Skip to main content
SpringerLink
Log in

Low-Grade Urothelial Neoplasia (LGUN)

  • Chapter
The Paris System for Reporting Urinary Cytology

Abstract

The ability to consistently diagnose low-grade urothelial neoplasia (LGUN) in urinary cytologic specimens remains controversial. Cytologically, we cannot unequivocally distinguish among the different types of LGUN such as urothelial papilloma, papillary urothelial neoplasms of low malignant potential (PUNLMP), low-grade papillary urothelial carcinoma (LGPUC), as well as flat low-grade urothelial dysplasia. Furthermore, non-neoplastic lesions such as papillary urothelial hyperplasia may also shed pseudopapillary structures into the urine. Although cytomorphologic criteria to diagnose LGPUC in urine cytology have been described, the reported sensitivity ranges from 10 to 70 %. The main purpose of this chapter is to review the previously described cytologic criteria of LGPUC in urinary specimens and to define appropriate circumstances that enable the diagnosis of LGUN.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Comperat E, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013;64:639–53.

    Article  PubMed  Google Scholar 

  2. Curry JL, Wojcik EM. The effects of the current World Health Organization/International Society of Urologic Pathologists bladder neoplasm classification system on urine cytology results. Cancer. 2002;96:140–5.

    Article  PubMed  Google Scholar 

  3. Epstein JI. The new World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification for TA, T1 bladder tumors: is it an improvement? Crit Rev Oncol Hematol. 2003;47:83–9.

    Article  PubMed  Google Scholar 

  4. May M, Brookman-Amissah S, Roigas J, Hartmann A, Störkel S, Kristiansen G, et al. Prognostic accuracy of individual uropathologists in noninvasive urinary bladder carcinoma: a multicentre study comparing the 1973 and 2004 World Health Organisation classifications. Eur Urol. 2010;57:850–8.

    Article  PubMed  Google Scholar 

  5. van Rhijn BW, van Leenders GJ, Ooms BC, Kirkels WJ, Zlotta AR, Boevé ER, et al. The pathologist’s mean grade is constant and individualizes the prognostic value of bladder cancer grading. Eur Urol. 2010;57:1052–7.

    Article  PubMed  Google Scholar 

  6. Miyamoto H, Brimo F, Schultz L, Ye H, Miller JS, Fajardo DA, et al. Low-grade papillary urothelial carcinoma of the urinary bladder: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center. Arch Pathol Lab Med. 2010;134:1160–3.

    PubMed  Google Scholar 

  7. Tuna B, Yorukoglu K, Duzcan E, Sen S, Nese N, Sarsik B, et al. Histologic grading of urothelial papillary neoplasms: impact of combined grading (two-numbered grading system) on reproducibility. Virchows Arch. 2011;458:659–64.

    Article  PubMed  Google Scholar 

  8. Sauter G, Algaba F, Amin MB, Busch C, Cheville J, Gasser T, et al. Noninvasive urothelial neoplasias. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. World Health Organization classification of tumours. Pathology and genetics of tumors of the urinary system and male genital organs. Lyon: IARCC; 2004. p. 110–23.

    Google Scholar 

  9. Renshaw AA, Nappi D, Weinberg DS. Cytology of grade 1 papillary transitional cell carcinoma. A comparison of cytologic, architectural and morphometric criteria in cystoscopically obtained urine. Acta Cytol. 1996;40:676–82.

    Article  CAS  PubMed  Google Scholar 

  10. Renshaw AA. Compassionate conservatism in urinary cytology. Diagn Cytopathol. 2000;22:137–8.

    Article  CAS  PubMed  Google Scholar 

  11. Layfield LJ, Elsheikh TM, 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;30:24–30.

    Article  PubMed  Google Scholar 

  12. Mai KT, Ball CG, Kos Z, Belanger EC, Islam S, Sekhon H. Three-dimensional cell groups with disordered nuclei and cellular discohesion (3DDD) are associated with high sensitivity and specificity for cystoscopic urine cytopathological diagnosis of low-grade urothelial neoplasia. Diagn Cytopathol. 2014;42:555–63.

