Urine cytology

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Author: Mikael Häggström [note 1]

Normal urothelial cells.

Clinical information

It is not necessary to look through more than readily available reports from previous urine cytologies.

Evaluation

Mainly look for:

  • Reactive urothelial changes, Pap stain, showing urothelial cells with enlarged nuclei but a nucleus-cytoplasm ratio of less than 0.5. There are bacteria, as well as an inflammatory response of neutrophils, providing a cause for the changes. Can be reported as "Benign urothelial cells, neutrophils and bacteria".
    Reactive urothelial changes, Pap stain, showing urothelial cells with enlarged nuclei but a nucleus-cytoplasm ratio of less than 0.5. There are bacteria, as well as an inflammatory response of neutrophils, providing a cause for the changes. Can be reported as "Benign urothelial cells, neutrophils and bacteria".
  • High-grade urothelial carcinoma. Cytologic diagnosis of high-grade urothelial carcinoma requires > 10 cells with high N/C ratio, irregular chromatin pattern and hyperchromatic nuclei (Pap stain).[1]
    High-grade urothelial carcinoma. Cytologic diagnosis of high-grade urothelial carcinoma requires > 10 cells with high N/C ratio, irregular chromatin pattern and hyperchromatic nuclei (Pap stain).[1]
  • Distinguish urothelial carcinoma from decoy cells, which are virally infected epithelial cells (Pap stain).
    Distinguish urothelial carcinoma from decoy cells, which are virally infected epithelial cells (Pap stain).
  • Also report the presence of red blood cells (here seen compared to benign urothelial cells, Pap stain).
    Also report the presence of red blood cells (here seen compared to benign urothelial cells, Pap stain).
The Paris System for reporting urine cytology, version 2.0.[2]

The N/C ratios apply to the finding of any cells meeting the criteria, and not the average among atypical cells (in the majority of obviously positive cases, N/C/ratio averages 0.5).[2] When there are obvious features of malignancy, there is no need to hunt for cells that fulfil all criteria to make such diagnosis.[2]

  • Nuclear/cytoplasmic ratios.
    Nuclear/cytoplasmic ratios.
  • Fibrovascular cores weakly indicate a urothelial neoplasm, but can be present in all Paris System categories.
    Fibrovascular cores weakly indicate a urothelial neoplasm, but can be present in all Paris System categories.

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Wang Y, Auger M, Kanber Y, Caglar D, Brimo F (2018). "Implementing The Paris System for Reporting Urinary Cytology results in a decrease in the rate of the "atypical" category and an increase in its prediction of subsequent high-grade urothelial carcinoma. ". Cancer Cytopathol 126 (3): 207-214. doi:10.1002/cncy.21958. PMID 29278461. Archived from the original. . 
  2. ↑ 2.0 2.1 2.2 - Image by Mikael Häggström. Reference: Wojcik EM, Kurtycz DFI, Rosenthal DL (2022). "We'll always have Paris The Paris System for Reporting Urinary Cytology 2022. ". J Am Soc Cytopathol 11 (2): 62-66. doi:10.1016/j.jasc.2021.12.003. PMID 35094954. Archived from the original. . 

Image sources


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