MATERIALS AND METHODSĪpproval to conduct the study with a consent waiver was obtained from the Institutional Review Board.
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The purpose of the current study was to reevaluate the importance of the presence of BUTF in VU specimens as well as the degree of its association with neoplasms and to determine how to cytologically classify them. 13 These different thoughts have engendered controversy regarding the appropriate diagnostic categorization of specimens containing UTF (ie, atypical or negative for urothelial atypia or malignancy). 12 According to other authors, this finding can be neglected. Some authors believe that even the presence of benign-appearing UTF (BUTF) is a reliable indicator of urothelial neoplasia. 11 However, the presence of UTF in VU alerts the cytopathologist to the possibility of a urothelial neoplasm. UTF are expected in instrumented urine specimens because urothelium can exfoliate with the slightest trauma. 10 One of the major diagnostic dilemmas is the presence of urothelial tissue fragments (UTF) in voided urine (VU). 1, 8, 9 In the practice of urinary cytopathology, various diagnostic pitfalls and challenges may be encountered. 7 Although the performance of cytology is high for high-grade urothelial carcinoma (HGUC), the sensitivity has been generally low for low-grade lesions. 4- 6 The success or failure of cytologic evaluations of urothelial tumors depends for the most part on the morphology of the lesion. 1- 3 With the evolution of cytologic classification schemes, it has become more effective, especially in targeting those patients who need to undergo cystoscopy. Urinary cytopathology is an important and noninvasive method that has been widely used for many years in the diagnosis and follow-up of patients with urothelial neoplasms. They also present a low risk of low-grade urothelial neoplasia (3.6%) and high-grade urothelial carcinoma (0.7%) when compared with the overall benign category at the study institution (2.3% and 0.7%, respectively). If recent instrumentation is not identified, the etiology of BUTF is not usually determined in the current study, BUTF were found to be associated with urinary tract stones in 16.4% of cases. The presence of BUTF in VU specimens requires careful examination of the medical history because their presence may be explained by recent instrumentation. Forty-five cases (16.4%) were determined to have urinary tract stones on follow-up. The overall rate of urothelial neoplasia on follow-up was 3.6% for low-grade urothelial neoplasia (10 cases) and 0.7% for high-grade urothelial carcinoma (2 cases). Of the 274 cases, 29 (10.6%) had follow-up surgical pathology specimens available. A total of 170 cases (38.3%) had UTF with atypical cytologic features and were therefore excluded. In the remaining 444 cases, 274 cases (61.7%) had BUTF. Fifteen cases were excluded because the slides were not available for review. Of these, 459 cases (40.6%) did not have a recent history of instrumentation. METHODSĪ retrospective search of the electronic pathology database system over a 5-year period (2009-2013) revealed 1131 VU specimens containing UTF. In the current study, the authors reviewed VU specimens containing benign-appearing UTF (BUTF) to determine the associated rate of urothelial neoplasia at the study institution. The presence of urothelial tissue fragments (UTF) in voided urine (VU) is often considered an abnormal finding that may be associated with the presence of urothelial papillary neoplasms.
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