{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T04:54:53Z","timestamp":1762145693004,"version":"build-2065373602"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T00:00:00Z","timestamp":1639699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>In high\u2010grade urothelial carcinoma (UC) of the bladder, bacillus Calmette\u2010Guerin (BCG) therapy is a therapeutic mainstay, and urinary cytology is recommended to detect recurrences. However, intravesical BCG instillations can induce morphologic changes in urothelial cells. The authors investigated the impact of BCG therapy on the efficacy of urinary cytology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Matched pathology and cytology samples from patients undergoing transurethral resection of the bladder after BCG therapy were assessed. Cytology samples were graded according to The Paris System for Reporting Urinary Cytology. Diagnostic quality criteria were tested for different cutoff definitions, and the results were compared between those obtained &lt;100 versus \u2265100 days after the last BCG instillation. In addition, the oncologic outcome of false\u2010positive results was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 389 matched cases from 197 patients who had a history of high\u2010grade UC (HGUC) were identified. Sixty cases (15.7%) were diagnosed as high\u2010grade urothelial bladder cancer. The cytology diagnoses were as follows: non\u2010HGUC, 191 cases (49.1%); atypical urothelial cells, 80 cases (20.6%); suspicious for HGUC, 56 cases (14.4%); and HGUC, 56 cases (14.4%). Interrater reliability was substantial (\u03ba = 0.660). Sensitivity increased from 45% to 75% when cases diagnosed as suspicious for HGUC were also counted as positive. Notably, sensitivity was reduced within the first 100 days after BCG therapy (61.9%) compared with sensitivity at longer intervals (82.1%). Reactive atypia (odds ratio, 4.155; 95% confidence interval, 2.136\u20108.085; <jats:italic>P<\/jats:italic> &lt; .001) and cellular degeneration (odds ratio, 5.050; 95% CI, 2.094\u201012.175; <jats:italic>P<\/jats:italic> &lt; .001) of urothelial cells were associated with false\u2010positive rates, and 44.7% of patients who had a false\u2010positive cytology classification presented with HGUC during follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>BCG therapy has a short\u2010term adverse impact on the efficacy of urinary cytology. After BCG therapy, cases classified as suspicious for HGUC should be considered positive. Importantly, patients with false\u2010positive cytology findings should be closely monitored.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncy.22539","type":"journal-article","created":{"date-parts":[[2021,12,17]],"date-time":"2021-12-17T09:14:30Z","timestamp":1639732470000},"page":"294-302","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Impact of bacillus Calmette\u2010Guerin intravesical therapy on the diagnostic efficacy of The Paris System for Reporting Urinary Cytology in patients with high\u2010grade bladder cancer"],"prefix":"10.1002","volume":"130","author":[{"given":"Julian","family":"Hermans","sequence":"first","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friedrich","family":"Jokisch","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannic","family":"Volz","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennert","family":"Eismann","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo","family":"Pfitzinger","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Ebner","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Weinhold","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Schlenker","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian G.","family":"Stief","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Tritschler","sequence":"additional","affiliation":[{"name":"Department of Urology and Urologic Oncology Loretto Hospital Freiburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0340-0304","authenticated-orcid":false,"given":"Gerald B.","family":"Schulz","sequence":"additional","affiliation":[{"name":"Department of Urology Ludwig\u2010Maximilians University Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.06.010"},{"volume-title":"Cancer Today (powered by GLOBOCAN 2018). 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