title: Automated urinalysis with expert review for incidental identification of atypical urothelial cells: An anticipated bladder carcinoma diagnosis.
abstract: BACKGROUND
  The most common diagnostic technique for the detection of malignant/atypical urothelial cells (m/AUC) is urinary cytology (Ucytol). Urinary sediment (Used) examination, often prescribed for asymptomatic, healthy subjects, can incidentally identify suspicious/AUC (s/AUC) in routine daily practice.
  
  
  METHODS
  Unstained, unfixed and uncentrifuged urine samples were analyzed with an automated intelligent microscopy (AIM) system. From January 2010, any incidental identification of s/AUC through expert revision of unclassified cell images was reported, according to internal protocols, as an additional note on the patients' laboratory report. Patients' symptomatology or previous history was unknown to the pathologist. All referrals from January 2010 to December 2014, with the s/AUC note, were reviewed and cross-referenced with Ucytol and histology data from a central database.
  
  
  RESULTS
  Of the 162 patients identified with s/AUC (0.1/1000 samples), 84% (n=136) performed further Ucytol and/or histological examinations. The sensitivity of the identification of non-transitory AUC at Used was 87.5%. Positive histological examinations were 91.2% classified as high-grade urothelial carcinoma.
  
  
  CONCLUSIONS
  Routine Used examination, with an AIM and expert revision, can identify the presence of AUC in a clinical laboratory setting, and for some subjects, may anticipate bladder carcinoma diagnosis.
authors.affiliation: CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy. Electronic address: r.anderlini@ausl.mo.it.
authors.forename: R
authors.initials: R
authors.lastname: Anderlini
authors.affiliation: Cytopathology Laboratory, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, Mirandola Hospital, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Manieri
authors.affiliation: Cytopathology Laboratory, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, Mirandola Hospital, Modena, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Lucchi
authors.affiliation: Cytopathology Laboratory, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, Mirandola Hospital, Modena, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Raisi
authors.affiliation: CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy.
authors.forename: A R
authors.initials: AR
authors.lastname: Soliera
authors.affiliation: CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Torricelli
authors.affiliation: CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Varani
authors.affiliation: CoreLab, Dipartimento Interaziendale ad Attività Integrata Medicina di Laboratorio ed Anatomia Patologica, NOCSAE Hospital, Modena, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Trenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D033162:Incidental Findings; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D016482:Urinalysis / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000652:urine*; D019459:Urothelium / Q000473:pathology*; D055815:Young Adult
keywords: Atypical urothelial cells; Automated urinalysis; Bladder carcinoma; Early diagnosis; Urinary sediment; iQ200