Atypical squamous cells in urine cytology are associated with a significant risk of high-grade malignancy

IF 2.6 3区 医学 Q3 ONCOLOGY Cancer Cytopathology Pub Date : 2024-04-13 DOI:10.1002/cncy.22816
Linh Ho MD, Tarik M. Elsheikh MD
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Abstract

Background

Atypical squamous cells (ASC) in urine cytology are rarely found, and their clinical significance is not well studied. Previous studies were limited by a small number of cases and a lack of objective grading of ASC and/or their correlation with accompanying urothelial cell abnormality (UCA).

Methods

The institutional database was searched over 10 years for urine cytology reports containing ASC or from patients who had a concurrent diagnoses of high-grade (HG) urothelial carcinoma with squamous differentiation or squamous carcinoma. ASC were defined as keratinized squamous cells and were subcategorized as reactive, koilocytosis, low-grade (LG) atypia, and HG atypia. Correlations with age, sex, specimen type, accompanying UCA, number of ASC, and the risk of HG malignancy (ROHM) were assessed.

Results

ASC were present in 0.15% of all urine specimens (123 of 81,018). Slides and clinical follow-up were available on 91 patients (median age, 71 years). LG and HG squamous atypia had ROHMs of 70% and 92%, respectively. ASC not accompanied and accompanied by UCA had ROHMs of 37% and 94%, respectively. Most malignancies (34 of 67; 51%) showed rare ASC in urine. Reactive changes and koilocytosis had 0% ROHM.

Conclusions

ASC in urine cytology is a significant finding and is associated with a high ROHM. In the absence of accompanying UCA, LG squamous atypia had a lower ROHM than HG atypia. In the presence of UCA, LG and HG squamous atypia had ROHMs of over 90%. These findings suggest that ASC and their grade of atypia should be noted in the cytology report, and clinicians should be made aware of their clinical significance.

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尿液细胞学检查中的非典型鳞状细胞与高级别恶性肿瘤的重大风险有关
背景尿液细胞学检查中很少发现非典型鳞状细胞(ASC),对其临床意义的研究也不多。研究方法在机构数据库中搜索了10年来含ASC的尿液细胞学报告,或同时诊断为高级别(HG)鳞状分化尿路上皮癌或鳞状癌患者的尿液细胞学报告。ASC被定义为角化的鳞状细胞,并被细分为反应性、柯伊细胞增多症、低级别(LG)不典型性和HG不典型性。评估了ASC与年龄、性别、标本类型、伴随的UCA、ASC数量和HG恶性风险(ROHM)的相关性。91名患者(中位年龄为71岁)的切片和临床随访结果可用。LG和HG鳞状不典型性的ROHMs分别为70%和92%。伴有和不伴有UCA的ASC的ROHMs分别为37%和94%。大多数恶性肿瘤(67 例中有 34 例,占 51%)的尿液中出现罕见的 ASC。结论尿液细胞学中的ASC是一个重要发现,与高ROHM有关。在不伴有 UCA 的情况下,LG 鳞状细胞不典型性的 ROHM 值低于 HG 不典型性。在存在UCA的情况下,LG和HG鳞状不典型性的ROHM超过90%。这些研究结果表明,细胞学报告中应注明 ASC 及其不典型程度,临床医生也应了解其临床意义。
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来源期刊
Cancer Cytopathology
Cancer Cytopathology 医学-病理学
CiteScore
7.00
自引率
17.60%
发文量
130
审稿时长
1 months
期刊介绍: Cancer Cytopathology provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines. The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content. The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.
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