    Article  PubMed  Google Scholar 

  13. Murphy WM, Soloway MS, Jukkola AF, Crabtree WN, Ford KS. Urinary cytology and bladder cancer. The cellular features of transitional cell neoplasms. Cancer. 1984;53:1555–65.

    Article  CAS  PubMed  Google Scholar 

  14. Raab SS, Lenel JC, Cohen MB. Low grade transitional cell carcinoma of the bladder. Cytologic diagnosis by key features as identified by logistic regression analysis. Cancer. 1994;74:1621–6.

    Article  CAS  PubMed  Google Scholar 

  15. Raab SS, Slagel DD, Jensen CS, Teague MW, Savell VH, Ozkutlu D, et al. Low-grade transitional cell carcinoma of the urinary bladder: application of select cytologic criteria to improve diagnostic accuracy [corrected]. Mod Pathol. 1996;9:225–32.

    CAS  PubMed  Google Scholar 

  16. Brimo F, Vollmer RT, Case B, Aprikian A, Kassouf W, Auger M. Accuracy of urine cytology and the significance of an atypical category. Am J Clin Pathol. 2009;132:785–93.

    Article  PubMed  Google Scholar 

  17. Hughes JH, Raab SS, Cohen MB. The cytologic diagnosis of low-grade transitional cell carcinoma. Am J Clin Pathol. 2000;114(Suppl):S59–67.

    PubMed  Google Scholar 

  18. Reid MD, Osunkoya AO, Siddiqui MT, Looney SW. Accuracy of grading of urothelial carcinoma on urine cytology: an analysis of interobserver and intraobserver agreement. Int J Clin Exp Pathol. 2012;5:882–91.

    PubMed Central  PubMed  Google Scholar 

  19. Renshaw AA. Subclassifying atypical urinary cytology specimens. Cancer. 2000;90:222–9.

    Article  CAS  PubMed  Google Scholar 

  20. MacLennan GT, Kirkali Z, Cheng L. Histologic grading of noninvasive papillary urothelial neoplasms. Eur Urol. 2007;51:889–97. discussion 97-8.

    Article  PubMed  Google Scholar 

  21. McCroskey Z, Kliethermes S, Bahar B, Barkan GA, Pambuccian SE, Wojcik EM. Is a consistent cytologic diagnosis of low-grade urothelial carcinoma in instrumented urinary tract cytologic specimens possible? A comparison between cytomorphologic features of low-grade urothelial carcinoma and non-neoplastic changes shows extensive overlap, making a reliable diagnosis impossible. J Am Soc Cytopathol. 2014;4:90–7.

    Article  Google Scholar 

  22. Amin MB, Murphy WM, Reuter VE, Ro JY, Ayala AG, Weiss MA, et al. A symposium on controversies in the pathology of transitional cell carcinomas of the urinary bladder. Part I. Anat Pathol. 1996;1:1–39.

    CAS  PubMed  Google Scholar 

  23. Amin MB, McKenney JK. An approach to the diagnosis of flat intraepithelial lesions of the urinary bladder using the World Health Organization/ International Society of Urological Pathology consensus classification system. Adv Anat Pathol. 2002;9:222–32.

    Article  PubMed  Google Scholar 

  24. Dean PJ, Murphy WM. Carcinoma in situ and dysplasia of the bladder urothelium. World J Urol. 1987;5:103–7.

    Article  Google Scholar 

  25. Ooms EC, Veldhuizen RW. Cytological criteria and diagnostic terminology in urinary cytology. Cytopathology. 1993;4:51–4.

    Article  CAS  PubMed  Google Scholar 

  26. Owens CL, VandenBussche CJ, Burroughs FH, Rosenthal DL. A review of reporting systems and terminology for urine cytology. Cancer Cytopathol. 2013;121:9–14.

    Article  PubMed  Google Scholar 

  27. Lopez-Beltran A, Montironi R, Vidal A, Scarpelli M, Cheng L. Urothelial dysplasia of the bladder: diagnostic features and clinical significance. Anal Quant Cytopathol Histpathol. 2013;35:121–9.

