title: Comparative evaluation of ProEx C and ImmunoCyt/uCyt assays in atypical urine cytology.
abstract: BACKGROUND
  Detection of urothelial carcinoma by urine cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of urothelial carcinoma. ProEx C is an assay targeting expression of topoisomerase II-α and the minichromosome maintenance protein-2 and is used to assist in diagnoses of gynecologic specimens.
  
  
  OBJECTIVE
  To evaluate the utility of ProEx C and uCyt in atypical urine cytology.
  
  
  METHODS
  Sixty-eight specimens with a diagnosis of atypical urine cytology, concurrent uCyt testing, and surgical biopsy follow-up were included. Slides were restained with ProEx C. ProEx C was recorded as positive when nuclear staining was seen in at least one morphologically atypical urothelial cell. The uCyt was scored as positive if at least one morphologically atypical urothelial cell showed positive fluorescence staining. Thirteen cases (19%) had benign histologic diagnoses, 18 (26%) had low-grade papillary urothelial carcinoma, and 37 (54%) had high-grade urothelial carcinoma.
  
  
  RESULTS
  The overall sensitivity was 85% for ProEx C, 85% for uCyt, and 93% for the combination of the 2 assays. The overall specificity was 69% for ProEx C, 31% for uCyt, and 23% for the combination of the 2 tests. In predicting high-grade urothelial carcinoma, sensitivity was 92% for ProEx C, 86% for uCyt, and 92% for both tests. In predicting low-grade papillary urothelial carcinoma, sensitivity was best with the combination of the 2 tests at 94%.
  
  
  CONCLUSIONS
  ProEx C has superior specificity to uCyt. The combination of the 2 tests yielded high sensitivity not only for high-grade urothelial carcinoma but also for low-grade papillary urothelial carcinoma.
authors.affiliation: From the Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles. Dr Vergara-Lluri and Ms Hu are now with the Department of Pathology & Laboratory Medicine, University of Southern California, Los Angeles.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Vergara-Lluri
authors.forename: Eugenia
authors.initials: E
authors.lastname: Hu
authors.forename: Jian-Yu
authors.initials: JY
authors.lastname: Rao
authors.forename: Mary
authors.initials: M
authors.lastname: Levin
authors.forename: Sophia K
authors.initials: SK
authors.lastname: Apple
authors.forename: Neda A
authors.initials: NA
authors.lastname: Moatamed
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003584:Cytological Techniques / Q000379:methods*; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014556:Urine / Q000166:cytology*; D014571:Urologic Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D019459:Urothelium / Q000473:pathology