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Kannan N, Gochhait D, Ramanitharan M, Siddaraju N. A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update. Diagn Cytopathol 2024; 52:187-199. [PMID: 38164657 DOI: 10.1002/dc.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Owing to certain inherent limitations of earlier reporting systems, "The Paris System for Reporting Urinary Cytology (TPS)" was implemented in 2015 to standardize reporting urine cytology with more stringent cytomorphologic criteria. We share our post-TPS experience, comparing it with the conventional system (CS). AIM To assess and compare the cyto-histopathologic/cystoscopic agreement between the conventional and the Paris systems (CS and TPS) for reporting urine cytology. MATERIALS AND METHODS It is a cross-sectional study involving urine samples from 170 patients divided into two groups (CS and TPS). Of the 170 cases, 85 were reported according to the CS, and 85 were reported according to TPS with all the relevant clinical, radiologic, and cystoscopic findings. Using the kappa statistics, both groups were statistically analyzed for sensitivity, specificity, predictive values, and agreement. RESULTS The sensitivity and specificity for high-grade urothelial carcinoma (HGUC) as per TPS were 83.33% and 94.59%, respectively, while they were 73.47% and 80.56% for the conventional system. The agreement for HGUC with TPS was 87.06% with a kappa value of 0.7416, while it was 76.5% with a kappa value of 0.53 for the CS. Implementing the TPS minimized usage of the atypical urothelial cells (AUC) category, increasing the clarity in detecting HGUC. CONCLUSION TPS provides better agreement with histopathology than the CS for diagnosing HGUC, which is attributable to stringent TPS criteria that prompt cytopathologists to look more diligently for morphologic and numeric criteria.
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Affiliation(s)
- Narasimhapriyan Kannan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Manikandan Ramanitharan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Downes MR, Hartmann A, Shen S, Tsuzuki T, van Rhijn BWG, Bubendorf L, van der Kwast TH, Cheng L. International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 1: Comparison of Bladder Cancer Grading System Performance. Am J Surg Pathol 2024; 48:e1-e10. [PMID: 37246824 DOI: 10.1097/pas.0000000000002059] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Grade is a key prognostic factor in determining progression in nonmuscle invasive papillary urothelial carcinomas. The 2 most common grading methods in use worldwide are the World Health Organization (WHO) 2004 and 1973 schemes. The International Society of Urological Pathology (ISUP) organized the 2022 consensus conference in Basel, Switzerland on current issues in bladder cancer and tasked working group 1 to make recommendations for future iterations of bladder cancer grading. For this purpose, the ISUP developed in collaboration with the European Association of Urology a 10-question survey for their memberships to understand the current use of grading schemes by pathologists and urologists and to ascertain the areas of potential improvements. An additional survey was circulated to the ISUP membership for their opinion on interobserver variability in grading, reporting of urine cytology, and challenges encountered in grade assignment. Comprehensive literature reviews were performed on bladder cancer grading prognosis and interobserver variability along with The Paris System for urine cytology. There are notable differences in practice patterns between North American and European pathologists in terms of used grading scheme and diagnosis of papillary urothelial neoplasm of low malignant potential. Areas of common ground include difficulty in grade assignment, a desire to improve grading criteria, and a move towards subclassifying high-grade urothelial carcinomas. The surveys and in-person voting demonstrated a strong preference to refine current grading into a 3-tier scheme with the division of WHO 2004 high grade into clinically relevant categories. More variable opinions were voiced regarding the use of papillary urothelial carcinoma with low malignant potential.
