title: Evaluation of double immunocytochemical staining for CK20 and P53 as a potential adjunct to cytology for urothelial cancer diagnosis.
abstract: OBJECTIVE
  To evaluate double immunocytochemical staining with p53 and CK20, as a tool for improving the accuracy of urinary cytology. The aim of the present study was to clarify the diagnostic significance of the expression of these markers and to investigate the possibility of using this information for better monitoring of bladder cancer patients during follow-up.
  
  
  METHODS
  One hundred and twenty-five urine cytology cases were retrieved with corresponding histology from our files. One ThinPrep® smear was available for each of them and dual immunocytological staining for p53 and CK20 was performed. Eleven cases were excluded from the study because of hypocellularity. The material comprised 58 malignant, 36 atypical and 20 negative for malignancy cases. Immunocytochemistry was evaluated by two cytopathologists, blinded to the histological diagnosis or follow-up data. A cut-off threshold of five stained atypical cells, according to the literature, was used for evaluation.
  
  
  RESULTS
  Fifty-two out of 58 malignant cases were positive for at least one of the markers (89.6%). In the atypical and negative groups, 18 (50%) and 5 (25%) cases were positive, respectively. Accuracy parameters evaluation for cytology versus the combination of cytology with immunocytological staining were: sensitivity 73.4% versus 91.1%, specificity 100% versus 74.3%, positive predictive value (PPV) 100% versus 88.9% and negative predictive value (NPV) 62.5% versus 78.8%.
  
  
  CONCLUSIONS
  Double immunocytochemical staining for p53 and CK20 is easy to perform and evaluate and can improve cytology sensitivity. It is helpful in establishing a diagnosis of malignancy and may be used as a triage tool to select patients that require cystoscopy during clinical follow-up.
authors.affiliation: Cytopathology Department, Laiko Hospital, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Lenos
authors.affiliation: 1st University Urology Clinic, Athens Medical School, Laiko Hospital, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Katafigiotis
authors.affiliation: Cytopathology Department, Laiko Hospital, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Vrettou
authors.affiliation: Histopathology Department, "Hygeia" Hospital, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Papaioannou
authors.affiliation: Department of Histopathology, St James University Hospital, Leeds, UK.
authors.forename: F
authors.initials: F
authors.lastname: Malta
authors.affiliation: 1st Histopathology Department, Athens Medical School, Laiko Hospital, Athens, Greece.
authors.forename: E-A
authors.initials: EA
authors.lastname: Trigka
authors.affiliation: Cytopathology Department, Laiko Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Sousouris
authors.affiliation: 1st University Urology Clinic, Athens Medical School, Laiko Hospital, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Constantinides
authors.affiliation: Cytopathology Department, Laiko Hospital, Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Mikou
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D003558:Cystoscopy / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D053554:Keratin-20 / Q000378:metabolism; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*
chemical_list: D014408:Biomarkers, Tumor; C507499:KRT20 protein, human; D053554:Keratin-20; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
keywords: CK20; cytology; p53; urine