بسم الله الرحمن الرحيم
DESCRIPTION
بسم الله الرحمن الرحيم. Interpretation of urine cytology Nashwa Emara M.D.,phd ASS. Prof. Pathology. Function. Majority of UT malignancies are urothelial CA. The main function of urine cytology is diagnosis of UC. Indications. Diagnosis of symptomatic patients ( hematuria ). - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/1.jpg)
اللهاللهبسم بسم الرحمن الرحيمالرحمن الرحيم
![Page 2: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/2.jpg)
Interpretation of urine cytology
Nashwa Emara M.D.,phdASS. Prof. Pathology
![Page 3: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/3.jpg)
Function
• Majority of UT malignancies are urothelial CA.
• The main function of urine cytology is diagnosis of UC.
![Page 4: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/4.jpg)
IndicationsDiagnosis of symptomatic patients Diagnosis of symptomatic patients (hematuria).(hematuria).
Screen high risk patients (industrial Screen high risk patients (industrial chemicals, metals, etc.)chemicals, metals, etc.)
Follow-up patients with UT neoplasia.Follow-up patients with UT neoplasia.
Complementary to cystoscopy and biopsy: Complementary to cystoscopy and biopsy: detect small and hidden lesions (diverticuli, detect small and hidden lesions (diverticuli, ureters, renal pelvis)..ureters, renal pelvis)..
Urine cytology is the most reliable method Urine cytology is the most reliable method for detecting urothelial CIS (>biopsies).for detecting urothelial CIS (>biopsies).
![Page 5: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/5.jpg)
Types of SpecimensVoided urineVoided urine (avoid 1st morning (avoid 1st morning specimens) specimens)
Catheterized urineCatheterized urine (in Females) (in Females)
Washings/Brushings Washings/Brushings
Superior to voided urine but localized, Superior to voided urine but localized, may not sample upper urinary tract may not sample upper urinary tract and urethra and urethra
Ileal conduit urineIleal conduit urine
![Page 6: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/6.jpg)
Deep Vs Superficial CellsDeep Vs Superficial Cells
![Page 7: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/7.jpg)
Columnar and Squamous CellsColumnar and Squamous Cells
![Page 8: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/8.jpg)
Normal Urine CytologyNormal Urine Cytology
![Page 9: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/9.jpg)
Washing, Instrumentation, Washing, Instrumentation, LithiasisLithiasis
![Page 10: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/10.jpg)
Diagnostic AccuracyNumber of Specimens:Number of Specimens:
-Voided urine on 3 consecutive days.-Voided urine on 3 consecutive days.
+ 50% accuracy (1 specimen)+ 50% accuracy (1 specimen)
+ 75-90% accuracy (3 specimens)+ 75-90% accuracy (3 specimens)
Patient Population:Patient Population:
High risk and history of CAHigh risk and history of CA
Tumor Grade:Tumor Grade:
• • HG UC: 78 - 98%HG UC: 78 - 98%
• • LG UC: 0 - 70%LG UC: 0 - 70%
![Page 11: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/11.jpg)
Grading Systems for Papillary UCGrading Systems for Papillary UC
1973 WHO1998 WHO/ISUPUrinary Cytology
PapillomaPapillomaLow-grade Papillary Urothelial Lesion*
Grade IPUNLMP
Low-grade Papillary Urothelial Lesion
Grade IILow-GradeLow-grade Urothelial Carcinoma
Grade IIIHigh-GradeHigh-grade Urothelial Carcinoma
![Page 12: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/12.jpg)
WHO GradingWHO Gradingof Papillary Urothelial Malignanciesof Papillary Urothelial Malignancies
FeaturesPUNLMPLow-grade UCHigh-grade UC
PolarityNormalMinimal lossDisordered
Superficial cellsUsually presentMay be presentAbsent
Papillary architectureDelicateFused+ DelicateFused
Nuclear sizeIncreasedIncreasedGreatly increased
PleomorphismSlightModerateMarked
Nuclear polarizationSlight abnormalAbnormalAbsent
HyperchromasiaSlightModerateMarked
MitosesNone or RarePresentProminent
Nuclear groovesPresentPresentAbsent
ChromatinFine, uniformMild variationMarked variation
![Page 13: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/13.jpg)
PUNLMPPUNLMP
![Page 14: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/14.jpg)
Low-grade Urothelial CarcinomaCytologic diagnosis of LG PUC is Cytologic diagnosis of LG PUC is
problematicproblematic
Minimal shedding of neoplastic cellsMinimal shedding of neoplastic cells
Subtle cytologic alterationsSubtle cytologic alterations
Difficult to distinguish from reactive Difficult to distinguish from reactive changes, i.e. stones, instrumentation changes, i.e. stones, instrumentation
Cytologic overlap between PUNLMP and Cytologic overlap between PUNLMP and LG UC, some cases indistinguishable LG UC, some cases indistinguishable
![Page 15: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/15.jpg)
Low-grade Urothelial Carcinoma vs Reactive
![Page 16: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/16.jpg)
Low-grade Urothelial Carcinoma
![Page 17: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/17.jpg)
Diff. Diag. of LGUC
Reactive/reparative changesReactive/reparative changes
Instrumentation effectInstrumentation effect
LithiasisLithiasis
Upper urinary tract samplingUpper urinary tract sampling
![Page 18: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/18.jpg)
Low-grade UC Vs BenignLow-grade UC Vs Benign
![Page 19: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/19.jpg)
LGUC Vs InstrumentationLGUC Vs Instrumentation
![Page 20: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/20.jpg)
Instrumentation Effect
Catheterized urine & bl. wash specimens.Catheterized urine & bl. wash specimens.
