Cytohistologic correlation of recurrent urothelial carcinoma detected in urinary diversion specimens

BACKGROUND Urinary diversion specimens from patients who undergo radical cystectomy are often submitted for urine cytology to screen for recurrent urothelial carcinoma. The objective of the current study was to investigate the frequency and cytohistologic features of cancer recurrence in diversion urine specimens. METHODS A 10-year retrospective review of archival urinary diversion specimens was conducted. For abnormal cytology cases, cytology slides were reviewed, and their cytomorphology and available corresponding histopathology were documented. RESULTS In total, 679 diversion urine cytology specimens were identified, of which 39 specimens from 25 patients (5.7 %) had abnormal cytology diagnoses. Seven of 25 patients (28%) had postcystectomy surgical follow-up, and 5 of them manifested with local recurrence. Among the patients who had local recurrence, 3 (60%) developed lymph node and distant metastases and subsequently died. Sites of tumor recurrence included anastomoses in 4 of 5 patients and the penile urethra in 1 of 5 patients. The diversion urine cytology slides in patients who had carcinoma revealed scant, well preserved urothelial cells either alone or in clusters with high-grade features, including eccentrically located, enlarged, hyperchromatic nuclei; irregular nuclear borders; and high nuclear-to-cytoplasmic ratios. CONCLUSIONS The current data demonstrate that abnormal cytology in urinary diversion specimens is rare but, when present, can help to detect recurrent urothelial carcinoma. Careful examination of these specimens is warranted to screen for features of high-grade urothelial carcinoma among a degenerated cellular and sometimes inflammatory background. Cancer Cytopathol 2017;125:120–127. © 2016 American Cancer Society.