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Affiliation(s)
- Michelle R Downes
- Precision Diagnostics & Therapeutics Program, Department of Anatomic Pathology, Sunnybrook Health Sciences Centre
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg, Erlangen, Germany
| | - Steven Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Aichi Prefecture, Japan
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Theodorus H van der Kwast
- Laboratory Medicine Program, Department of Anatomic Pathology, University Health Network, Toronto, ON, Canada
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, RI
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Sakumo K, Morihashi K, Nakamura A, Nukaya T, Sumitomo M, Nakamura M, Sofue T, Haba R, Itoh T, Kamoshida S, Ohsaki H. The usefulness of nuclear area in the diagnosis of high-grade urothelial carcinoma cells in voided urine cytology. Cytopathology 2023; 34:295-301. [PMID: 36959684 DOI: 10.1111/cyt.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The Paris System for Reporting Urinary Cytology considered the nuclear-to-cytoplasmic (N:C) ratio as the most important cytomorphological feature for detecting high-grade urothelial carcinoma (HGUC) cells. Few quantitative studies have been conducted on other features although quantitative studies on the N:C ratio have been reported. Therefore, this study quantitatively analysed important cytomorphological features in distinguishing benign reactive cells from HGUC cells. METHODS We analysed 2866 cells from the urine of 52 patients. A digital image analyser was used to quantitatively measure the nuclear area, cell area, N:C ratio, and nuclear roundness for HGUC cells and benign reactive cells. Additionally, the diagnostic value of quantitative cytomorphological criteria in HGUC cells was evaluated by the receiver operating characteristic curve. RESULTS The area under the curve for the prediction of HGUC cells for all cells and the top five cells was in the following order: nuclear area (0.920 and 0.992, respectively), N:C ratio (0.849 and 0.977), cell area (0.781 and 0.920), and nuclear roundness (0.624 and 0.605). The best cutoff value of the N:C ratio to differentiate HGUC cells from benign reactive cells was 0.438, and using the N:C ratio of 0.702, the positive predictive value obtained was 100%. CONCLUSIONS Our study indicated that nuclear area is a more important cytomorphological criterion than the N:C ratio for HGUC cell detection. Moreover, extracted data of the top five cells were more valuable than the data of all cells, which can be helpful in the routine practice and future criteria definition in urine cytology.
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Affiliation(s)
- Kazuma Sakumo
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kenta Morihashi
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Takuhisa Nukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Muneo Nakamura
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Kita-gun, Kagawa, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kamoshida
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
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Torous VF, Mito JK, VanderLaan PA. Leveraging thoughtful quality metric selection for individual and system improvements: the atypical category and use of dashboards. J Am Soc Cytopathol 2023; 12:3-9. [PMID: 36336566 DOI: 10.1016/j.jasc.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/31/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
Quality management is integral to the practice of cytopathology, especially given the heavily manual workflows and expanding ancillary testing requirements inherent to the cytopathology laboratory. Monitoring quality data like turnaround time, specimen unsatisfactory rates, and diagnostic category utilization rates allows for better understanding of performance with opportunities for targeted improvement if there are variations from that which is expected. However, there are costs to quality monitoring including the time and resources needed, and, in already taxed systems, quality management risks being viewed as just another box to check. While there are mandated quality metrics that must be collected by cytology laboratories, thoughtful selection of key performance indicators can be of tremendous benefit in helping to better understand complex laboratory processes and directing improvement endeavors where needed. The following short communication is a discussion on quality management in the cytopathology laboratory from 3 Cytopathology Quality Management Directors. The discussion focuses on monitoring the atypical reporting category with an emphasis on how trending and visualizing quality metrics can provide laboratories with key data.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Yuan L, Gero M, Zia S, Aryal SC, Shetty S, Reynolds JP. Cyto-histo correlation and false-negative urine: Before and after the Paris system for reporting urinary cytology. Diagn Cytopathol 2022; 50:404-410. [PMID: 35652594 DOI: 10.1002/dc.24982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of implementing the Paris system (TPS) on the rate of discrepant cases in the negative for high-grade urothelial carcinoma (NHGUC) category that had a subsequent diagnosis of high-grade urothelial carcinoma (HGUC) on histology is not well studied. METHODS We adopted TPS in May 2019. We searched discrepant cases with negative urine cytology 2017-2019 in our cyto-histo correlation database. The urine cytology and follow-up biopsy/resection were reviewed by a cytopathologist who also did Genitourinary (GU) Pathology subspecialty sign-out. Voided urine and instrumented urine were included in this study. RESULTS There were total of 70 discrepant cases with negative cytology interpretation but HGUC on the subsequent biopsy or resected specimen. Following the TPS criteria, the rate of discrepant negative cytology cases increased from 6 cases between January 2017 and May 2019 to 64 cases after May 2019 when we adopted TPS. There were 2 discrepant negative cases in 2017, 3 cases in 2018, and 65 cases in 2019. Out of 65 cases in 2019, 64 cases were identified after May 2019. Additional 55 urine cytology slides were reviewed according to the TPS criteria, of which, the diagnoses remained unchanged in 45 (82%) cases and 10 (19%) cases were reassigned to either atypical or suspicious categories. The discrepancy was noted more on the instrumented urine and the upper tract urine. However, the false-negative rate rose faster in voided urine and lower tract urine. The risk of HGUC with the category of NHGUC was 0.03% in 2017, 0.05% in 2018, and 1.06% in 2019 at our institution. The increase in false-negative rate could not be attributed to a single cytopathologist. CONCLUSION After adopting TPS for reporting urine cytology, there was an increase in HGUC from negative urine cytology which was subsequently confirmed on histology as cases of HGUC. The quality control of negative urines could be important monitoring the process when implementing TPS.
