Advertisement

Diagnostic Utility of Selective Upper Tract Urinary Cytology: A Systematic Review and Meta-analysis of the Literature

      The diagnosis of upper tract urothelial carcinoma (UTUC) can be a challenging diagnostic pursuit. To date, there is no large-scale study assessing the statistical utility (eg, sensitivity and specificity) of selective cytology. Herein, we systematically reviewed and meta-analyzed the published literature to evaluate the efficacy of selective cytology for the detection of UTUC in patients with a suspicious clinical profile Selective cytology confers a high specificity but marginal sensitivity for the detection of UTUC. The sensitivity is greater for high-grade UTUC lesions. The statistical assessment of its utility is limited by the heterogeneity and bias of previous studies.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Munoz J.J.
        • Ellison L.M.
        Upper tract urothelial neoplasms: incidence and survival during the last 2 decades.
        J Urol. 2000; 164: 1523-1525https://doi.org/10.1016/S0022-5347(05)67019-X
        • Roupret M.
        • Babjuk M.
        • Comperat E.
        • et al.
        European Association of Urology Guidelines on Upper Urinary Tract Urothelial Cell Carcinoma: 2015 Update.
        Eur Urol. 2015; 68: 868-879https://doi.org/10.1016/j.eururo.2015.06.044
        • Chlapoutakis K.
        • Theocharopoulos N.
        • Yarmenitis S.
        • Damilakis J.
        Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma in patients presenting with hematuria: systematic review and meta-analysis.
        Eur J Radiol. 2010; 73: 334-338https://doi.org/10.1016/j.ejrad.2008.10.026
        • Lodde M.
        • Mian C.
        • Wiener H.
        • Haitel A.
        • Pycha A.
        • Marberger M.
        Detection of upper urinary tract transitional cell carcinoma with ImmunoCyt: a preliminary report.
        Urology. 2001; 58: 362-366https://doi.org/10.1016/S0090-4295(01)01182-7
        • Walsh I.K.
        • Keane P.F.
        • Ishak L.M.
        • Flessland K.A.
        The BTA stat test: a tumor marker for the detection of upper tract transitional cell carcinoma.
        Urology. 2001; 58: 532-535https://doi.org/10.1016/S0090-4295(01)01307-3
        • Raica M.
        • Mederle O.
        • Ioiart I.
        Upper urinary tract washing in the diagnosis of transitional cell carcinoma of the renal pelvis and calices. A comparison with voided urine.
        Rom J Morphol Embryol. 1995; 41: 101-105
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        Ann Intern Med. 2009; 151: W65-W94https://doi.org/10.7326/0003-4819-151-4-200908180-00136
        • Eble J.N.
        • Sauter G.
        • Epstein J.I.
        • Sesterhenn I.A.
        World Health Organization Classification of Tumours.
        in: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press, Lyon2004
        • Layfield L.J.
        • Elsheikh T.M.
        • Fili A.
        • Nayar R.
        • Shidham V.
        • Papanicolaou Society of Cytopathology
        Review of the state of the art and recommendations of the Papanicolaou Society of Cytopathology for urinary cytology procedures and reporting: the Papanicolaou Society of Cytopathology practice guidelines task force.
        Diagn Cytopathol. 2004; 30: 24-30https://doi.org/10.1002/dc.10401
        • Reynolds J.P.
        • Voss J.S.
        • Kipp B.R.
        • et al.
        Comparison of urine cytology and fluorescence in situ hybridization in upper urothelial tract samples.
        Cancer Cytopathol. 2014; 122: 459-467https://doi.org/10.1002/cncy.21414
        • Cao D.
        • Vollmer R.T.
        • Luly J.
        • et al.
        Comparison of 2004 and 1973 World Health Organization grading systems and their relationship to pathologic staging for predicting long-term prognosis in patients with urothelial carcinoma.
        Urology. 2010; 76: 593-599https://doi.org/10.1016/j.urology.2010.01.032
        • Whiting P.F.
        • Rutjes A.W.
        • Westwood M.E.
        • et al.
        QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.
        Ann Intern Med. 2011; 155: 529-536https://doi.org/10.7326/0003-4819-155-8-201110180-00009
        • Viechtbauer W.
        Conducting meta-analyses in R with the metafor package.
        J Stat Softw. 2010; 36: 1-48https://doi.org/10.18637/jss.v036.i03
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Wang L.
        • Pambuccian S.E.
        • Wojcik E.M.
        • Barkan G.A.
