Atypical urothelial cells investigation with automated urinalysis and expert review of microscopic sediment as early parameter for suspected bladder cancer patients

Introduction and objectives: Automated urinalysis offers rapid and efficient evaluation of urine sediment; however, most systems do not routinely report epithelial cell atypia. This study aimed to evaluate the clinical relevance of the atypical cell (Atyp.C) parameter generated by the Sysmex UF-4000 analyzer as an early indicator of suspected urothelial carcinoma. Materials and methods: A prospective study was conducted using the UF-4000 analyzer to detect Atyp.C in urine specimens from high-risk patients. Atyp.C results were collected simultaneously for all samples. Specimens with positive Atyp.C findings underwent urinary tract cytology, which was independently reviewed by board-certified cytopathologists and categorized into four diagnostic groups. Statistical analyses were performed using IBM SPSS version 21. Results: Among 332 specimens, 20 samples (6.02%) showed Atyp.C values > 0.0/μL. The mean Atyp.C value was 0.6/μL (95% CI 0.064-1.135) in males and 1.20/μL (95% CI 0.608-1.791) in females, with no significant difference between sexes (p = 0.2549). Of the 20 Atyp.C-positive samples, 5 (25%) demonstrated abnormal cytology, including 2 cases of atypical urothelial cells, 1 case suspicious for high-grade malignancy, and 2 cases of confirmed high-grade urothelial carcinoma. Atyp.C values were significantly higher in abnormal compared with benign cytology (p < 0.01). Conclusions: The Atyp.C parameter may have potential as an adjunctive screening marker for urothelial abnormalities; however, further validation studies are required.