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Affiliation(s)
- Lisi Yuan
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Margaret Gero
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shereen Zia
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameer Chhetri Aryal
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sindhu Shetty
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jordan P Reynolds
- RJ Tomsich Pathology & Lab Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Allison DB, Zhang ML, Vohra P, VandenBussche CJ. The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens. Diagnostics (Basel) 2022; 12:diagnostics12040931. [PMID: 35453979 PMCID: PMC9025489 DOI: 10.3390/diagnostics12040931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Since the release of The Paris System for Reporting Urinary Cytology (TPS), the assessment of urine cytology specimens has primarily focused on the detection of high-grade urothelial carcinoma (HGUC) and carcinoma in situ (CIS). Fortunately, the malignant cells in these lesions tend to be loosely cohesive, resulting in the natural exfoliation of individual malignant cells into the urine. However, HGUC/CIS lesions occasionally exfoliate larger fragments which can be difficult to assess due to cellular overlap and fragment three-dimensionality. Furthermore, reactive benign urothelial fragments and fragments from low-grade urothelial neoplasms (LGUN) may also be seen in urine specimens and contain atypical cytomorphologic features. As a result, the significance of urothelial tissue fragments (UTFs) is often unclear. Herein, we discuss the literature on UTFs before and after the implementation of TPS, as well as strategies to help overcome this diagnostic challenge.
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Affiliation(s)
- Derek B. Allison
- Department of Pathology and Laboratory Medicine, Lexington, KY 40536, USA;
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536, USA
| | - M. Lisa Zhang
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Poonam Vohra
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Christopher J. VandenBussche
- Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence: ; Tel.: +1-410-955-1180
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Ulldemolins Aznar P, Muñoz Vicente E, Roselló-Sastre E. [How has the Paris System contributed to urine cytology? Evaluating the contribution of the Paris System to urine cytology. A comparative study of the Paris System and the Papanicolaou method in a tertiary centre]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55:125-134. [PMID: 35483768 DOI: 10.1016/j.patol.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES The Paris System (PS) has replaced the classical Papanicolaou System (PapS) in reporting urine cytology, due to its improved sensitivity and negative predictive value (NPV) without loss of specificity. Furthermore, it has enabled the risk of malignancy to be established in each cytological category. The aim of this study is to compare the Paris System with previous results and determine the changes in sensitivity, specificity, positive predictive value, NPV and risk of malignancy in our centre, MATERIALS AND METHODS: Evaluation of the diagnostic power of urine cytology by means of a retrospective cohort study, comparing two series of 400 cytological studies, one using the Papanicolaou System and the other the Paris System. RESULTS In the detection of high-grade urothelial carcinoma, Paris System has better specificity (93.82% PapS vs 98.64% PS; P=.001) and PPV (39.5% PapS vs 70.6% PS; P=.044) than Papanicolaou System, without changes in sensitivity (53.5% PapS vs 37.5% PS; P=.299) or NPV (96.4% PapS vs 94.8% PS; P=.183). The risk of malignancy for the atypical category increases from low to high levels (1.6% PapS vs 40.0% PS; P=.001); the other categories showed no significant statistical changes. CONCLUSION The Paris System improves specificity and positive predictive value and establishes a better indication of risk of malignancy for each category, enabling specific clinical management in each case.
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Affiliation(s)
| | - Elia Muñoz Vicente
- Servicio de Anatomía Patológica, Hospital General Universitari de Castellón, Castellón de la Plana, Castellón, España
| | - Esther Roselló-Sastre
- Servicio de Anatomía Patológica, Hospital General Universitari de Castellón, Castellón de la Plana, Castellón, España.
