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Cytopathology. 2016 Apr;27(2):83-90. doi: 10.1111/cyt.12230. Epub 2015 Jan 12.

Cytomorphological characteristics of low-grade papillary urothelial carcinoma for differential diagnosis from benign papillary urothelial lesions: logistic regression analysis in SurePath(™) liquid-based voided urine cytology.

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Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Department of Pathology, Cancer Center, Dongnam Institute of Radiological and Medical Sciences (DIRAMS), Busan, South Korea.



The diagnosis of low-grade papillary urothelial carcinoma (LGPUC) in urine cytology specimens is challenging because of its subtle, minimally atypical findings. Furthermore, as SurePath(™) liquid-based cytology (LBC) is becoming a widely used method in urine cytology, the inevitable cytomorphological alterations resulting from this technique call for new morphological diagnostic criteria in LGPUC.


Logistic regression analysis was carried out on SurePath slides from surgically proven voided urine specimens. The study was designed to include a test set (n = 141) and a validation set (n = 61), and evaluated significant discriminative parameters between LGPUC and benign papillary urothelial neoplasm (BPUN).


Of the seven cytological findings that were found to have statistical significance in univariate analysis, five were found to be independent variables: loss of polarity of papillaroid clusters, irregular contours, absence of columnar cells, hobnail features and hyperchromasia. These independent variables had an area under the curve (AUC) of 0.781.


The distinctive cytological criteria identified above may prove to be helpful in cases in which other conventional criteria for LGPUC are insufficient for diagnosis.


SurePath™; benign papillary urothelial neoplasm; liquid-based cytology; logistic regression analysis; low-grade papillary urothelial carcinoma; urine cytology

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