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Assessment of atypical cells in detecting bladder cancer in female patients

  • Yan Zhao , Enhao Zhang , Yinling Wang , Jun Zheng , Danning Jin und Hong Luan EMAIL logo
Veröffentlicht/Copyright: 18. Juni 2025
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 63 Heft 10

Abstract

Objectives

Atypical or malignant urothelial cells may be identified with a research parameter of atypical cells (Atyp.C) using a fully automated urine particle analyzer in routine urinalysis. This study aimed to determine whether Atyp.C can serve as an effective screening tool for female bladder cancer (BC) and to observe the impact of pyuria and bacteriuria on Atyp.C concentrations.

Methods

Patients were classified into six groups: primary BC, recurrent BC, post-treatment monitoring of BC, other urological tumors, pyuria and bacteriuria, and controls. Atyp.C concentrations were compared across these groups, and its diagnostic performance for BC or pyuria and bacteriuria was analyzed. Logistic regression determined whether Atyp.C was an independent risk factor for BC or pyuria and bacteriuria. Subsequently, key factors contributing to abnormal Atyp.C elevations were investigated.

Results

The median Atyp.C concentrations were significantly elevated in both primary (2.9/µL) and recurrent BC cases (4.0/µL) compared to patients with pyuria and bacteriuria (2.0/µL) and controls (1.7/µL) (p<0.01). Diagnostic performance of Atyp.C to detect primary female BC reached an area under curve of 0.818 when combined with age and urine conductivity. Multivariate analysis confirmed Atyp.C as an independent risk factor for BC in women. Falsely increased Atyp.C concentrations were caused by WBC clumps, clue cells covered by bacteria, and macrophages.

Conclusions

Atyp.C did not reach sufficient specificity for screening of BC in women with existing pyuria or bacteriuria. WBC clumps, macrophages and clue cells contributed to falsely positive Atyp.C counts.

Keywords: atypical cell; bladder cancer; urinary tract infection; flow cytometry; urinalysis; female patient
Corresponding author: Hong Luan, Department of Laboratory Medicine, National Clinical Research Center for Laboratory Medicine, The First Hospital of China Medical University, No. 155, Nanjingbei Street, Heping District, Shenyang, Liaoning Province, 110001, P.R. China; and Research Unit of Medical Laboratory, Chinese Academy of Medical Science, Beijing, P.R. China, E-mail:
Yan Zhao and Enhao Zhang contributed equally to this work.

Funding source: CAMS Innovation Fund for Medical Sciences

Award Identifier / Grant number: 2019-I2M-5-027

  1. Research ethics: This study was reviewed and approved by the Ethics Committee of the First Hospital of China Medical University (Reference No. 2024–121).

  2. Informed consent: Not applicable.

  3. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Hong Luan and Yan Zhao designed and conceived this manuscript. Hong Luan, Yan Zhao and EnHhao Zhang collected the samples, analyzed the data, and wrote the draft. Yinling Wang, Jun Zheng, and Danning Jin critically revised the manuscript and contributed to the final draft. All authors have read and approved the final manuscript.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: This study was supported by grants from CAMS Innovation Fund for Medical Sciences (2019-I2M-5-027).

  7. Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0268).

Received: 2025-03-06
Accepted: 2025-06-01
Published Online: 2025-06-18
Published in Print: 2025-09-25

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2025-0268
Schlagwörter für diesen Artikel
atypical cell; bladder cancer; urinary tract infection; flow cytometry; urinalysis; female patient

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. Quality indicators: an evolving target for laboratory medicine
  4. Reviews
  5. Regulating the future of laboratory medicine: European regulatory landscape of AI-driven medical device software in laboratory medicine
  6. The spectrum of nuclear patterns with stained metaphase chromosome plate: morphology nuances, immunological associations, and clinical relevance
  7. Opinion Papers
  8. Comprehensive assessment of medical laboratory performance: a 4D model of quality, economics, velocity, and productivity indicators
  9. Detecting cardiac injury: the next generation of high-sensitivity cardiac troponins improving diagnostic outcomes
  10. Perspectives
  11. Can Theranos resurrect from its ashes?
  12. Guidelines and Recommendations
  13. Australasian guideline for the performance of sweat chloride testing 3rd edition: to support cystic fibrosis screening, diagnosis and monitoring
  14. General Clinical Chemistry and Laboratory Medicine
  15. Recommendations for the integration of standardized quality indicators for glucose point-of-care testing
  16. A cost-effective assessment for the combination of indirect immunofluorescence and solid-phase assay in ANA-screening
  17. Assessment of measurement uncertainty of immunoassays and LC-MS/MS methods for serum 25-hydroxyvitamin D
  18. A novel immunoprecipitation-based targeted liquid chromatography-tandem mass spectrometry analysis for accurate determination for copeptin in human serum
  19. Histamine metabolite to basal serum tryptase ratios in systemic mastocytosis and hereditary alpha tryptasemia using a validated LC-MS/MS approach
  20. Machine learning algorithms with body fluid parameters: an interpretable framework for malignant cell screening in cerebrospinal fluid
  21. Impact of analytical bias on machine learning models for sepsis prediction using laboratory data
  22. Immunochemical measurement of urinary free light chains and Bence Jones proteinuria
  23. Serum biomarkers as early indicators of outcomes in spontaneous subarachnoid hemorrhage
  24. High myoglobin plasma samples risk being reported as falsely low due to antigen excess – follow up after a 2-year period of using a mitigating procedure
  25. Candidate Reference Measurement Procedures and Materials
  26. Commutability evaluation of glycated albumin candidate EQA materials
  27. Reference Values and Biological Variations
  28. Health-related reference intervals for heavy metals in non-exposed young adults
  29. Hematology and Coagulation
  30. Practical handling of hemolytic, icteric and lipemic samples for coagulation testing in European laboratories. A collaborative survey from the European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM)
  31. Cancer Diagnostics
  32. Assessment of atypical cells in detecting bladder cancer in female patients
  33. Cardiovascular Diseases
  34. False-positive cardiac troponin I values due to macrotroponin in healthy athletes after COVID-19
  35. Diabetes
  36. A comparison of current methods to measure antibodies in type 1 diabetes
  37. Letters to the Editor
  38. The neglected issue of pyridoxal- 5′ phosphate
  39. Error in prostate-specific antigen levels after prostate cancer treatment with radical prostatectomy
  40. Arivale is dead ‒ Hooke is alive
  41. A single dose of 20-mg of ostarine is detectable in hair
  42. Growing importance of vocabularies in medical laboratories
  43. Congress Abstracts
  44. 62nd National Congress of the Hungarian Society of Laboratory Medicine Szeged, Hungary, August 28–30, 2025
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