title: Two-tiered subdivision of atypia on urine cytology can improve patient follow-up and optimize the utility of UroVysion.
abstract: BACKGROUND
  The annual incidence of urothelial carcinoma continues to increase, and it is projected that greater than 70,000 new cases will occur in the year 2015. However, as much as 23% of cytologic specimens will demonstrate some degree of atypia without meeting the criteria for urothelial carcinoma and thus will be reported as atypical.
  
  
  METHODS
  The authors conducted 2 laboratory information searches and 1 survey. In total, 311 patients who had atypical cytology-biopsy pairs available were identified from the initial data search. The second data search identified 942 patients who had fluorescence in situ hybridization (FISH) results available.
  
  
  RESULTS
  There was fair agreement between FISH results and cytology results (κ = 0.34; 95% confidence interval, 0.27-0.41). The analysis did not reveal any benefits of using additional atypical subcategories beyond the 2 suggested in the literature. It was determined that 2 strategies would provide an optimal balance: standardizing patient management and facilitating the adoption of universally recognized templates.
  
  
  CONCLUSIONS
  When combining cytology and the 2-tiered atypical classification system with FISH testing, a marked increase in sensitivity and an accompanying decrease in specificity were observed compared with either test individually. Thus, highly sensitive FISH testing may help to identify high-risk patients among those in the group with uncertain atypical findings.
authors.affiliation: Department of Pathology, North Shore-LIJ Staten Island University Hospital, Staten Island, New York.
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Glass
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Coutsouvelis
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Silvat
authors.initials: S
authors.lastname: Sheikh-Fayyaz
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Karen
authors.initials: K
authors.lastname: Chau
authors.affiliation: Department of Biostatistics, Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, New York.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosen
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: Brenkert
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Farah
authors.initials: F
authors.lastname: Slim
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Fanya
authors.initials: F
authors.lastname: Epelbaum
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Kasturi
authors.initials: K
authors.lastname: Das
authors.affiliation: Department of Cytopathology, North Shore-LIJ Health System, Lake Success, New York.
authors.forename: Rubina S
authors.initials: RS
authors.lastname: Cocker
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis; D014556:Urine / Q000166:cytology*
keywords: 2-tiered system; Paris system; UroVysion; atypical; atypical urine; fluorescence in situ hybridization (FISH); urine