Cyto-histo correlations of plasmacytoid and micropapillary variants of high-grade urothelial carcinoma: do they fit well in The Paris System for reporting urinary cytology?

Suo, Liye; Vega, Ivonne; Thrall, Michael J.

doi:10.1016/j.jasc.2020.05.013

Cited by 11 publications

(6 citation statements)

References 18 publications

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“…As for the method of processing, Cowan et al 37 believe that there could be cytomorphologic variation between the conventional and LBC techniques, while Richardson et al 38 found no such variation, at least in the HGUC and SHGUC categories. The morphologic challenges encountered with variants of urothelial carcinoma, such as hypochromatic HGUC, plasmacytoid, and micropapillary urothelial carcinomas, have also been emphasized by some authors 39,40 …”

Section: Discussionmentioning

confidence: 99%

A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update

Kannan,

Gochhait,

Ramanitharan

et al. 2024

Diagnostic Cytopathology

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IntroductionOwing 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).AimTo assess and compare the cyto‐histopathologic/cystoscopic agreement between the conventional and the Paris systems (CS and TPS) for reporting urine cytology.Materials and MethodsIt 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.ResultsThe 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.ConclusionTPS 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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Section: Discussionmentioning

confidence: 99%

A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update

Kannan,

Gochhait,

Ramanitharan

et al. 2024

Diagnostic Cytopathology

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“…This finding has a great clinical significance, as before the implementation of TPS, many urologists were regarding atypical cases as negative [6]. However, to enhance its sensitivity, some points for future TPS improvement have been pointed out, including the description of the hypochromatic HGUC [52], low-n/c-ratio HGUC [53], and plasmacytoid and micropapillary HGUC variants [54], besides the redefining the diagnostic criteria for the upper urinary tract, as the current ones miss a few positive cases [53,55].…”

Section: Discussionmentioning

confidence: 99%

The Paris System for Reporting Urinary Cytology: A Meta-Analysis

Nikas

Seide

Proctor

et al. 2022

JPM

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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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“…44,45 In UTC, there are only a few reports of cases described as showing micropapillary features. [46][47][48][49] However, these features are very subtle in urine specimens, most notably lacking the easiest-to-recognize feature, which is the presence of lacunar retraction seen in tissue samples. In UTC, tumour cells are typically in small three-dimensional clusters with no fibrovascular cores and with regular borders, showing minimal scalloping at the edges (Figure 4).…”

Section: Micropapillary Urothelial Carcinomamentioning

confidence: 99%

“…These studies describe large, discohesive cells with abundant dense and variably vacuolated cytoplasm and eccentrically placed large, round, and hyperchromatic nuclei with coarse chromatin and inconspicuous nucleoli (Figure 5). 46,47,49,62,63 Furthermore, a large study was performed reviewing UTC specimens in patients diagnosed with urothelial CIS with plasmacytoid features on biopsy. 64 In this study, similar cytomorphologic changes were seen in UTC as the invasive variant; however, most cases did not meet TPS criteria, largely because abundant cytoplasm, resulting in a low N:C ratio, is a characteristic feature of this variant.…”

Section: Plasmacytoid Urothelial Carcinomamentioning

confidence: 99%

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Urinary tract cytology showing variant morphology and divergent differentiation

Arshia,

Hassan,

Hensley

et al. 2023

Cytopathology

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Urothelial carcinoma represents a diverse group of tumours with distinct histologic subtypes, each exhibiting unique cytomorphologic features, architectural growth patterns, and/or well‐developed aberrant differentiation. In fact, there are more than 13 subtypes of urothelial carcinoma recognized in the 2022 WHO classification of tumours in the urinary tract. The identification of these subtypes is crucial for an accurate diagnosis of urothelial carcinoma, and many have important clinical implications. Variant/divergent features may coexist with conventional high‐grade urothelial carcinoma (HGUC) or present with 100% variant morphology. In urinary tract cytology (UTC), urothelial carcinoma can display divergent differentiation, such as squamous, glandular, or small cell carcinoma differentiation. The use of cell block preparations and immunohistochemistry with available residual urine can enhance diagnostic accuracy. On the other hand, identifying urothelial carcinoma variants, including nested, micropapillary, and plasmacytoid subtypes, poses significant challenges in UTC. Many cases of these variants are only detected retrospectively after variant histology has been established from resection specimens. Moreover, some variants exhibit features inconsistent with the diagnostic criteria for HGUC according to the Paris System for Reporting Urinary Tract Cytology. Nevertheless, the rarity of pure variant morphology and the occurrence of some false negatives for these variant cases are essential to maintain the specificity of UTC overall. This review covers the histology, cytomorphology, and important clinical aspects observed in urothelial carcinoma exhibiting divergent differentiation and various urothelial carcinoma variants detected in UTC.

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Cyto-histo correlations of plasmacytoid and micropapillary variants of high-grade urothelial carcinoma: do they fit well in The Paris System for reporting urinary cytology?

Cited by 11 publications

References 18 publications

A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update

A comparison between conventional and the Paris systems of reporting urinary cytopathology with a literature update

The Paris System for Reporting Urinary Cytology: A Meta-Analysis

Urinary tract cytology showing variant morphology and divergent differentiation

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