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Nikas IP, Seide S, Proctor T, Kleinaki Z, Kleinaki M, Reynolds JP. The Paris System for Reporting Urinary Cytology: A Meta-Analysis. J Pers Med 2022; 12:jpm12020170. [PMID: 35207658 PMCID: PMC8874476 DOI: 10.3390/jpm12020170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 01/06/2023] Open
Abstract
The Paris System (TPS) for Reporting Urinary Cytology is a standardized, evidence-based reporting system, comprising seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other malignancies. This study aimed to calculate the pooled risk of high-grade malignancy (ROHM) of each category and demonstrate the diagnostic accuracy of urine cytology reported with TPS. Four databases (PubMed, Embase, Scopus, Web of Science) were searched. Specific inclusion and exclusion criteria were applied, while data were extracted and analyzed both qualitatively and quantitatively. The pooled ROHM was 17.70% for the nondiagnostic category (95% CI, 0.0650; 0.3997), 13.04% for the NHGUC (95% CI, 0.0932; 0.1796), 38.65% for the AUC (95% CI, 0.3042; 0.4759), 12.45% for the LGUN (95% CI, 0.0431; 0.3101), 76.89 for the SHGUC (95% CI, 0.7063; 0.8216), and 91.79% for the HGUC and other malignancies (95% CI, 0.8722; 0.9482). A summary ROC curve was created and the Area Under the Curve (AUC) was 0.849, while the pooled sensitivity was 0.669 (95% CI, 0.589; 0.741) and false-positive rate was 0.101 (95% CI, 0.063; 0.158). In addition, the pooled DOR of the included studies was 21.258 (95% CI, 14.336; 31.522). TPS assigns each sample into a diagnostic category linked with a specific ROHM, guiding clinical management.
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Affiliation(s)
- Ilias P. Nikas
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Correspondence:
| | - Svenja Seide
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Tanja Proctor
- Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany; (S.S.); (T.P.)
| | - Zoi Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
- Internal Medicine Department, General Hospital of Nikea, 18454 Athens, Greece
| | - Maria Kleinaki
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus; (Z.K.); (M.K.)
| | - Jordan P. Reynolds
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32256, USA;
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Rohra P, Ocampo Gonzalez FA, Yan L, Mir F, Furlan K, Basu S, Barua A, Cheng L, Park JW. Effect of the Paris system for reporting urinary cytology with histologic follow-up. Diagn Cytopathol 2021; 49:691-699. [PMID: 33600080 DOI: 10.1002/dc.24723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Paris system (TPS) for Reporting Urinary Cytology provides a standardized reporting system whose main focus is the diagnosis of high-grade urothelial carcinoma (HGUC). We conducted a study to see the impact of The Paris System on our cytologic diagnoses with associated histology. MATERIALS AND METHODS We reviewed our pathology database regarding urinary specimens in the year before implementation of The Paris System and the year after. We gathered the data regarding cytologic diagnosis and concurrent/subsequent histology. RESULTS Over a 1-year period from 2016-2017, 486 urine cytology specimens were identified before implementation of The Paris System and diagnosed as follows: 83% benign/negative, 10% atypical, 2% suspicious, 5% HGUC, 0.2% low grade urothelial neoplasm (LGUN), and 0.2% unsatisfactory. Over a next 1-year period from 2017 to 2018, 602 specimens used TPS and diagnosed as follows: 85% negative for HGUC, 6% atypical, 3% suspicious, 4% HGUC, 0.17% LGUN, and 2% unsatisfactory. Although, not listed as a standardized category in The Paris System, our institution used "Negative for high-grade, cannot rule out low-grade urothelial neoplasm (NHL)" as a subcategory of Negative for HGUC. 4% of the cases fell into this category. Focusing on the Atypical category before TPS, histology was available in 15/49 (31%) cases. Of these, 40% had HGUC. Regarding the Atypical category after TPS, histology was available in 21/36 (58%) cases. Of these, 52% were HGUC. For the NHL category, concurrent histology was available in 13/26 (50%) cases. Of these, 67% were low grade urothelial neoplasms. CONCLUSION Our study showed that TPS lowered the rate of Atypical from 10% to 6%. After the implementation of TPS, Atypical corresponded to a higher rate of high-grade urothelial carcinoma. Also, the NHL subcategory had a high positive predictive value for diagnosing low grade urothelial neoplasms.
