title: Urinary cytology with acridine orange fluorescence is highly valuable for predicting high-grade upper urinary tract urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate the clinical value of acridine orange fluorescent staining in urinary cytology for the diagnosis of upper urinary tract urothelial carcinoma.
  
  
  METHODS
  A retrospective analysis was conducted with 510 cases of upper urinary tract urothelial carcinoma (UTUC) in terms of the results of acridine orange fluorescence (AO-F) staining of the exfoliated cells in urine. The percentage of positive AO-F result and the positive predictive value of AO-F for high-grade and muscle invasive urothelial carcinoma were calculated and analyzed in terms of clinical characteristics.
  
  
  RESULTS
  The overall percentage of positive AO-F result was 49% in the 510 patients, 54.1% for males and 40.6% for females. AO-F was positive in 51.9% of the patients with hematuria and 36.2% of the patients without hematuria. AO-F was positive in 56.4% of the patients with renal pelvis carcinoma and 42.8% of the patients with ureteral cancer; in 44.6% of the patients with non-muscle invasive carcinoma and 53.5% of the patients with muscle-invasive carcinoma. AO-F was positive in 26.8% of the cases with low-grade carcinoma and 55.3% of the patients with high-grade carcinoma. The positive predictive value of AO-F was 88% for high-grade cancer, and only 53.6% for muscle invasive carcinoma.
  
  
  CONCLUSIONS
  Acridine orange fluorescence microscopy cannot increase the sensitivity of urine exfoliative cytology in the diagnosis of UTUC. It may be used as a predictor of high-grade UTUC. Acridine orange fluorescence microscopy in urinary cytodiagnosis does not show high value in predicting muscle invasive UTUC.
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology 23 Pingjiang Road, Tianjin, 300211, China ; Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital 127 Dongming Road, Zhengzhou, 450008, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Zhihong
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Changwen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology 23 Pingjiang Road, Tianjin, 300211, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000165:Acridine Orange; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D003581:Cytodiagnosis / Q000379:methods*; D005260:Female; D005456:Fluorescent Dyes; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014556:Urine / Q000166:cytology; D014571:Urologic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000652:urine; D019459:Urothelium / Q000473:pathology*
chemical_list: D005456:Fluorescent Dyes; D000165:Acridine Orange
keywords: Urothelial carcinoma; acridine orange fluorescence; cytodiagnosis; upper urinary tract