Chapter

The Paris System for Reporting Urinary Cytology

pp 115-136

Ancillary Studies in Urinary Cytology

  • Lukas BubendorfAffiliated withInstitute of Pathology, University Hospital Basel Email author 
  • , Nancy P. CarawayAffiliated withDepartment of Pathology, The University of Texas MD Anderson Cancer Center
  • , Andrew H. FischerAffiliated withDepartment of Pathology and Cell Biology, University of Massachusetts Memorial Medical Center
  • , Ruth L. KatzAffiliated withDepartment of Pathology, MD Anderson Cancer Center, The University of Texas
  • , Matthew T. OlsonAffiliated withDepartment of Pathology, The Johns Hopkins Hospital, The Johns Hopkins University
  • , Fernando SchmittAffiliated withLaboratoire National de Santé
  • , Margareta Strojan FležarAffiliated withInstitute of Pathology, Faculty of Medicine, University of Ljubljana
  • , Theodorus H. Van Der KwastAffiliated withDepartment of Laboratory Medicine & Pathobiology, Toronto General Hospital, University of Toronto
  • , Philippe VielhAffiliated withDepartment of Biopathology, Gustave Roussy Comprehensive Cancer Center

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Abstract

In the last two decades, different markers and diagnostic assays have been developed to overcome limitations of urinary cytology and improve the timely detection of urothelial carcinoma (UC). Among ancillary tests that can be used on cytological preparations, namely cell-based tests UroVysion® Fluorescence in situ Hybridization (U-FISH; Abbott Laboratories, Abbott Park, IL, USA) and ImmunoCyt/UCyt+® (uCyt; Diagnocure Inc, Quebec, Canada) have been approved by the U.S. Food and Drug Administration (FDA) for diagnosis of UC in patients with hematuria and/or monitoring for tumor recurrence in patients previously diagnosed with UC. The pre-analytical procedures, technique, and evaluation of U-FISH including imaging and automation are described, followed by discussion on the performance of the assay. U-FISH is used for the determination of neoplasia after an interpretation of atypical urinary cytology or finding residual neoplastic cells after intravesical bacillus Calmette-Guerin (BCG) treatment. This seems to be the most important indication. uCyt is another promising diagnostic assay; however, further validation studies are needed.

Most commonly used liquid- or non-cytology-based urine tests are the BTA and the NMP22 (Bladder Check). Both were approved by the FDA for detection of UC in symptomatic patients and for monitoring of patients with a history of UC.

No single ancillary test is being recommended as part of the routine evaluation in the Guidelines of the American Urological Association and the European Association of Urology at this time.The classification in The Paris System for Reporting Urinary Cytology lays the ground for prospective studies in search of cost-effective combinations of urine cytology with ancillary testing to improve diagnosis and clinical outcome of UC.

Keywords

Urothelial carcinoma Atypical Urine cytology Ancillary testing Marker Biomarker FISH UroVysion Immunocyt NMP22 BTA