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Affiliation(s)
- Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Sanjib Basu
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Animesh Barua
- Departments of Cell and Molecular Medicine, Pathology and OB/GYN, Rush University Medical Center, Chicago, Illinois, USA
| | - Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ji-Weon Park
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Compton ML, Weiss VL, Barkan GA, Ely KA. Targeted education as a method for reinforcing Paris System criteria and reducing urine cytology atypia rates. J Am Soc Cytopathol 2021; 10:9-13. [PMID: 32771394 PMCID: PMC10030068 DOI: 10.1016/j.jasc.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Paris System for Urine Cytology (TPS) provides well-defined diagnostic criteria for the category of atypical urothelial cells (AUC). The current study compares the rate of AUC diagnoses at a large academic medical center before and after an educational intervention (EI) by a urine cytology expert. MATERIALS AND METHODS An expert in TPS delivered an educational intervention consisting of an interactive microscope session and a didactic session that focused on the AUC diagnostic category. The number of urine cytology cases, the AUC rate, and the false-negative percentage were calculated before and after the EI, using the electronic medical records and cytologic-histologic correlation records. RESULTS A total of 4026 urine cytology cases were signed out in the 25 months prior to the educational intervention and 1585 cases were signed out in the 10 months after the intervention. EI had a significant impact on diagnostic categorization, including a reduction in AUC (19.6% versus 12.5%) and suspicious for high-grade urothelial carcinoma (3.9% versus 3.1%) diagnoses. The cytotechnologists also placed fewer cases into the AUC category during primary screening (27.6% versus 23.0%). Although a higher percentage of cases was reported as negative for high-grade urothelial carcinoma, the false-negative rate did not significantly change after the intervention (1.8% versus 2.0% of negative cases, P = 0.65). CONCLUSIONS Focused educational sessions for pathologists and cytotechnologists on the diagnostic criteria for AUC as defined by TPS can significantly reduce the rate of atypical diagnoses without a significant increase in the rate of false negatives.
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Affiliation(s)
- Margaret L Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Güliz A Barkan
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Kim A Ely
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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Danakas A, Sweeney M, Cheris S, Agrawal T. Urinary tract cytology: a cytologic-histopathologic correlation with The Paris System, an institutional study. J Am Soc Cytopathol 2020; 10:56-63. [PMID: 33132054 DOI: 10.1016/j.jasc.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Urothelial carcinoma (UC) requires lifelong monitoring, commonly through urinary cytology and cystoscopy. Urine cytology has a relatively high sensitivity for detecting high-grade urothelial carcinoma (HGUC); however, its sensitivity for low-grade urothelial neoplasm (LGUN) is significantly lower with wide interobserver variability. The Paris System (TPS) was proposed to create standardized diagnostic categories with defined cytomorphologic criteria. We attempt to evaluate diagnostic efficacy of identifying UC using TPS through cytologic-histologic correlation. MATERIALS AND METHODS A retrospective search identified 170 cases of urine cytology cases with concurrent biopsies collected during a 2-year time period at University of Rochester Medical Center. Patient age, sex, smoking history, prior malignancy diagnoses, cystoscopy findings, specimen collection method, UroVysion results, and 1-year follow-up of surgical pathology cases were included. RESULTS Cytologic-histologic correlation was identified in 59% of cases, with 18% true positives and 41% true negatives. Discordant results were identified in 41% of cases; of these, 4% were false positives, 11% false negatives, 12% potential sampling bias, and 14% were low-grade urothelial carcinoma (LGUC). The analysis of this 2-year study finds a positive predictive value of urine cytology for HGUC to be 81%, a negative predictive value of 79%, a sensitivity of 61%, a specificity of 91%, and an accuracy of 79%. CONCLUSIONS Our results support TPS's ability to improve the reliability and accuracy of interpretations in urine cytology for HGUC. Nevertheless, additional studies are essential to improve the diagnostic accuracy of LGUN, and urine adequacy, in order to improve patient care and early detection, while identifying potential sampling bias.
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Affiliation(s)
- Alexandra Danakas
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Melissa Sweeney
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Sachica Cheris
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York
| | - Tanupriya Agrawal
- Department of Pathology, University of Rochester Medical Center (URMC), Rochester, New York.
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12
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Pastorello RG, Barkan GA, Saieg M. Experience on the use of The Paris System for Reporting Urinary Cytopathology: review of the published literature. J Am Soc Cytopathol 2020; 10:79-87. [PMID: 33160893 DOI: 10.1016/j.jasc.2020.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (TPS) was first published in 2016 with clear objectives to standardize cytologic diagnostic criteria and provide uniform reporting, in order to improve patient stratification and associated clinical management. The aim of this paper is to evaluate the performance of TPS and review the literature published since TPS was introduced. MATERIALS AND METHODS Original articles focusing on the utilization and performance of TPS in urinary cytology specimens were identified using PubMed for publications from January 2016 to July 2020, using the keywords "Paris System", "urine cytology", and "urinary cytology". RESULTS Twenty-three relevant articles in the literature regarding the use of TPS were included in the review from a total of 30,802 urine cytology specimens, of which 21,485 (69.8%) had available diagnoses. Distribution of cases among categories ranged from 50.5% to 95.3% for negative for high-grade urothelial carcinoma (NHGUC), 1.2% to 23% for atypical urothelial cells (AUC), 0.2% to 6.6% for suspicious for high-grade urothelial carcinomas (SHGUC), and 2.2% to 14.1% for high-grade urothelial carcinomas (HGUC). The calculated risk of high-grade malignancy (ROHM) ranged from 8.7% to 36.8% for NHGUC, 12.3% to 60.9%% for AUC, 33.3% to 100% for SHGUC, and 58.8% to 100% for HGUC. Mean ROHM weighted by sample size was calculated at 15.7% (±7.8%), 38.5% (±14.3%), 76.2% (±17.2%), and 88.8% (±12.7%) for NHGUC, AUC, SHGUC, and HGUC, respectively. Reported sensitivity of TPS ranged from 40% to 84.7%, specificity from 73% to 100%, PPV from 62.3% to 100%, and NPV from 46% to 90%. CONCLUSIONS The application of TPS in the selected series has improved the screening and surveillance potential of urine cytology, while reducing high rates of indeterminate diagnoses, improving sensitivity and providing proper risk stratification for patients.
