title: The Johns Hopkins Hospital template for urologic cytology samples: part I-creating the template.
abstract: BACKGROUND
  The most important indicator for urologic surgeons at The Johns Hopkins Hospital to have a patient undergo cystoscopy is a cytologic diagnosis of high-grade urothelial carcinoma. The template was designed to standardize diagnostic categories so clinicians can manage their patients uniformly. The template was based in part on the Bethesda System for cervical cytology.
  
  
  METHODS
  According to the template, reactive/inflammatory changes were included in the negative group (no urothelial atypia or malignancy identified). The category atypical urothelial cells of undetermined significance (AUC-US) was akin to atypical squamous cells of undetermined significance (ASC-US), as was the category of atypical urothelial cells, favor high-grade carcinoma (AUC-H). The categories high-grade urothelial carcinoma (HGUC) and low-grade urothelial carcinoma also were added.
  
  
  RESULTS
  The Pathology Data System at the Johns Hopkins Hospital was searched for cases that met the following criteria over a period from July 1, 2007 to June 30, 2009: all cytologic specimens from the urinary tract and all surgical specimens with a diagnosis of HGUC, regardless of invasion status. All cytologic specimens were then matched with biopsies during the same period, and all surgical specimens from patients who had a cytologic diagnosis of AUC-US or AUC-H were retrieved for 18 months after the end of the 2-year study period. Greater than 50% of patients who had biopsy-confirmed HGUC had a preceding cytologic diagnosis of AUC-H or HGUC. When patients with AUC-US were added to the analysis, 80% of patients with HGUC had at least 1 abnormal urinary cytology result. Of those patients who had a diagnosis of AUC-H, 38% had urothelial cancer discovered at biopsy compared with only 10% of those with an AUC-US diagnosis.
  
  
  CONCLUSIONS
  The authors concluded that their template is effective in targeting those patients who need to undergo cystoscopy.
authors.affiliation: Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287-6940, USA. drosenthal@jhmi.edu
authors.forename: Dorothy L
authors.initials: DL
authors.lastname: Rosenthal
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Vandenbussche
authors.forename: Frances H
authors.initials: FH
authors.lastname: Burroughs
authors.forename: Srividya
authors.initials: S
authors.lastname: Sathiyamoorthy
authors.forename: Hui
authors.initials: H
authors.lastname: Guan
authors.forename: Christopher
authors.initials: C
authors.lastname: Owens
mesh_terms: D003558:Cystoscopy; D003581:Cytodiagnosis / Q000379:methods / Q000592:standards*; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D014556:Urine / Q000166:cytology; D019459:Urothelium / Q000473:pathology