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67th Annual Meeting Abstracts
Diagnostic Accuracy of Urinary Cytology for Upper-Tract Urothelial Carcinoma (UTUC)
Jamie C Messer1, James Brien1, Shahrokh Shariat2, Casey Ng3, Benjamin Scoll4, Stephen Boorjian4, Robert Uzzo4, Scott Eggener5, John Terrell6, Jay Raman1
1Penn State Milton S Hershey Medical Center, Hershey, PA;2Memorial Sloan Kettering Cancer Center, New York, NY;3Cornell University, New York, NY;4Fox Chase, Philadelphia, PA;5Univeristy of Chicago, Chicago, IL;6University of Texas Southwestern, Dallas, TX
Introduction: Urinary cytology has proven benefit for the diagnosis and staging of urothelial carcinoma of the bladder. Its role, however, is less well defined for patients with upper-tract malignancies.
Materials & Methods: The records of 335 patients who underwent a radical nephroureterectomy or a segmental ureterectomy at 5 academic medical centers for UTUC were reviewed. Urinary cytology data (reported as positive, atypical, and negative) was correlated with the final pathology from surgical specimens.
Results: 126 women and 209 men with a median age of 70 years were included. 3% had pT0 disease, 52% had superficial UTUC (pTa, pTis, pT1), and 46% had invasive disease (> pT2 or greater). Low grade UTUC was present in 34% and high grade disease in 66% of patients. Overall, positive, atypical, and negative urine cytologies were noted in 42%, 38%, and 20% of cases, respectively. Positive urinary cytology had a sensitivity of 56%, specificity of 14%, and a positive predictive value (PPV) of 54% for high grade UTUC. When including atypical with positive cytologies, sensitivity and PPV increased to 74% and 64%, although specificity decreased to 10%. For pathologic stage, a positive cytology had a sensitivity of 62%, specificity of 29%, and PPV of 44% for invasive UTUC. Similar to pathologic grade, including atypical cytologies improved sensitivity (77%) and PPV (45%) at the expense of specificity (18%).
Conclusions: For patients with UTUC, cytologic data in isolation is limited in its accuracy to predict final pathologic stage and grade.
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