    PubMed  Google Scholar 

  28. Amin MB, Trpkov K, Lopez-Beltran A, Grignon D, Members of the ISUP Immunohistochemistry in Diagnostic Urologic Pathology Group. Best practices recommendations in the application of immunohistochemistry in the bladder lesions: report from the International Society of Urologic Pathology consensus conference. Am J Surg Pathol. 2014;38:e20–34.

    Article  PubMed  Google Scholar 

  29. van Rhijn BW, Montironi R, Zwarthoff EC, Jöbsis AC, van der Kwast TH. Frequent FGFR3 mutations in urothelial papilloma. J Pathol. 2002;198:245–51.

    Article  PubMed  Google Scholar 

  30. McKenney JK, Amin MB, Young RH. Urothelial (transitional cell) papilloma of the urinary bladder: a clinicopathologic study of 26 cases. Mod Pathol. 2003;16:623–9.

    Article  PubMed  Google Scholar 

  31. Cheng L, Zhang S, MacLennan GT, Williamson SR, Lopez-Beltran A, Montironi R. Bladder cancer: translating molecular genetic insights into clinical practice. Hum Pathol. 2011;42:455–81.

    Article  CAS  PubMed  Google Scholar 

  32. Jackson J, Barkan GA, Kapur U, Wojcik EM. Cytologic and cystoscopic predictors of recurrence and progression in patients with low-grade urothelial carcinoma. Cancer Cytopathol. 2013;121:398–402.

    Article  PubMed  Google Scholar 

  33. Cheng L, Cheville JC, Neumann RM, Bostwick DG. Natural history of urothelial dysplasia of the bladder. Am J Surg Pathol. 1999;23:443–7.

    Article  CAS  PubMed  Google Scholar 

  34. Zuk RJ, Rogers HS, Martin JE, Baithun SI. Clinicopathological importance of primary dysplasia of bladder. J Clin Pathol. 1988;41:1277–80.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Nathan NA, Narayan E, Smith MM, Horn MJ. Cell block cytology. Improved preparation and its efficacy in diagnostic cytology. Am J Clin Pathol. 2000;114:599–606.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Loyola University Medical Center, Maywood, IL, USA

    Eva M. Wojcik

  2. Department of Cellular Pathology, Guy’s & St Thomas’ NHS Foundation Trust, London, England, UK

    Tatjana Antic

  3. Department of Pathology, Loyola University Health Systems, Loyola University, Chicago, IL, USA

    Ashish Chandra

  4. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA

    Michael B. Cohen

  5. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Zulfia McCroskey

  6. Department of Pathology, Yonsei and Ewha Womans University Hospitals, Seoul, South Korea

    Jae Y. Ro

  7. Department of Oncologic Pathology, Institute of Medical Life Sciences, Mie University Graduate School, Mie, Japan

    Taizo Shiraish

Authors
  1. Eva M. Wojcik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatjana Antic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashish Chandra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael B. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zulfia McCroskey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jae Y. Ro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Taizo Shiraish
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva M. Wojcik .

Editor information

Editors and Affiliations

  1. The Johns Hopkins Hospital, The Johns Hopkins University, Baltimore, Maryland, USA

    Dorothy L. Rosenthal

  2. Department of Pathology, Loyola University Medical Center Department of Pathology, MAYWOOD, Illinois, USA

    Eva M. Wojcik

  3. Department of Pathology and Laboratory M, University of Wisconsin School of Medine Department of Pathology and Laboratory M, MADISON, Wisconsin, USA

    Daniel F.I. Kurtycz

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Wojcik, E.M. et al. (2016). Low-Grade Urothelial Neoplasia (LGUN). In: Rosenthal, D., Wojcik, E., Kurtycz, D. (eds) The Paris System for Reporting Urinary Cytology. Springer, Cham. https://doi.org/10.1007/978-3-319-22864-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-22864-8_7

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22863-1

  • Online ISBN: 978-3-319-22864-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation