{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:10:51Z","timestamp":1790244651709,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Urothelial carcinoma with squamous differentiation (UCSD) carries adverse outcomes, yet cytological recognition is challenging because keratinized atypical squamous cells (ASCs) often show deceptively low nuclear\u2010to\u2010cytoplasmic ratios. A size\u2010based ASC classification anchored to neutrophils was evaluated as a biological internal reference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All cytology specimens were prepared with the ThinPrep liquid\u2010based cytology system. Seventeen urine cytology specimens from histologically confirmed UCSD and 79 cytologically benign (BE) specimens with squamous cells were retrospectively reviewed. ASCs with orangeophilic cytoplasm were subclassified by nuclear size relative to the adjacent neutrophils: ASC\u2010S (small nuclei; &gt;1\u00d7 neutrophil) and ASC\u2010L (large nuclei; &gt;2\u00d7 neutrophil). Counts were obtained from five high\u2010power fields. UCSD was stratified by the extent of squamous differentiation (&lt;50% vs.\u00a0\u226550%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>No ASC\u2010S\/L was identified in BE specimens, whereas either subtype was present in 15 of the 17 UCSD cases, which yielded a cohort\u2010level sensitivity of 88% and specificity of 100% for UCSD detection (95% CI, 65.7%\u201396.7% and 95.4%\u2013100%, respectively). ASC\u2010S was more prevalent than ASC\u2010L, and was observed across Paris System categories\u2014including atypical urothelial cells (AUCs)\u2014whereas ASC\u2010L appeared mainly in suspicious for high\u2010grade urothelial carcinoma\/high\u2010grade urothelial carcinoma. ASC\u2010S counts tended to increase with greater histological squamous differentiation, and were detectable even when tissue involvement was &lt;50%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neutrophil\u2010calibrated ASC classification provides an objective, biologically grounded framework that aligns cytology with histology in UCSD. Reporting ASC\u2010S\/L\u2014particularly ASC\u2010S in equivocal (AUC) specimens\u2014may facilitate earlier recognition of squamous differentiation and inform subsequent tissue evaluation. Prospective, multi\u2010institutional validation with interobserver agreement and receiver operating characteristic\u2013based thresholds is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncy.70055","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T01:35:20Z","timestamp":1760405720000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neutrophil\u2010calibrated atypical squamous cells in ThinPrep urine cytology for detecting squamous differentiation in urothelial carcinoma"],"prefix":"10.1002","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6920-438X","authenticated-orcid":false,"given":"Ayako","family":"Furuhata","sequence":"first","affiliation":[{"name":"Department of Diagnostic Pathology Kyoto University Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8620-0710","authenticated-orcid":false,"given":"Yuki","family":"Teramoto","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology Kyoto University Hospital  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5800-6769","authenticated-orcid":false,"given":"Sachiko","family":"Minamiguchi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology Fujita Health University  Toyoake Aichi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9211-0511","authenticated-orcid":false,"given":"Masahiro","family":"Hirata","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology Kyoto University Hospital  Kyoto 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