        Diagnosis of upper tract urothelial carcinoma-a comparative study of urinary cytology and surgical biopsy.
        J Am Soc Cytopathology. 2015; 4: 3-9https://doi.org/10.1016/j.jasc.2014.09.203
        • Yamany T.
        • Van Batavia J.
        • Ahn J.
        • Shapiro E.
        • Gupta M.
        Ureterorenoscopy for upper tract urothelial carcinoma: how often are we missing lesions?.
        Urology. 2015; 85: 311-315https://doi.org/10.1016/j.urology.2014.08.030
        • Gruschwitz T.
        • Gajda M.
        • Enkelmann A.
        • et al.
        FISH analysis of washing urine from the upper urinary tract for the detection of urothelial cancers.
        Int Urol Nephrol. 2014; 46: 1769-1774https://doi.org/10.1007/s11255-014-0714-1
        • Naib Z.M.
        Exfoliative cytology of renal pelvic lesions.
        Cancer. 1961; 14: 1085-1087https://doi.org/10.1002/1097-0142(196109/10)14:5<1085:AID-CNCR2820140527>3.0.CO;2-K
        • Zincke H.
        • Aguilo J.J.
        • Farrow G.M.
        Significance of urinary cytology in the early detection of transitional cell cancer of the upper urinary tract.
        J Urol. 1976; 116: 781-783
        • Leistenschneider W.
        • Nagel R.
        Lavage of cytology of the renal pelvis and ureter with special reference to tumors.
        J Urol. 1980; 124: 597-600
        • Highman W.J.
        Transitional carcinoma of the upper urinary tract: a histological and cytopathological study.
        J Clin Pathol. 1986; 39: 297-305
        • Seldenrijk C.A.
        • Verheggen W.J.
        • Veldhuizen R.W.
        • Blok A.P.
        • Ooms E.C.
        Use of cytomorphometry and cytology in the diagnosis of transitional-cell carcinoma of the upper urinary tract.
        Acta Cytol. 1987; 31: 137-142
        • Chaubal A.
        • McCue P.A.
        • Bagley D.
        • Bibbo M.
        Multimodal cytologic evaluation of upper urinary tract urothelial lesions.
        J Surg Pathol. 1995; : 31-35
        • Wu W.J.
        • Liu L.T.
        • Huang C.N.
        • Huang C.H.
        • Chang L.L.
        The clinical implications of telomerase activity in upper tract urothelial cancer and washings.
        BJU Int. 2000; 86: 213-219https://doi.org/10.1046/j.1464-410x.2000.00830.x
        • Skolarikos A.
        • Griffiths T.R.
        • Powell P.H.
        • Thomas D.J.
        • Neal D.E.
        • Kelly J.D.
        Cytologic analysis of ureteral washings is informative in patients with grade 2 upper tract TCC considering endoscopic treatment.
        Urology. 2003; 61: 1146-1150https://doi.org/10.1016/S0090-4295(03)00026-8
        • Williams S.K.
        • Denton K.J.
        • Minervini A.
        • et al.
        Correlation of upper-tract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma.
        J Endourol. 2008; 22: 71-76https://doi.org/10.1089/end.2007.9853
        • Mian C.
        • Mazzoleni G.
        • Vikoler S.
        • et al.
        Fluorescence in situ hybridisation in the diagnosis of upper urinary tract tumours.
        Eur Urol. 2010; 58: 288-292https://doi.org/10.1016/j.eururo.2010.04.026
        • Jovanovic M.
        • Soldatovic I.
        • Janjic A.
        • et al.
        Diagnostic value of the nuclear matrix protein 22 test and urine cytology in upper tract urothelial tumors.
        Urol Int. 2011; 87: 134-137https://doi.org/10.1159/000330246
        • Furukawa J.
        • Miyake H.
        • Sakai I.
        • Fujisawa M.
        Significance of ureteroscopic biopsy grade in patients with upper tract urothelial carcinoma.
        Curr Urol. 2012; 6: 156-159https://doi.org/10.1159/000343531
        • Straub J.
        • Strittmatter F.
        • Karl A.
        • Stief C.G.
        • Tritschler S.
        Ureterorenoscopic biopsy and urinary cytology according to the 2004 WHO classification underestimate tumor grading in upper urinary tract urothelial carcinoma.
        Urol Oncol. 2013; 31: 1166-1170https://doi.org/10.1016/j.urolonc.2011.12.021
        • Sverrisson E.F.
        • Kim T.
        • Espiritu P.N.
        • et al.
