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The participant diagnoses for the UC reference diagnosis included 83.5% HGUC (59 985 of 71 581), 4.1% atypical urothelial cells (2942 of 71 581), 3.1% ADC (2201 of 71 581), 1.1% SCC (776 of 71 581) and 0.9% Polyomavirus (609 of 71 581), among others, as presented in Table 5.
The criticism is levied particularly in detecting low-grade urothelial lesions; lesions that are typically diagnosed by cystoscopic examination and have a less than 10% risk of progression, compared with the close to 60% risk of progression in HGUC. (14, 15) Thus, the primary aim of urinary cytology is to detect HGUC.
Participants performed better on the specific diagnosis of HGUC with liquid-based preparations (17 529 of 20 495 responses; 85.5%), compared with cytospin (24 877 of 29 544 responses; 84.2%), and conventional preparations (17 579 of 21 513 responses; 81.7%) (P < .002).
Abbreviations: ADC, adenocarcinoma; HGUC, high-grade urothelial carcinoma, SCC, squamous cell carcinoma.
For histologic biopsies on follow-up, 19% of the cases were benign (n = 13), 26% (n = 18) were LGUC, and 54% (n = 37) were HGUC. The interval ranges between cytology and histology diagnoses were 1 to 908 days, with a median of 92.5 days.
There were 37 patients (54%) with HGUC, 8 women (22%) and 29 men (78%), with a median age of 73 years (Table 3).
The first published study (22) using ProEx C in urinary cytology presented quite favorable test characteristics for ProEx C in defining definitive benign and malignant cytologic specimens for predicting both LGUC and HGUC. In particular, the study showed that ProEx C was most useful in stratifying the diagnosis when the cytology was nondefinitive (ie, AUC).
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