients with concomitant UC accounted for 105 (23.6%) of the atypical samples, 147 (40.1%) of the indeterminate samples, and 139 (49.8%) of the suspicious of malignancy samples (p<0.0001). The rate of subsequent diagnosis of UC during a 1-year follow-up period after harvesting of a sample with false positive urine cytology initially diagnosed as benign was significantly higher in the suspicious of malignancy category than in the other categories (p<0.001). The total numbers of UCs were 150 (33.8%) for atypical samples, 213 (58.0%) for indeterminate samples, and 199 (71.3%) for samples categorized as suspicious of malignancy. Conclusions: Urine cytology remains the most specific adjunctive method for the surveillance of UC. We demonstrated the clinical value of dividing false positive urine cytology findings into three categories, and our results may help clinicians better manage patients with suspicious findings.

• The Korean Journal of Cytopathology
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• v.14 no.2
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• pp.82-85
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• 2003

Prostatic adenocarcinoma cells can be detected in urine cytology specimens when the tumor extends to the bladder mucosa. We report a case of prostatic adenocarcinoma diagnosed by urine cytology. A 70-year-old man presented with urinary frequency and low back pain On rectal examination, a nodular mass was palpated in the left side of prostate. Bone scan revealed multifocal hot lesions suggesting metastasis. Urine cytology revealed hypocellular smear on clean or bloody background. Tumor cells were mainly arranged in syncytial or papillary clusters which occasionally contained fool of luminal formation The cytoplasm of tumor cells was finely granular. The nuclei of tumor cells revealed evenly distributed fine chromatin and large prominent nucleoli without nuclear pleomorphism. In needle biopsy specimen of prostate, tumor cells were detected in entire prostatic tissue with extension to pericapsular soft tissue. The tumor cells infiltrated individually or in a cord-like fashion with fool of cribriform pattern. Inconspicuous nuclear pleomorphism and prominent nucleoli were also noted.

• The Korean Journal of Cytopathology
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• v.5 no.2
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• pp.137-142
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• 1994

Urine cytology is of limited value in the diagnosis of renal cell carcinoma with reported detection rates of $0\sim80%$. The aim of this study is to demonstrate the usefulness of urine cytology in renal cell carcinoma. In the eleven histologically proven cases of renal cell carcinoma, urinary smears were reevaluated. The cytologic results were as follows; positive for malignant cells in 3 cases(27%), suspicious in 2 cases(18%) and negative in 6 cases(55%). The average diameter of the tumor of the 5 cases reported as positive or suspicious for malignant cells was 9.7cm and 3 had invaded the renal pelvis. The other 6 tumors, reported as negative, were 5.7 cm in average diameter and one of them showed involvement of the renal pelvis. These results suggest that urine cytology is considered unsatisfactory in the early defection of renal cell carcinoma. However, careful examination of urinary smear could improve the detection rate especially in more advanced cases involving the renal pelvis as well as those of larger tumors.

• The Korean Journal of Cytopathology
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• v.18 no.2
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• pp.153-156
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• 2007

Primary small cell carcinoma of the urinary bladder is an extremely rare but important entity. We experienced a case of small cell carcinoma of the urinary bladder diagnosed by urine cytology. A 59-year-old man presented with gross hematuria and dysuria, and a calcified mass was detected at the left ureterovesical junction by cystoscopy. Abdominal ultrasonography revealed focal wall thickening at the left lateral side of the urinary bladder, and urine cytology findings were of an inflammatory background and atypical small round cells with minute hyperchromatic or pyknotic nuclei, scant cytoplasm, and rare nucleoli. In addition, atypical cells were scattered in an isolated single cell pattern or in small loose clusters with prominent nuclear molding. Subsequent histological and immunohistochemical examinations confirmed a diagnosis of small cell carcinoma.

• The Korean Journal of Cytopathology
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• v.18 no.2
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• pp.119-125
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• 2007

Urine cytology is an important screening tool for urinary tract neoplasms. Liquid-based preparation methods, such as $ThinPrep^{(R)}$, have been introduced for non-gynecological samples. We aimed to assess the diagnostic accuracy of liquid-based preparations in urine cytology by comparing the results of the conventional Cytospin preparation method for the same samples. A total of 236 cases subject to urine cytology were enrolled in this study from January 2005 to December 2005. All cases were subjected to cystoscopy and if a malignancy was suspected, a biopsy was performed. Urine cytology slides were made using the $ThinPrep^{(R)}$ preparation method and the conventional Cytospin and/or direct smear method from the individual samples. The results of urine cytology were compared with the final cystoscopic or histological diagnoses. We analyzed the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of both cytology preparation methods. A total of 236 slides made using the liquid based method were satisfactory for slide quality, whereas 5 slides (2.1%) prepared by conventional methods were unsatisfactory because of air-drying, a thick smear, or a bloody or inflammatory background. The $ThinPrep^{(R)}$ method showed 53.1% sensitivity, 92.6% specificity, a 92,6% positive predictive value, a 94.1% negative predictive value and 85,6% accuracy, while the conventional method showed 51% sensitivity, 98.4% specificity, a 92.6% positive predictive value, a 98.4% negative predictive value and 88,6% accuracy. Although the diagnostic values were equivalent between the use of the two methods, the quality of the cytology slides and the time consumed during the microscopic examination for a diagnosis were superior for the $ThinPrep^{(R)}$ method than for the conventional method. In conclusion, our limited studies have shown that the use of the liquid based preparation method is beneficial to improve the quality of slides and reduce the duration for a microscopic examination, but did not show better sensitivity, accuracy and predictive values.