        The merits of cytology in the workup for upper tract urothelial carcinoma—a contemporary review of a perplexing issue.
        Int Braz J Urol. 2014; 40: 493-498https://doi.org/10.1590/S1677-5538.IBJU.2014.04.07
        • Sakano S.
        • Matsuyama H.
        • Kamiryo Y.
        • et al.
        Risk group stratification based on preoperative factors to predict survival after nephroureterectomy in patients with upper urinary tract urothelial carcinoma.
        Ann Surg Oncol. 2013; 20: 4389-4396https://doi.org/10.1245/s10434-013-3259-0
        • Dodd L.G.
        • Johnston W.W.
        • Robertson C.N.
        • Layfield L.J.
        Endoscopic brush cytology of the upper urinary tract. Evaluation of its efficacy and potential limitations in diagnosis.
        Acta Cytol. 1997; 41: 377-384
        • Minimo C.
        • Tawfiek E.R.
        • Bagley D.H.
        • McCue P.A.
        • Bibbo M.
        Grading of upper urinary tract transitional cell carcinoma by computed DNA content and.
        Urology. 1997; 50 (p53 expression)https://doi.org/10.1016/s0090-4295(97)00404-4
        • Potts S.A.
        • Thomas P.A.
        • Cohen M.B.
        • Raab S.S.
        Diagnostic accuracy and key cytologic features of high-grade transitional cell carcinoma in the upper urinary tract.
        Mod Pathol. 1997; 10: 657-662
        • Witte D.
        • Truong L.D.
        • Ramzy I.
        Transitional cell carcinoma of the renal pelvis the diagnostic role of pelvic washings.
        Am J Clin Pathol. 2002; 117: 444-450https://doi.org/10.1309/hc0u-8mel-9ggv-g9ew
        • Iborra I.
        • Solsona E.
        • Casanova J.
        • Ricós J.V.
        • Rubio J.
        • Climent M.A.
        Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression.
        J Urol. 2003; 169: 82-85https://doi.org/10.1016/S0022-5347(05)64041-4
        • Siemens D.R.
        • Morales A.
        • Johnston B.
        • Emerson L.
        A comparative analysis of rapid urine tests for the diagnosis of upper urinary tract malignancy.
        Can J Urol. 2003; 10: 1754-1758
        • Boorjian S.
        • Ng C.
        • Munver R.
        • et al.
        Abnormal selective cytology results predict recurrence of upper-tract transitional-cell carcinoma treated with ureteroscopic laser ablation.
        J Endourol. 2004; 18: 912-916https://doi.org/10.1089/end.2004.18.912
        • Renshaw A.A.
        Comparison of ureteral washing and biopsy specimens in the community setting.
        Cancer. 2006; 108: 45-48https://doi.org/10.1002/cncr.21456
        • Asai S.
        • Fukumoto T.
        • Tanji N.
        • et al.
        Fluorodeoxyglucose positron emission tomography/computed tomography for diagnosis of upper urinary tract urothelial carcinoma.
        Int J Clin Oncol. 2015; 20: 1042-1047https://doi.org/10.1007/s10147-015-0817-4
        • Chau K.
        • Rosen L.
        • Coutsouvelis C.
        • et al.
        Accuracy and risk of malignancy for diagnostic categories in urine cytology at a large tertiary institution.
        Cancer Cytopathol. 2015; 123: 10-18https://doi.org/10.1002/cncy.21477
        • Chen L.
        • He H.
        • Zarka M.A.
        • Zhou M.
        • Magi-Galluzzi C.
        Upper tract urinary cytology to detect upper tract urothelial carcinoma: using the Johns Hopkins Hospital template and evaluation of its feasibility.
        Cytojournal. 2015; 12: 17https://doi.org/10.4103/1742-6413.161608
        • Tavora F.
        • Fajardo D.A.
        • Lee T.K.
        • et al.
        Small endoscopic biopsies of the ureter and renal pelvis: pathologic pitfalls.
        Am J Surg Pathol. 2009; 33: 1540-1546https://doi.org/10.1097/PAS.0b013e3181aec42a
        • Glas A.S.
        • Roos D.
        • Deutekom M.
        • Zwinderman A.H.
        • Bossuyt P.M.
        • Kurth K.H.
        Tumor markers in the diagnosis of primary bladder cancer. A systematic review.
        J Urol. 2003; 169: 1975-1982https://doi.org/10.1097/01.ju.0000067461.30468.6d
        • Razdan S.
        • Johannes J.