Large pseudopapillary groups and 3D Large pseudopapillary groups and 3D clusters.clusters.
Nuclear overlap and crowding.Nuclear overlap and crowding.
Low N/C ratio. Low N/C ratio.
Finely granular chromatin with even Finely granular chromatin with even distribution.distribution.
Well defined cytoplasmic borders.Well defined cytoplasmic borders.
Nuclear palisading at periphery of clusters Nuclear palisading at periphery of clusters with abundant cytoplasm.with abundant cytoplasm.
![Page 21: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/21.jpg)
LithiasisLithiasis
![Page 22: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/22.jpg)
Cytology of Upper Urinary Tract specimens
Direct sampling of upper UT is effective in Direct sampling of upper UT is effective in detecting HG UC, but poor for low grade detecting HG UC, but poor for low grade lesionslesions
Normal upper UT epithelium shows more Normal upper UT epithelium shows more atypia than lower UT and occasionally more atypia than lower UT and occasionally more than LG UCthan LG UC
High N/C ratio, enlarged nuclei, nuclear High N/C ratio, enlarged nuclei, nuclear membrane irregularitiesmembrane irregularities
Often present in papillary clustersOften present in papillary clusters
Almost impossible to distinguish low grade Almost impossible to distinguish low grade UC from upper tract benign changes UC from upper tract benign changes
![Page 23: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/23.jpg)
Renal Pelvis & Ureter BrushingsRenal Pelvis & Ureter Brushings
![Page 24: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/24.jpg)
High-grade Urothelial Carcinoma
Often invasive, 70 mortality.Often invasive, 70 mortality.
Can not reliably separate CIS from Can not reliably separate CIS from invasive high-grade UC.invasive high-grade UC.
High diagnostic accuracy of cytology:High diagnostic accuracy of cytology:
- Sensitivity 80 %.- Sensitivity 80 %.
- Specificity > 95%.- Specificity > 95%.
![Page 25: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/25.jpg)
HGUCHGUC
![Page 26: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/26.jpg)
Diff. Diag. of HGUC
Viral infectionViral infection
Therapy effectTherapy effect
Degenerative and reactive Degenerative and reactive changeschanges
Upper urinary tract specimensUpper urinary tract specimens
StonesStones
![Page 27: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/27.jpg)
Polyoma Virus (Decoy Cells)Polyoma Virus (Decoy Cells)
![Page 28: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/28.jpg)
Therapy EffectTherapy Effect
![Page 29: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/29.jpg)
Degenerative ChangesDegenerative Changes
![Page 30: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/30.jpg)
Diagnostic categories
NegativeNegative
Atypical, rule out LGUC Atypical, rule out LGUC /PUNLMP/PUNLMP
Suspicious for HG UC/ Suspicious for HG UC/ malignancymalignancy
HG UC/ other HG UC/ other malignanciesmalignancies(Murphy)(Murphy)
![Page 31: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/31.jpg)
Summary Urothelial neoplasms can be separated into Urothelial neoplasms can be separated into 2 main categories:2 main categories:
– –Low grade neoplasia (PUNLMP and LG UC).Low grade neoplasia (PUNLMP and LG UC).
– –High grade UC.High grade UC.
Urine cytology best applied to HG UC.Urine cytology best applied to HG UC.
Cytology less helpful for detecting and Cytology less helpful for detecting and monitoring LG neoplasms.monitoring LG neoplasms.
– –Not major limitation.Not major limitation.
– –LG neoplasms rarely aggressive and can be LG neoplasms rarely aggressive and can be readily detected by cystoscopy.readily detected by cystoscopy.
N.B.:N.B.: Ancillary techniques are highly sensitive Ancillary techniques are highly sensitive poorly specific, not for routine use poorly specific, not for routine use
![Page 32: بسم الله الرحمن الرحيم](https://reader035.vdocuments.site/reader035/viewer/2022062314/5681453f550346895db20852/html5/thumbnails/32.jpg)
GOOD LUCKGOOD LUCK..…..…