Adequacy of Urine Specimens (Adequacy)

Abstract

Adequacy is a source of disagreement and controversy in cytopathology, and urinary tract specimens are no exception. For the purposes of this chapter, the term “adequacy” for urinary tract specimens is used to refer to the usefulness of the specimen to diagnose or raise suspicion for high-grade urothelial carcinoma (HGUC). As such, adequacy of urinary tract specimens for the diagnosis of HGUC is determined by the interplay of four specimen characteristics: collection type, cellularity, volume, and cytomorphological findings. In this chapter, we provide an algorithm for how these variables should be used to arrive at a systematic adequacy determination, review the available literature, provide recommendations for voided urinary sample volume, and build the framework for future investigations into the adequacy of urinary specimens.Background In the reporting of cytologic samples, a statement of adequacy provides the clinician and pathologist confidence that the specimen is representative of the target site or lesion. Defining adequacy is controversial in all areas of cytopathology, and urinary tract cytology is no exception. For the purposes of this chapter, the term “adequacy” for urine specimens is used to refer to the usefulness of the specimen to diagnose or raise the suspicion for high-grade urothelial carcinoma (HGUC). The adequacy of urine specimens for the diagnosis of urothelial carcinoma is determined by the interplay of four specimen characteristics: collection type, cellularity, volume, and cytomorphological findings. The Paris System for Reporting Urinary Cytology (TPS) provides an algorithm for how these variables should be used to arrive at a systematic adequacy determination and to provide a framework for further investigations into the adequacy of urinary cytology specimens.