Zusammenfassung
Wenig differenzierte Urothelkarzinome und das bioptisch oft schwierig fassbare Carcinoma in situ lassen sich im Gegensatz zu den „low-grade“ urothelialen Neoplasien in der Urinzytologie zuverlässig diagnostizieren. Wir empfehlen folgendes Klassifikationssytem: negativ, zweifelhaft, suspekt und positiv. Angesichts der komplexen klinisch-pathologischen Zusammenhänge sollte die Klassifikation stets von einem Kommentar begleitet sein. Die 2004 WHO-Klassifikation der urothelialen Tumoren stellt die klinisch weniger relevanten „Low-grade-Tumoren“ den klinisch relevanten „High-grade-Tumoren“ gegenüber, die sich zytologisch meist als „positiv“ klassifizieren lassen. Die zytologische Diagnose der zystoskopisch meist sichtbaren Low-grade-Neoplasien ist klinisch nicht dringlich. Urotheliale Neoplasien zeichnen sich im Gegensatz zu reaktiven Veränderungen durch chromosomale Aberrationen aus. Fluoreszenz-in-situ-Hybridisierung (FISH) mit mehreren DNS-Sonden eignet sich deshalb für die Abklärung unklarer Befunde. Bei eindeutig positiver Zytologie ist eine FISH-Untersuchung dagegen nicht notwendig. Eine standardisierte Diagnoseformulierung und die Möglichkeit zu weiteren Abklärungen mittels FISH erhöhen den diagnostischen Stellenwert der Harntraktzytologie.
Abstract
Reliable detection of poorly differentiated urothelial carcinoma and the detection of carcinoma in situ, which is often invisible by cystoscopy, are the undisputed strength of urinary cytology. In contrast, well-differentiated urothelial tumors are often missed by cytology. We suggest the following classification: negative, questionable, suspicious, and positive. Due to the complex clinico-pathological associations, the classification should always be accompanied by an appropriate commentary. The WHO 2004 classification separates the clinically less important low-grade tumors from the clinically relevant high-grade tumors, usually classified as “positive” by cytology. A cytological diagnosis of low-grade tumors by cytology is of minor clinical importance. Most urothelial neoplasias are characterized by chromosomal aberrations. This makes multi-target fluorescence in situ hybridization (FISH) assay suitable for the clarification of non-definitive cytology. In contrast, positive cytology does not need further confirmation by FISH analysis. Standardized diagnosis and the possibility for supplementary analyses increase the diagnostic value of urinary cytology.
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Danksagung
Wir danken Frau Prof. Ruth Knüchel, Direktorin des Instituts für Pathologie am Universitätsklinikum Aachen, für die konstruktiven Diskussionen, welche zu dem gemeinsamen Vorschlag eines Klassifikationssystems in der Harntraktzytologie geführt haben.
Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor Prof. Dr. L. Bubendorf hat von der Firma Abbott Molecular Inc. Vortragshonorare, Forschungsdrittmittel und Studienunterstützungen erhalten.
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Bubendorf, L., Dalquen, P. & Savic, S. Zytologie der ableitenden Harnwege. Pathologe 30 (Suppl 2), 173–178 (2009). https://doi.org/10.1007/s00292-009-1190-8
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DOI: https://doi.org/10.1007/s00292-009-1190-8