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Affiliation(s)
- Ricardo G Pastorello
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Healthcare System, Maywood, Illinois; Department of Urology, Loyola University Healthcare System, Maywood, Illinois
| | - Mauro Saieg
- Department of Pathology, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Pathology, Santa Casa Medical School, São Paulo, Brazil.
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McIntire PJ, Elsoukkary SS, Robinson BD, Siddiqui MT. High-grade urothelial carcinoma in urine cytology: different spaces - different faces, highlighting morphologic variance. J Am Soc Cytopathol 2020; 10:36-40. [PMID: 32958411 DOI: 10.1016/j.jasc.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Paris System for Reporting Urinary Cytology (TPS) was first published in 2016 to standardize reporting and placed a specific emphasis on high-grade urothelial carcinoma (HGUC). The urinary tract is anatomically divided into the upper tract (UT) and the lower tract (LT). A major morphologic criterion in TPS for HGUC defines the nuclear-to-cytoplasmic (N/C) ratio as ≥ 0.7. In this study, we evaluated N/C ratios of HGUC arising from UT and LT urine specimens, to ascertain differences due to location. MATERIALS AND METHODS Digital annotations of whole slide scanned images were performed and enumerated. RESULTS The cohort consisted of 59 ThinPrep specimens from 52 patients. The majority of the tumors were located in LT (39 of 59, 66.1%). A total of 590 cells were analyzed (10 cells per case). In UT, the average N/C was 0.58 and LT the average was 0.54 (P < 0.001). The average nuclear area for UT was 126.3 and for LT was 158.2 μm2 (P = 0.01). The average cytoplasmic area for UT was 219.1 μm2 and for LT was 296.2 μm2 (P < 0.001). The average cellular circumference for UT was 59.4 μm and for LT was 66.1 μm (P < 0.001). CONCLUSIONS We found that UT HGUCs have higher N/C ratios, smaller cell circumference, smaller nuclei, and less cytoplasm compared with LT. When UT was divided into renal pelvis and ureter, no statistical difference was identified.
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Affiliation(s)
- Patrick J McIntire
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, New York, New York.
| | - Sarah S Elsoukkary
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, New York, New York
| | - Brian D Robinson
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, New York, New York
| | - Momin T Siddiqui
- New York-Presbyterian Hospital/Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, New York, New York
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14
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Sahai R, Rajkumar B, Joshi P, Singh A, Kumar A, Durgapal P, Gupta A, Kishore S, Chowdhury N. Interobserver reproducibility of The Paris System of Reporting Urine Cytology on cytocentrifuged samples. Diagn Cytopathol 2020; 48:979-985. [PMID: 32543091 DOI: 10.1002/dc.24476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/05/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Paris System of Reporting Urine Cytology aims to screen samples for HGUC and to provide a universally acceptable reporting format for urine cytology specimens. However, studies detailing the reproducibility of this system, especially on cyto-centrifuge preparations, are lacking. METHODS 149 voided urine samples received in Department of Pathology were reviewed independently by five cytopathologists. To estimate the overall agreement, Gwet's AC and AC1statistics between each pair of raters were used. To measure the random error component, polychoric correlations were used. To assess the systematic error, Friedman test was used. RESULTS There was moderately good inter-rater agreement between the raters. Gwets AC2 ranged between 0.67 and 0.89 for the classification of the cases once the sample was found adequate for assessment, while the Gwet's AC1 ranged between 0.61 and 0.94 in assessing for adequacy. There were significant systematic differences between raters in their thresholds for the different categories as well as in differentiating between an adequate and inadequate sample (P value by Friedman test <.001). The association between pathologists was moderately high (polychoric correlations ranging from 0.67 to 0.93). In the majority (108 of 149, 72.5%) of the cases, the range of differences between raters were of one category or less, suggesting satisfactory agreement, but having large disagreements in minority. CONCLUSION The interobserver reproducibility for the Paris System is moderately good, and is suitable for adoption. It is limited by the lack of agreement as to what constitutes an adequate specimen and differing threshold for categorizing the lesions in differing groups.
