title: Diagnostic terminology for urinary cytology reports including the new subcategories 'atypical urothelial cells of undetermined significance' (AUC-US) and 'cannot exclude high grade' (AUC-H).
abstract: OBJECTIVE
  We studied whether atypical, non-superficial urothelial cells (AUC) could be separated into new subcategories including AUC 'of undetermined significance' (AUC-US) and 'cannot exclude high grade'' (AUC-H) in order to help to standardize urine cytopathology reports, as it is widely accepted in the Bethesda system for gynaecological cytopathology.
  
  
  METHODS
  We investigated whether AUC-US and AUC-H, defined by distinctive cytological criteria, might be separated with statistical significance according to actual diagnosis and follow-up data. A series of 534 cyto-histological comparisons taken in 139 patients, including 221 AUC at various steps of their clinical history was studied. There were 513 (96.1%) postcystoscopy and 469 (87.8%) ThinPrep® liquid-based specimens (95.9% and 89.1% of AUC cases, respectively). Patients viewed between 1999 and 2011 had histological control in a 0- to 6-months delay and were followed-up during an additional 5.9 ± 9.2 (0- to 56-) months period.
  
  
  RESULTS
  The 221 AUC represented 0.8-2% of the specimens viewed during the study period. Among AUC-H cases, 70 out of 185 (37.8%) matched with high-grade lesions, compared with 3 of 38 (8.3%) of AUC-US cases (P = 0.0003). Conservatively treated patients with AUC-H more frequently developed high-grade lesions than those with AUC-US (54.1% versus 16.7%, P = 0.0007) with a 17.6-months mean delay. Nuclear hyperchromasia, a nuclear to cytoplasm (N/C) ratio > 0.7 and the combination of both were the more informative diagnostic criteria, all with P < 0.01.
  
  
  CONCLUSIONS
  We conclude that the new subcategories could help to standardize urine cytopathology reports and contribute to the patient's management, provided it is validated by multicentric studies.
authors: Hospices Civils de Lyon, Centre de Pathologie Est, Hôpital Femme-Mère-Enfant, Bron, France; Université Claude Bernard Lyon 1, Lyon, France.
authors: E
authors: E
authors: Piaton
authors: M
authors: M
authors: Decaussin-Petrucci
authors: F
authors: F
authors: Mege-Lechevallier
authors: A-S
authors: AS
authors: Advenier
authors: M
authors: M
authors: Devonec
authors: A
authors: A
authors: Ruffion
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003581:Cytodiagnosis; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009626:Terminology as Topic; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology*
keywords: atypical urothelial cells; bladder cancer; high grade; reporting; terminology; urinary cytology