Upper tract urinary cytology to detect upper tract urothelial carcinoma: Using the Johns Hopkins Hospital template and evaluation of its feasibility.
BACKGROUND
Primary upper urinary tract (UT) urothelial carcinoma (UC) is rare. UT washing cytology is often used during UT surveillance. The Johns Hopkins Hospital template (JHHT) is primarily designed to use on lower tract urine cytology and the data on applying JHHT on UT cytology is limited. We herein study the value of UT cytology in detecting UTUC using JHHT in a cohort.


METHODS
One hundred UT cytologic specimens were retrieved from our database during a 10-year period (2001-2011). For each patient, the cytology specimen with the highest degree of abnormality was selected. Histologic sections of these cases were also studied.


RESULTS
Seventy-six cases of UT cytology had histologic follow-up by either serial (>2) endoscopic biopsies or nephroureterectomy or ureterectomy. Among them, the cytologic diagnosis of positive or suspicious for high-grade UC (HGUC) was made in 15 cases; suspicious for low-grade UC (LGUC) in 3 cases; atypical urothelial cells (AUCs) of undetermined significance in 19 cases; and negative in 39 cases. Of the 15 cases with diagnosis of positive for HGUC or AUC-HGUC (AUC-H), 10 had histologically confirmed HGUC, 1 had LGUC, and 4 had benign histology. All 3 cases of cytologically suspicious for LGUC had LGUC on concomitant histology. Among the 19 washings with AUCs with unknown significance, 7 were LGUC, 1 was HGUC, and 11 were benign on histology. Six of 39 cases with negative cytology had UC (3 low-grade and 3 high-grade) on histology. Combining positive and AUC-H for UC diagnoses, sensitivity, and specificity for detecting HGUC were 71.4% and 91.9%, while for LGUC were 21.4% and 100%, respectively.


CONCLUSIONS
UT washing cytology has high specificity for detecting UC, especially HGUC. Using JHHT on UT washing cytology is feasible, but the category of LGUC may need modification.
Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA ; Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
Longwen
L
Chen
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathology, Peking University, Health Science Center, Beijing, China.
Huiying
H
He
Address: Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
Matthew A
MA
Zarka
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA ; Department of Pathology, New York University Langone Medical Center, New York, NY, USA.
Ming
M
Zhou
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
Cristina
C
Magi-Galluzzi
Johns Hopkins Hospital template; upper urinary tract; urine cytology; urothelial carcinoma