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Evaluation of a triple combination of cytokeratin 20, p53 and CD44 for improving detection of urothelial carcinoma in urine cytology specimens.

Arville B, O'Rourke E, Chung F, Amin M, Bose S - Cytojournal (2013)

Bottom Line: Based on the validation and published literature, two distinct immunoprofiles were defined - malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns.Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics.However Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA.

ABSTRACT

Background: Atypical urine cytology results trigger cystoscopy or molecular tests, both of which are costly, complex and difficult to perform tests. Several immunostains are being investigated to improve cancer detection; however, cytology material is limited and restricts the use of multiple immunostains. This study was designed to determine the utility of a cocktail of three stains, cytokeratin (CK20), p53 and CD44 in urine cytology samples for improving the detection of urothelial carcinoma.

Materials and methods: Urine cytology specimens with cell blocks containing adequate cytologic material between 2005 and 2010 and subsequent follow-up biopsy and/or Urovysion test (102 cases including 29 negative, 56 atypical and 17 malignant) were included in the study and evaluated with the triple stain. Results were first validated on the positive and negative cases and then applied to the atypical cases to determine the utility in the diagnosis of urothelial carcinoma.

Results: Based on the validation and published literature, two distinct immunoprofiles were defined - malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns. The malignant immunoprofile showed 88% sensitivity, 78% specificity, 74% positive predictive value (PPV) and 90% negative predictive value (NPV) for detecting urothelial carcinoma. These values improved to 95% sensitivity and 96% NPV when low-grade urothelial carcinoma cases were excluded.

Summary: Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics. However Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.

No MeSH data available.


Related in: MedlinePlus

Examples of atypical cells expressing a malignant immunoprofile. Atypical cells are positive for p53 (brown nuclear stain) and cytokeratin20 (red cytoplasmic stain) immunostains (×600)
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Figure 2: Examples of atypical cells expressing a malignant immunoprofile. Atypical cells are positive for p53 (brown nuclear stain) and cytokeratin20 (red cytoplasmic stain) immunostains (×600)

Mentions: 1. A malignant immunoprofile: This was defined as the presence of at least five morphologically atypical cells staining for CK20 (cytoplasmic red) and/or p53 (nuclear brown) [Figure 2]. The cut-off of five cells was arbitrarily defined.


Evaluation of a triple combination of cytokeratin 20, p53 and CD44 for improving detection of urothelial carcinoma in urine cytology specimens.

Arville B, O'Rourke E, Chung F, Amin M, Bose S - Cytojournal (2013)

Examples of atypical cells expressing a malignant immunoprofile. Atypical cells are positive for p53 (brown nuclear stain) and cytokeratin20 (red cytoplasmic stain) immunostains (×600)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927070&req=5

Figure 2: Examples of atypical cells expressing a malignant immunoprofile. Atypical cells are positive for p53 (brown nuclear stain) and cytokeratin20 (red cytoplasmic stain) immunostains (×600)
Mentions: 1. A malignant immunoprofile: This was defined as the presence of at least five morphologically atypical cells staining for CK20 (cytoplasmic red) and/or p53 (nuclear brown) [Figure 2]. The cut-off of five cells was arbitrarily defined.

Bottom Line: Based on the validation and published literature, two distinct immunoprofiles were defined - malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns.Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics.However Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA, USA.

ABSTRACT

Background: Atypical urine cytology results trigger cystoscopy or molecular tests, both of which are costly, complex and difficult to perform tests. Several immunostains are being investigated to improve cancer detection; however, cytology material is limited and restricts the use of multiple immunostains. This study was designed to determine the utility of a cocktail of three stains, cytokeratin (CK20), p53 and CD44 in urine cytology samples for improving the detection of urothelial carcinoma.

Materials and methods: Urine cytology specimens with cell blocks containing adequate cytologic material between 2005 and 2010 and subsequent follow-up biopsy and/or Urovysion test (102 cases including 29 negative, 56 atypical and 17 malignant) were included in the study and evaluated with the triple stain. Results were first validated on the positive and negative cases and then applied to the atypical cases to determine the utility in the diagnosis of urothelial carcinoma.

Results: Based on the validation and published literature, two distinct immunoprofiles were defined - malignant, characterized by at least five CK20 and/or p53 positive atypical cells and reactive, all other staining patterns. The malignant immunoprofile showed 88% sensitivity, 78% specificity, 74% positive predictive value (PPV) and 90% negative predictive value (NPV) for detecting urothelial carcinoma. These values improved to 95% sensitivity and 96% NPV when low-grade urothelial carcinoma cases were excluded.

Summary: Our results indicate that the triple stain is an inexpensive, easy to perform test most useful for differentiating high-grade urothelial carcinoma from its mimics. However Inclusion of CD44 in the cocktail did not provide additional value and is best excluded.

No MeSH data available.


Related in: MedlinePlus