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Affiliation(s)
- Rishabh Sahai
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bindu Rajkumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prashant Joshi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashok Singh
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arvind Kumar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prashant Durgapal
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Arvind Gupta
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sanjeev Kishore
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nilotpal Chowdhury
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Vosoughi A, Ordobazari A, Lora Gonzalez MA, Guido LP, Skiba M, Campuzano-Zuluaga G, Kryvenko ON, Gomez-Fernandez C, Garcia-Buitrago M, Jorda M. The Paris System "atypical urothelial cells" category: can the current criteria be improved? J Am Soc Cytopathol 2020; 10:3-8. [PMID: 32732113 DOI: 10.1016/j.jasc.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The Paris System (TPS) for reporting urine cytology was developed for standardization of diagnosis focusing on the detection of high-grade urothelial carcinoma (HGUC). Probably the most challenging task for TPS is to provide criteria for the atypical urothelial cell (AUC) category. The TPS criteria for AUC include increased nuclear/cytoplasmic (N/C) ratio (>0.5) and 1 of the 3 minor criteria including nuclear hyperchromasia (NH), coarse chromatin (CC) and irregular nuclear membrane (INM). We evaluated TPS-AUC diagnostic value and investigated whether other morphologic parameters can improve its criteria. MATERIALS AND METHODS Urine samples with diagnoses of AUC collected during a 6-month period were re-reviewed. Data captured included N/C ratio >0.5, NH, CC, INM, and 2 additional criteria including enlarged nuclear size (ENS) and the presence of nucleolus (N). ENS was considered when the nucleus was 2 times larger than the urothelial cell or 3 times larger than lymphocyte. RESULTS By applying the TPS-AUC criteria, the rate of atypia diagnosis reduced in comparison to Pre-TPS (9% versus 13%, P = 0.02). Among the AUC minor criteria, NH was the best criterion with the highest interobserver agreement (IOA) and correlation with HGUC (k = 0.342, r = 0.61, P < 0.001) and strong PPV (93.6%). ENS had the highest PPV (95.8%) and, after NH, had the highest IOA and correlation with HGUC (k = 0.29, r = 0.52, P < 0.001). CONCLUSION TPS improves the diagnostic value of urine cytology, particularly in cases with atypia. ENS is a strong criterion for increasing the diagnostic value of AUC and potentially can improve TPS performance as a minor criterion.
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Affiliation(s)
- Aram Vosoughi
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Atousa Ordobazari
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Manuel A Lora Gonzalez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Luiz Paulo Guido
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Magdalena Skiba
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - German Campuzano-Zuluaga
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Monica Garcia-Buitrago
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida; Department of Urology, University of Miami Miller School of Medicine, Miami, Florida; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
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16
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Ma C, Zhang L. Comparison of urine cytology diagnostic reports before and after the implementation of the Paris System classification system in China. Cytopathology 2020; 31:457-462. [PMID: 32246545 DOI: 10.1111/cyt.12827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 03/07/2020] [Accepted: 03/22/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In 2013, The Paris System for Reporting Urinary Cytology (TPS) was developed as a uniform practical urine cytology system that could be applied worldwide. Here, we investigated the effectiveness of TPS diagnostic approach compared with that of the traditional urine cytological diagnosis method used in China. METHODS Based on the diagnostic criteria of TPS, 412 urine samples from 143 patients with histological follow-up data were retrospectively analysed, and the diagnoses were compared with the original cytological diagnoses. RESULTS In total, 110 patients were histologically diagnosed with high-grade urothelial carcinoma (HGUC), and 33 patients were diagnosed with low-grade urothelial neoplasia. Based on the traditional urine cytological analysis method, 50 patients (34.9%) were diagnosed as negative, 48 patients (33.6%) were diagnosed as having atypical urothelial cells, and 45 patients (31.5%) were diagnosed as positive. After reclassification using TPS, urine samples from 11 cases (7.7%) were categorised as unsatisfactory, 34 cases (23.8%) were negative, 21 cases (14.7%) were categorised as having atypical urothelial cells, 12 cases (8.4%) were diagnosed as suspicious for HGUC, 59 cases (41.2%) were diagnosed with HGUC, and six cases (4.2%) were reclassified as having low-grade urothelial neoplasia. Thus, after implementing TPS criteria, the sensitivity for positive malignancy diagnoses (HGUC alone) increased from 38.2% to 50.9%, while the specificity of the diagnosis was barely changed. CONCLUSIONS The Paris System for Reporting Urinary Cytology greatly contributes to the standardisation of urine cytology reports and significantly improves the diagnostic sensitivity for HGUC.
