Evidence-based adequacy criteria for urinary bladder barbotage cytology Jennifer Prather, MD a , Brent Arville, DO a , Grazina Chatt, CT (ASCP) a , Stefan E. Pambuccian, MD a , Eva M. Wojcik, MD a,b , Marcus L. Quek, MD b , Güliz A. Barkan, MD a,b, * a Department of Pathology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois b Department of Urology, Loyola University Medical Center, 2160 S. First Avenue, Maywood, Illinois Received 5 April 2014; received in revised form 17 September 2014; accepted 22 September 2014 KEYWORDS Urine; Adequacy; Bladder washing; Bladder barbotage; Instrumented Introduction Adequacy criteria are well established in some areas of cytopathology to prevent false nega- tive diagnoses. To date, no such criteria have been proposed and validated for urinary tract specimens. Our aim was to determine a cellularity cutoff point that significantly affects the sensitivity of detecting high- grade or in situ urothelial carcinoma (HGUC or UCIS) in bladder barbotage/washing specimens. Materials and methods Bladder barbotage specimens collected in liquid-based media were selected. Spec- imens diagnosed as “positive for HGUC” (with histologic confirmation) composed the study group, with negative cases as control specimens. Samples were serially diluted and ThinPrep slides of decreasing cellu- larity were made and reviewed for diagnosis and cellularity. In a retrospective validation study, we identified cases with a “negative for malignancy” bladder barbotage/washing and a surgical pathology diagnosis of UCIS or HGUC (ie, false negative cytology). Cellularity was assessed. Results A distinct difference in sensitivity was noted at a cutoff point of 2644 (20 per 10 high-power fields) urothelial cells. Sensitivities increased for atypical or higher (68.3% versus 100%) and HGUC (43.3% versus 88.0%) after application of this cutoff point with high statistical significance (P Z 0.001 and 0.0001, respectively). For the retrospective review, cases below the cutoff point were reclassified as un- satisfactory, and sensitivity rose from 76.3% to 84.8% (P Z 0.0027). Conclusions Our results indicate that, in the absence of atypical or malignant cells, an adequate bladder barbotage specimen should have a minimum of 2644 (20 per 10 high-power fields) well-visualized, well- preserved urothelial cells to increase the positive predictive value of this test. Ó 2014 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved. Introduction Urinary tract cytology (UTC) is widely used for the evaluation of hematuria, irritative voiding symptoms, and in the follow- *Corresponding author. Güliz A. Barkan, MD, Department of Pathol- ogy, Loyola University Medical Center, 2160 S. First Avenue, Maywood, IL 60153; Tel.: 1 (708) 327-2572; fax: 1 (708)-327-2620. E-mail address: gbarkan@lumc.edu (G.A. Barkan). 2213-2945/$36 Ó 2014 American Society of Cytopathology. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jasc.2014.09.206 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.jascyto.org/ Journal of the American Society of Cytopathology (2014) xx,1e6