title: The impact of subdividing the "atypical" category for urinary cytology on patient management.
abstract: BACKGROUND
  The purpose of the study is to determine the impact of subdividing the "atypical" cytology interpretation into two groups: Atypical urothelial cells of uncertain significance (AUC-US) and Atypical urothelial cells suspicious for high-grade urothelial carcinoma (AUC-H/SHGUC), on management of patients with no prior history of UC.
  
  
  METHODS
  This is a retrospective study of "atypical" urine cytology with subsequent tissue examination occurring within six months. Cytology reports with "atypical" interpretation were reclassified into AUS-UC and AUC-H based on morphologic features identified by the Johns Hopkins system and the Paris system for urine cytology. Follow-up and categorical outcomes were compared between the reclassified AUC-US and AUC-H groups.
  
  
  RESULTS
  There was no significant difference (P < 0.4539) in the rate of cytology follow-up, the follow-up cytology result (P < 0.1845), or time between follow-up cytologies (P < 0.0869) between the reclassified atypical group of AUC-H and AUC-US. There was a significant association (P < 0.0001) of rate of malignancy with the reclassified AUC-H (87.18%) compared to the AUC-US (58.68%) groups.
  
  
  CONCLUSIONS
  There was no difference in follow-up between the AUC-H and AUC-US, however there was a difference in the rates of malignancy in the two groups. The AUC-H group is similar to the SHGUC group of the Paris system and can be considered as such, whereas the AUC-US group should continue to be considered atypical. We conclude that reclassification of the "atypical" category into AUC-US and AUC-H/SHGUC can reduce the rate of atypia and help in focused follow-up and targeted management. Diagn. Cytopathol. 2016;44:477-482. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology, Staten Island University Hospital, New York, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: Glass
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Rubina
authors.initials: R
authors.lastname: Cocker
authors.affiliation: North Shore-LIJ Health System, Feinstein Institute for Medical Research, New York, New York.
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosen
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Coutsouvelis
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Karen
authors.initials: K
authors.lastname: Chau
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Farah
authors.initials: F
authors.lastname: Slim
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: Brenkert
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Silvat
authors.initials: S
authors.lastname: Sheikh-Fayyaz
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Farmer
authors.affiliation: Department of Pathology, Hofstra North Shore LIJ School of Medicine, New York, New York.
authors.forename: Kasturi
authors.initials: K
authors.lastname: Das
mesh_terms: D002277:Carcinoma / Q000145:classification / Q000191:economics / Q000473:pathology*; D019468:Disease Management; D006801:Humans; D001749:Urinary Bladder Neoplasms / Q000145:classification / Q000191:economics / Q000473:pathology*; D014556:Urine / Q000166:cytology*; D019459:Urothelium / Q000473:pathology*
keywords: Paris classification system; atypical urothelial cells; urine cytology; urothelial carcinoma