@article{3171465,
    title = "Audit of cytology of upper urinary tract",
    author = "Malta, F. and Lenos, M. and Leotsakos, I. and Katafigiotis, I. and and Gakiopoulou, H. and Constantinides, C. and Mikou, P.",
    journal = "Cytopathology",
    year = "2016",
    volume = "27",
    number = "5, SI",
    pages = "369-373",
    publisher = "Wiley",
    issn = "0956-5507, 1365-2303",
    doi = "10.1111/cyt.12310",
    keywords = "audit; cytology; upper urinary tract; malignancy",
    abstract = "ObjectiveCytology is an essential tool for the investigation of urinary
tract malignancy. In this audit, we aimed to assess our laboratory
performance in the diagnosis of upper urinary tract malignancy and to
use the information provided to improve our service.
MethodsWe retrieved cytology reports of upper urinary tract specimens
from two periods, re-evaluated the cases, compared the reports with
histology data and estimated the sensitivity, specificity and positive
predictive value (PPV). In the time interval between the two periods, we
adopted new terminology, established better communication with
clinicians and gained experience in the field. Finally, the data from
the two periods were compared.
ResultsIn phase A, we estimated a sensitivity of 73%, specificity of
86% and PPV of 84.6%. As a result of the cytological re-evaluation,
correlation with histology and clinical follow-up, plus communication
with the clinicians during the audit, we established new terminology and
a new request form. A three tiered grading system of atypia (mild,
moderate and severe) was replaced by a two tiered grading system. The
first category atypia probably benign corresponded to mild atypia while
the second category atypia, not otherwise specified corresponded to
moderate atypia. The cases diagnosed as severe atypia were reclassified
as suspicious for malignancy. In phase B, the sensitivity, specificity
and PPV were 75%, 89% and 90%, respectively.
ConclusionsOur laboratory performance is in concordance with reported
data and has been improved through this study. The audit process is
extremely valuable for the identification of problems, for taking action
and, finally, for the improvement of the clinical cytology service in
the field of upper urinary tract malignancy.
In this audit, performance in the diagnosis of upper urinary tract
malignancy was assessed, with the information obtained leading to
establishment of new terminology and a new request form. A re-audit
demonstrated improvement in the service."
}