title: The merits of cytology in the workup for upper tract urothelial carcinoma - a contemporary review of a perplexing issue.
abstract: BACKGROUND
  The importance of upper tract cytology for evaluating tumors is unclear. We correlated upper tract cytology with histologic findings in patients who underwent nephroureterectomy for upper tract urothelial carcinoma (UTUC) at a single tertiary care referral center.
  
  
  METHODS
  137 patients underwent nephroureterectomy between 2004 and 2012. 18 patients were excluded (benign tumors, atrophic kidneys with the remaining 119 patients serving as our study population). Upper tract cytology from the renal pelvis and/or ureter were retrospectively reviewed and analyzed with final pathology data in the remaining patients with UTUC.
  
  
  RESULTS
  57% (68/119) had preoperative upper tract cytology collected. 73% (50/68) patients had abnormal cytology (positive, suspicious) with a sensitivity of 74% (which increased to 90% if atypical included), specificity of 50% and a positive predictive value of 98%. High grade tumors were more common than expected (77% high grade vs. 20% low grade). Abnormal cytology did not predict T stage or tumor grade. Interestingly, positive upper tract cytology was found in all of the UTUC CIS specimen.
  
  
  CONCLUSIONS
  Upper tract cytology has been utilized to support the diagnosis of upper tract urothelial carcinoma. Our data demonstrates that abnormal cytology correlates well with the presence of disease but does not predict staging or grading in these respective patients.
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: E F
authors.initials: EF
authors.lastname: Sverrisson
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kim
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: P N
authors.initials: PN
authors.lastname: Espiritu
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Dhillon
authors.affiliation: Genitourinary Oncology Program, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002277:Carcinoma / Q000473:pathology*; D005260:Female; D006801:Humans; D007682:Kidney Pelvis / Q000166:cytology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014513:Ureter / Q000166:cytology / Q000473:pathology*; D014516:Ureteral Neoplasms / Q000473:pathology*