        • Cox M.
        • Bagley D.H.
        Current practice patterns in urologic management of upper-tract transitional-cell carcinoma.
        J. Endourol. 2005; 19: 366-371https://doi.org/10.1089/end.2005.19.366
        • Caoili E.M.
        • Cohan R.H.
        • Inampudi P.
        • et al.
        MDCT urography of upper tract urothelial neoplasms.
        AJR Am J Roentgenol. 2005; 184: 1873-1881https://doi.org/10.2214/ajr.184.6.01841873
        • Roupret M.
        • Babjuk M.
        • Comperat E.
        • et al.
        European Association of Urology Guidelines on upper urinary tract urothelial cell carcinoma: 2015 update.
        Eur Urol. 2015; https://doi.org/10.1016/j.eururo.2015.06.044
        • Aziz A.
        • Rink M.
        • Gakis G.
        • et al.
        Preoperative C-reactive protein in the serum: a prognostic biomarker for upper urinary tract urothelial carcinoma treated with radical nephroureterectomy.
        Urol Int. 2014; 93: 352-360https://doi.org/10.1159/000362248
        • Carvajal-Hausdorf D.E.
        • Schalper K.A.
        • Neumeister V.M.
        • Rimm D.L.
        Quantitative measurement of cancer tissue biomarkers in the lab and in the clinic.
        Lab Invest. 2015; 95: 385-396https://doi.org/10.1038/labinvest.2014.157
        • Gayed B.A.
        • Bagrodia A.
        • Gaitonde M.
        • et al.
        Feasibility of obtaining biomarker profiles from endoscopic biopsy specimens in upper tract urothelial carcinoma: preliminary results.
        Urol Oncol. 2015; 33: e21-e26https://doi.org/10.1016/j.urolonc.2014.09.017
        • Krabbe L.M.
        • Bagrodia A.
        • Haddad A.Q.
        • et al.
        Multi-institutional validation of the predictive value of Ki-67 in patients with high grade urothelial carcinoma of the upper urinary tract.
        J Urol. 2015; 193: 1486-1493https://doi.org/10.1016/j.juro.2014.11.007
        • Bagrodia A.
        • Cha E.K.
        • Sfakianos J.P.
        • et al.
        Genomic biomarkers for the prediction of stage and prognosis of upper tract urothelial carcinoma.
        J Urol. 2016; https://doi.org/10.1016/j.juro.2016.01.006
        • Caraway N.P.
        • Khanna A.
        • Payne L.
        • Kamat A.M.
        • Katz R.L.
        Combination of cytologic evaluation and quantitative digital cytometry is reliable in detecting recurrent disease in patients with urinary diversions.
        Cancer. 2007; 111: 323-329https://doi.org/10.1002/cncr.22950
        • Bus M.T.
        • de Bruin D.M.
        • Faber D.J.
        • et al.
        Optical diagnostics for upper urinary tract urothelial cancer: technology, thresholds, and clinical applications.
        J Endourol. 2015; 29: 113-123https://doi.org/10.1089/end.2014.0551
        • Whiting P.
        • Rutjes A.W.
        • Reitsma J.B.
        • Glas A.S.
        • Bossuyt P.M.
        • Kleijnen J.
        Sources of variation and bias in studies of diagnostic accuracy: a systematic review.
        Ann Intern Med. 2004; 140: 189-202https://doi.org/10.7326/0003-4819-140-3-200402030-00010
        • Owens C.L.
        • Vandenbussche C.J.
        • Burroughs F.H.
        • Rosenthal D.L.
        A review of reporting systems and terminology for urine cytology.
        Cancer Cytopathol. 2013; 121: 9-14https://doi.org/10.1002/cncy.21253
        • Reid M.D.
        • Osunkoya A.O.
        • Siddiqui M.T.
        • Looney S.W.
        Accuracy of grading of urothelial carcinoma on urine cytology: an analysis of interobserver and intraobserver agreement.
        Int J Clin Exp Pathol. 2012; 5: 882-891
        • Yamal J.M.
        • Guillaud M.
        • Atkinson E.N.
        • et al.
        Prediction using hierarchical data: Applications for automated detection of cervical cancer.
        Stat Anal Data Min. 2015; 8: 65-74https://doi.org/10.1002/sam.11261
        • Hong S.
        • Kwon T.
        • You D.
        • et al.
        Incidence of benign results after laparoscopic radical nephroureterectomy.
        JSLS. 2014; : 18https://doi.org/10.4293/JSLS.2014.00335