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Affiliation(s)
- Cao Ma
- Department of Pathology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Lihua Zhang
- Department of Pathology, School of Medicine, Zhongda Hospital, Southeast University, Nanjing, China
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Paula R, Oliveira A, Nunes W, Bovolim G, Domingos T, De Brot L, Bezerra S, Cunha I, Morini M, Saieg M. Two‐year study on the application of the Paris system for urinary cytology in a cancer centre. Cytopathology 2019; 31:41-46. [DOI: 10.1111/cyt.12780] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/26/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Rafaela Paula
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Andrea Oliveira
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Warley Nunes
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Graziele Bovolim
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Tabata Domingos
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | - Louise De Brot
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
| | | | - Isabela Cunha
- Department of PathologyRede D'OR‐ São Luiz São Paulo Brazil
| | - Mariane Morini
- Department of PathologyRede D'OR‐ São Luiz São Paulo Brazil
| | - Mauro Saieg
- Department of PathologyAC Camargo Cancer Center São Paulo Brazil
- Department of PathologySanta Casa Medical School São Paulo Brazil
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Vlajnic T, Gut A, Savic S, Bubendorf L. The Paris System for reporting urinary cytology in daily practice with emphasis on ancillary testing by multiprobe FISH. J Clin Pathol 2019; 73:90-95. [DOI: 10.1136/jclinpath-2019-206109] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022]
Abstract
AimsThe Paris System (TPS) was introduced in the diagnostic routine with the goal to simplify and standardise diagnostic reporting of urinary cytology. The diagnostic categories of TPS are based on defined cytological criteria, with a focus on high-grade urothelial carcinoma (HGUC). While the categories ‘negative for HGUC (NHGUC)’ and ‘HGUC’ are straightforward, the categories ‘atypical urothelial cells (AUC)’ and ‘suspicious of HGUC (SHGUC)’ remain inconclusive. In this study, we evaluated the feasibility of TPS in daily practice with special emphasis on ancillary fluorescence in situ hybridisation (FISH) testing in the setting of TPS categories.MethodsIn a 19-month period, TPS was prospectively applied in the routine diagnostic setting on 3900 urinary cytology cases comprising bladder and upper urinary tract washings and voided urine specimens. Additionally, we analysed the results of the FISH assay UroVysion prospectively performed on a cohort of 128 cases enriched for AUC and SHGUC categories.ResultsThe most frequently reported category was NHGUC (n=3496, 89.7%), followed by AUC (n=178, 4.6%), HGUC (n=155, 4%), SHGUC (n=61, 1.6%), low-grade urothelial neoplasia (n=6, 0.1%) and other malignancies (n=4, 0.1%). In the FISH cohort, 40/90 (44%) cases within the AUC category were FISH positive, consistent with urothelial neoplasia. In the SHGUC category, 16/21 (76%) cases were FISH positive.ConclusionsWhen prospectively applying TPS in urinary cytology, inconclusive atypia accounts only for a small subset of cases. FISH additionally improves the stratification between reactive and malignant cells in the indeterminate AUC and SHGUC categories.
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Glass R, Rosca O, Raab S, Szabelska J, Chau K, Sheikh‐Fayyaz S, Cocker R. Applying the Paris system for reporting urine cytology to challenging cytology cases. Diagn Cytopathol 2019; 47:675-681. [DOI: 10.1002/dc.24166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 02/15/2019] [Accepted: 02/22/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Ryan Glass
- Department of PathologyStaten Island University Hospital Staten Island New York
| | - Oana Rosca
- Department of PathologyStaten Island University Hospital Staten Island New York
| | - Stephen Raab
- Department of PathologyUniversity of Mississippi Jackson Mississippi
| | | | - Karen Chau
- Department of PathologyNorthwell Health Lake Success New York
| | | | - Rubina Cocker
- Department of PathologyNorthwell Health Lake Success New York
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