Journal List > Korean J Cytopathol > v.19(2) > 1006517

Korean J Cytopathol. 2008 Sep;19(2):136-143. English.
Published online September 30, 2008.
Copyright © 2008 The Korean Society for Cytopathology
Detecting Malignant Urothelial Cells by Morphometric Analysis of ThinPrep® Liquid-based Urine Cytology Specimens
Bong Kyung Shin, M.D.,1,2 Young Suk Lee, M.D.,1 Hoiseon Jeong, M.D.,1,2 Sang Ho Lee, M.D.,1,2 Hyunchul Kim, M.D.,1 Aree Kim, M.D.,1,2 Insun Kim, M.D.,1 and Han Kyeom Kim, M.D.1,2
1Department of Pathology, Guro Hospital, Korea University Medical College, Seoul, Korea.
2Korea Lung Tissue Bank (KLTB), Seoul, Korea.
Received July 18, 2007; Accepted July 28, 2008.


Urothelial carcinoma accounts for 90% of all the cases of bladder cancer. Although many cases can be easily managed by local excision, urothelial carcinoma rather frequently recurs, tends to progress to muscle invasion, and requires regular follow-ups. Urine cytology is a main approach for the follow-up of bladder tumors. It is noninvasive, but it has low sensitivity of around 50% with using the conventional cytospin preparation. Liquid-based cytology (LBC) has been developed as a replacement for the conventional technique. We compared the cytomorphometric parameters of ThinPrep® and cytospin preparation urine cytology to see whether there are definite differences between the two methods and which technique allows malignant cells to be more effectively discriminated from benign cells. The nuclear-to-cytoplasmic ratio value, as measured by digital image analysis, was efficient for differentiating malignant and benign urothelial cells, and this was irrespective of the preparation method and the tumor grade. Neither the ThinPrep® nor the conventional preparation cytology was definitely superior for distinguishing malignant cells from benign cells by cytomorphometric analysis of the adequately preserved cells. However, the ThinPrep® preparation showed significant advantages when considering the better preservation and cellularity with a clear background.

Keywords: Liquid-based urine cytology; Urothelial carcinoma; Cytomorphometric analysis; Digital image analysis; Nuclear-to-cytoplasmic ratio


Fig. 1
ThinPrep® preparation cytology of urothelial carcinomas. (A) The cytological findings of a low grade urothelial carcinoma include cell clusters of papillae with irregular borders, variability in size and shape or nuclei with fine granular chromatin and small nucleoli (Papanicolaou stain). (C) In a higher grade tumor, the cells are significantly pleomorphic, individually scattered, or form small, loose clusters or syncytia in rather dirty background of inflammation, hemorrhage and/or necrosis (Papanicolaou stain). B and D are the correspondant histologic findings of A and C, respectively (H&E).
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Fig. 2
Conventionally prepared cytology of urothelial carcinoma. In malignant cases, cytospin preparation shows an adequate number of atypical cells for diagnosis in spite of the dirty background and cellular degeneration (Papanicolaou stain).
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Fig. 3
ThinPrep® and conventional preparation cytology of a benign condition ("negative for malignancy"). ThinPrep® preparation shows well-preserved cells with relatively clean background in benign cases as well as in malignant ones (A) while the cytospin preparation presents a lower cellularity and more degeneration (B). (Papanicolaou stain).
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Table 1
Comparison of ThinPrep® with cytospin preparation urine cytology in malignant and benign urothelial lesions
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Table 2
Comparison of malignant with benign urothelial lesions by ThinPrep® and conventional cytospin technique
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