title: Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma.
abstract: OBJECTIVE
  • To evaluate the diagnostic accuracy of urine cytology for detecting aggressive disease in a multi-institutional cohort of patients undergoing extirpative surgery for upper-tract urothelial carcinoma (UTUC).
  
  
  METHODS
  • We reviewed the records of 326 patients with urinary cytology data who underwent a radical nephroureterectomy or distal ureterectomy without concurrent or previous bladder cancer. • We assessed the association of cytology (positive, negative and atypical) with final pathology. Sensitivity and positive predictive value (PPV) of a positive (± atypical) cytology for high-grade and muscle-invasive UTUC was calculated.
  
  
  RESULTS
  • On final pathology, 53% of patients had non-muscle invasive disease (pTa, pTis, pT1) and 47% had invasive disease (≥ pT2). Low-grade and high-grade cancers were present in 33% and 67% of patients, respectively. • Positive, atypical and negative urine cytology was noted in 40%, 40% and 20% of cases. Positive urinary cytology had sensitivity and PPV of 56% and 54% for high-grade and 62% and 44% for muscle-invasive UTUC. • Inclusion of atypical cytology with positive cytology improved the sensitivity and PPV for high-grade (74% and 63%) and muscle-invasive (77% and 45%) UTUC. Restricting analysis to patients with selective ureteral cytologies further improved the diagnostic accuracy when compared with bladder specimens (PPV > 85% for high-grade and muscle-invasive UTUC).
  
  
  CONCLUSIONS
  • In this cohort of patients with UTUC treated with radical surgery, urine cytology in isolation lacked performance characteristics to accurately predict muscle-invasive or high-grade disease. • Improved surrogate markers for pathological grade and stage are necessary, particularly when considering endoscopic modalities for UTUC.
authors.affiliation: Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033-0850, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Messer
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: James C
authors.initials: JC
authors.lastname: Brien
authors.forename: Michael P
authors.initials: MP
authors.lastname: Herman
authors.forename: Casey K
authors.initials: CK
authors.lastname: Ng
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Benjamin
authors.initials: B
authors.lastname: Scoll
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Mark
authors.initials: M
authors.lastname: Wille
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
authors.forename: Gary
authors.initials: G
authors.lastname: Steinberg
authors.forename: John D
authors.initials: JD
authors.lastname: Terrell
authors.forename: Steven M
authors.initials: SM
authors.lastname: Lucas
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000652:urine*; D002295:Carcinoma, Transitional Cell / Q000473:pathology* / Q000652:urine*; D015331:Cohort Studies; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000652:urine*
chemical_list: D014408:Biomarkers, Tumor