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

Korean J Cytopathol. 2008 Sep;19(2):136-143. English.
Published online September 30, 2008.  https://doi.org/10.3338/kjc.2008.19.2.136
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.

Abstract

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

Figures


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).
Click for larger image


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).
Click for larger image


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).
Click for larger image

Tables


Table 1
Comparison of ThinPrep® with cytospin preparation urine cytology in malignant and benign urothelial lesions
Click for larger image


Table 2
Comparison of malignant with benign urothelial lesions by ThinPrep® and conventional cytospin technique
Click for larger image

References
1. Xin W, Raab SS, Michael CW. Low-grade urothelial carcinoma: reappraisal of the cytologic criteria on ThinPrep. Diagn Cytopathol 2003;29:125–129.
2. Saad A, Hanbury DC, McNicholas TA, Boustead GB, Woodman AC. The early detection and diagnosis of bladder cancer: a critical review of the options. Eur Urol 2001;39:619–633.
3. Piaton E, Hutin K, Faynel J, Ranchin MC, Cottier M. Cost efficiency analysis of modern cytocentrifugation methods versus liquid based (Cytyc Thinprep) processing of urinary samples. J Clin Pathol 2004;57:1208–1212.
4. Planz B, Jochims E, Deix T, Caspers HP, Jakse G, Boecking A. The role of urinary cytology for detection of bladder cancer. Eur J Surg Oncol 2005;31:304–308.
5. Bastacky S, Ibrahim S, Wilczynski SP, Murphy WM. The accuracy of urinary cytology in daily practice. Cancer 1999;87:118–128.
6. Lotan Y, Roehrborn CG. Sensitivity and specificity of commonly available bladder tumor markers versus cytology: results of a comprehensive literature review and metaanalyses. Urology 2003;61:109–118.
discussion 18.
7. Anagnostopoulou I SH, Rammou-Kinnia R, Karakitsos P, Gianni I, Georgoulakis J, Kittas C. Comparative study of Thinprep and conventional voided urine cytology (Abstract). Cytopathology 2000;11:373.
8. Nicol TL, Kelly D, Reynolds L, Rosenthal DL. Comparison of TriPath thin-layer technology with conventional methods on nongynecologic specimens. Acta Cytol 2000;44:567–575.
9. Papillo JL, Lapen D. Cell yield. ThinPrep vs. cytocentrifuge. Acta Cytol 1994;38:33–36.
10. Pondo A CB, Gupta PK. Use of Thinprep in urine cytology (Abstract). Acta Cytol 1992;37:584.
11. Wright RG, Halford JA. Evaluation of thin-layer methods in urine cytology. Cytopathology 2001;12:306–313.
12. Nassar H, Ali-Fehmi R, Madan S. Use of ThinPrep monolayer technique and cytospin preparation in urine cytology: a comparative analysis. Diagn Cytopathol 2003;28:115–118.
13. Bishop JW, Sims KL. Cellular morphometry in nongynecologic thin-layer and filter cytologic specimens. Anal Quant Cytol Histol 1998;20:257–267.
14. van der Poel HG, Boon ME, van Stratum P, et al. Conventional bladder wash cytology performed by four experts versus quantitative image analysis. Mod Pathol 1997;10:976–982.
15. Luthra UK, Dey P, George J, et al. : Comparison of ThinPrep and conventional preparations: urine cytology evaluation. Diagn Cytopathol 1999;21:364–366.
16. Piaton E, Faynel J, Hutin K, Ranchin MC, Cottier M. Conventional liquid-based techniques versus Cytyc Thinprep processing of urinary samples: a qualitative approach. BMC Clin Pathol 2005;5:9.
17. Elsheikh TM, Kirkpatrick JL, Wu HH. Comparison of ThinPrep and cytospin preparations in the evaluation of exfoliative cytology specimens. Cancer 2006;108:144–149.
18. Skacel M, Fahmy M, Brainard JA, et al. : Multitarget fluorescence in situ hybridization assay detects transitional cell carcinoma in the majority of patients with bladder cancer and atypical or negative urine cytology. J Urol 2003;169:2101–2105.
19. Tisserand P, Fouquet C, Marck V, et al. : ThinPrep-processed fine-needle samples of breast are effective material for RNA- and DNA-based molecular diagnosis: application to p53 mutation analysis. Cancer 2003;99:223–232.