• The Korean Journal of Cytopathology
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• v.18 no.1
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• pp.29-35
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• 2007

This study purposed to evaluate a $CellPrep^{(R)}$ (CP) of liquid-based cytology (LBC) to search for a less expensive and automated alternative cytologic preparation technique applicable to usually encountered cytologic specimens. Cervicovaginal direct-to-vial split samples from 457 gynecologic patients, 40 body fluid samples, and 34 urine samples were processed with the CP technique and the results were compared with those of currently used $ThinPrep^{(R)}$ (TP) method. Both CP and TP methods provide evenly distributed thin layers of cells with little cellular overlaps or significant obscuring elements in most of cases. Staining quality of both preparations showed a little difference due to the difference of fixative solutions without significant distractions in cytologic interpretation. On the supposition that TP was a gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of CP cytology were 89%, 98%, 86%, and 99% in the cervicovaginal smear, 89%, 82%, 80%, and 90% in body fluid, and all of these values were 100% in urine samples. To testify the availability of immunohistochemistry on CP preparations, cytokeratin, vimentin, and Ki-67 were applied on body fluid specimens, and all of these antibodies were specifically stained on targeted cells. Conclusively, the CP method gave comparable results to those of TP in terms of smear quality and cytologic diagnostic evaluation, and was available on immunohistochemistry. The CP method could offer a cost-effective and automated alternative to the current expensive techniques of liquid-based cytology on popular cytologic materials including cervicovaginal, body fluid, and urine specimens.

• The Korean Journal of Cytopathology
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• v.19 no.2
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• pp.136-143
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• 2008

Urothelial carcinoma accounts for 90% of all the cases of bladder cancer. Although many cases can be easily managed by local excision, urothelial carcinoma rather frequently recurs, tends to progress to muscle invasion, and requires regular follow-ups. Urine cytology is a main approach for the follow-up of bladder tumors. It is noninvasive, but it has low sensitivity of around 50% with using the conventional cytospin preparation. Liquid-based cytology (LBC) has been developed as a replacement for the conventional technique. We compared the cytomorphometric parameters of $ThinPrep^{(R)}$ and cytospin preparation urine cytology to see whether there are definite differences between the two methods and which technique allows malignant cells to be more effectively discriminated from benign cells. The nuclear-to-cytoplasmic ratio value, as measured by digital image analysis, was efficient for differentiating malignant and benign urothelial cells, and this was irrespective of the preparation method and the tumor grade. Neither the $ThinPrep^{(R)}$ nor the conventional preparation cytology was definitely superior for distinguishing malignant cells from benign cells by cytomorphometric analysis of the adequately preserved cells. However, the $ThinPrep^{(R)}$ preparation showed significant advantages when considering the better preservation and cellularity with a clear background.

• Biomedical Science Letters
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• v.15 no.1
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• pp.47-53
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• 2009

Urinary bladder cancer is diagnosed through urine cytology and cytoscopy with biopsy. An atypical urothelial cast is often found by voided urine cytology in a papillary urothelial cell carcinoma. The objective of this study is to demonstrate the significance of the evaluation of urinary nuclear matrix protein (NMP22) level and Sure Path Liquid-based cytology (SP-LBC) as compared to the examination of atypical urothelial cast in voided urine sediment for monitoring bladder cancer. From October 2007 to January 2008, we observed 3240 patients who visited the emergency laboratory of urology of Soonchunhyang University, Cheonan Hospital. Both NMP22 measurement and SP-LBC were performed in 31 patients who were positive in an atypical urothelial cast test. In particular, 26 men and 5 women were found to be atypical urothelial cast-positive persons. The average age for both men and women is 61.8. NMP22 test is positive in 23 of 31 cases (74.2%) from patients with atypical urothelial cast, while the test is negative in 8 of 31 cases (25.8%). The percentages of negativity, atypicality, suspicious malignancy, and malignancy in SP-LBC are 25.8% (8/31), 58.1% (18/31), 9.7% (3/31), and 6.5% (2/31), respectively. The relation of NMP22 positivity with the malignant degree in LBC is significant (P<0.01). Two malignant patients resulting from SP-LBC show the same results in histological examination. Overall, the study suggests the usefulness of NMP22 measurement and LBC as well as the examination of atypical urothelial cast for the diagnosis of early bladder cancer.