title: Immunocytochemical staining for p53 and Ki-67 helps to characterise urothelial cells in urine cytology.
abstract: OBJECTIVE
  The presence of atypical cells in urine cytology is unsatisfactory for both cytologists and clinicians. The objective of this study was to test whether p53 and Ki-67 immunostaining could improve urothelial carcinoma (UC) detection on urinary cytology.
  
  
  METHODS
  A total of 196 urine samples were analysed, 142 from the bladder, 41 from the upper tract and 13 from ileal bladder replacement. Cytology results were expressed as normal (N) (n = 81), atypia cannot exclude low-grade UC (ALG) (n = 25), suspicious for high-grade UC (SHG) (n = 39) and high-grade UC (HG) (n = 51). Actual diagnoses were confirmed by histopathological analysis, cystoscopic examination or follow-up for at least 1 year. Immunocytochemistry performed on CytoSpin™slides allowed the determination of the percentage of positive cells with p53 and Ki-67.
  
  
  RESULTS
  The median percentage values [first to third quartile] of p53 and Ki-67 were 0 [0-5] and 0 [0-1] for N cytology, 5 [0-40] and 2 [1-10] for ALG, 10 [0-30] and 6 [3-25] for SHG, and 30 [10-80] and 20 [10-30] for HG, respectively. Statistically higher values were observed for both tests (P < 0.001) in positive cytologies (ALG, SHG and HG). The optimal cut-offs were 5% for p53 and 3% for Ki-67. The sensitivity and specificity for the detection of all UC were 86.4% and 76.7% for cytology alone, 81.3% and 93.2% for cytology and p53, 75.7% and 88% for cytology and Ki-67, and 68.9% and 97.5% for cytology, p53 and Ki-67, respectively.
  
  
  CONCLUSIONS
  Using p53 and/or Ki-67 in addition to cytology increases the specificity without penalising the sensitivity.
authors.affiliation: Department of Pathology and Cytology, University Cancer Institute Toulouse Oncopole, Toulouse Universitary Hospital, Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Courtade-Saïdi
authors.affiliation: Department of Pathology and Cytology, University Cancer Institute Toulouse Oncopole, Toulouse Universitary Hospital, Toulouse, France.
authors.forename: J
authors.initials: J
authors.lastname: Aziza
authors.affiliation: Department of Pathology and Cytology, University Cancer Institute Toulouse Oncopole, Toulouse Universitary Hospital, Toulouse, France.
authors.forename: D
authors.initials: D
authors.lastname: d'Aure
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, UMR-1027 INSERM Toulouse University School of Medicine, Toulouse University Hospital, Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Bérard
authors.affiliation: Department of Pathology and Cytology, University Cancer Institute Toulouse Oncopole, Toulouse Universitary Hospital, Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Evrard
authors.affiliation: Department of Pathology and Cytology, University Cancer Institute Toulouse Oncopole, Toulouse Universitary Hospital, Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Basset
authors.affiliation: Department of Pathology and Cytology, University Cancer Institute Toulouse Oncopole, Toulouse Universitary Hospital, Toulouse, France.
authors.forename: L
authors.initials: L
authors.lastname: Lacoste-Collin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000652:urine; D002277:Carcinoma / Q000235:genetics / Q000473:pathology / Q000652:urine*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000652:urine*; D003581:Cytodiagnosis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000302:isolation & purification / Q000652:urine*; D008297:Male; D008875:Middle Aged; D016159:Tumor Suppressor Protein p53 / Q000652:urine*; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000652:urine*; D019459:Urothelium / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen; C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
keywords: Ki-67; immunocytochemistry; p53; urine cytology; urothelial carcinoma