A-176 Optimizing the Balance Between Emergency Diagnosis and Laboratory Testing: Identification of Urinary Cancer by Sysmex UF Atyp.C Parameter

Abstract Background Emergency department (ED) patients often present with acute onset, severe symptoms, and complex conditions, posing significant challenges for rapid and accurate diagnostic testing. Urothelial carcinoma cancer (UC), in the early stage, frequently manifests with painless hematuria, and less patients have microscopic hematuria, which is easily overlooked. The “gold standard” of UC is TURB (Transurethral resection) combined with histopathological examination, performed in the pathology department. Traditional Urine cytology can be another option for diagnosis but is time-consuming and extremely complicated, being often separated from routine urinalysis, which is not conducive to short turnaround time and rapid diagnosis. Studies have shown that abnormal/malignant urothelial cells can be identified through urine sediment analysis. The Sysmex UF-3000 urine analyzer novel parameter Atyp.C (atypical cells) offers a rapid, easy operated (without centrifuge and dying) and non-invasive way for routine detecting atypical cells in urine, providing a new approach for UC screening. Methods Patient data were collected from the electronic records of HIS and LIS. Complete blood count (CBC), urine dry chemistry, urine sediment analysis, centrifuged microscopy, and stained microscopy were performed in the emergency laboratory using Sysmex XN9000 and Sysmex UF3000 instruments and other instruments. Both diagnostic and research parameters are available on Sysmex Laboman 4.2 software. Also being as an ISO 15189 accredited laboratory, we evaluated and reviewed this special case in accordance with the laboratory*s quality documentation, then made specific improvement. Results A 62-year-old DM patient suffered from 1-month hypochondriac pain after travel, with low fever. Initial tests revealed a complete blood cell count (CBC) of 10.32×10?/L, urine appeared gross hematuria visible on naked eye, dry chemistry analysis occult blood 2+, and 12-14 red blood cells per high-power field (HPF) on microscopy after centrifuging. Patient was initially diagnosed with urinary tract infection and treated with antibiotics. Four hours later, ultrasound detected a cystic mass in the ureter, then followed sediment analysis showed red blood cells 35 /µL, white blood cells 40.6 /µL. besides these diagnostic parameters, the instrument reported atypical cells (2.7/µL ) under the heading of “research parameters.” Presence of atypical cells was confirmed by the manual microscopy. Later the patient had transurethral resection and the pathology report confirmed a urothelial carcinoma. Conclusion The application of novel and standardized laboratory techniques is essential for earlier diagnosis and precision therapeutic of UC. The Atyp.C parameter of the Sysmex UF-3000, combined with clinical indicators (e.g., hematuria, abdominal pain), effectively aids in early screening and diagnosis of UC. Compared to traditional methods, Sysmex UF-3000 offers rapid and non-invasive detection way, significantly improves emergency testing efficiency and reduces the risk of missed diagnoses. As an ISO 15189 accredited laboratory, we evaluated and reviewed this special case in accordance with the laboratory*s quality documentation, then made specific improvement, which is, any abnormal indication on important research parameters, like Atyp.C, should be documented and reported for clinician’s reference and better medical assistance.