INTRODUCTIONUrine cytology is an essential method for the surveillance and detection of urothelial neoplasms, with its strength being its specificity for the detection of high‐grade urothelial carcinoma (HGUC). In 2004, the Papanicolaou Society of Cytopathology developed a urine cytology classification scheme that included a category of “atypical urothelial cells” (AUC) and further subclassified this atypical group into reactive or neoplastic. However, this classification scheme was lacking in specific and reproducible criteria for the recommended atypical categories. To meet this need, various institutions independently developed in‐house diagnostic criteria as well as subclassifications for the “atypical” category, such as “AUCs favor a reactive process versus AUCs unclear whether reactive or neoplastic,” “AUCs of undetermined significance versus AUCs‐cannot rule out high‐grade carcinoma,” and “AUCs favor a reactive process versus AUCs favor neoplastic.” The wide variation in the use and criteria for the atypical category resulted in significant differences in the interinstitutional rates of the AUC diagnosis (range, 2%‐31%), as well as its association with subsequent histologic diagnoses of HGUC (range, 8.3%‐37.5%). The unpredictable nature of the atypical category contributed to the inclination of many urologists to treat AUC cases similarly to “negative” cases, thereby rendering it a clinically irrelevant diagnostic category.It is
Cancer Cytopathology – Wiley
Published: Jan 1, 2018
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