Improved diagnostic precision of urine cytology by implementation of The Paris System and the use of cell blocks

Chan, Emily; Balassanian, Ronald; Tabatabai, Z. Laura; Lou, Hubing; Vohra, Poonam

doi:10.1002/cncy.22034

Cited by 32 publications

(41 citation statements)

References 21 publications

(36 reference statements)

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“…Accordingly, other cytological specimens such as thyroid fine needle aspiration and urine have indeed witnessed a drop in the atypical rate after the broad implementation of terminology systems, with improved overall test performance. [15][16][17] The most common primary site of malignancy in males with pleural effusion was the lung, in agreement with the most recent literature. 18,19 Among women, carcinomas of the breast were the most common epithelial neoplasm, also in accordance with previ- is also a useful marker for the distinction between epithelial and mesothelial lineage and together with Ber-EP4 may serve as a limited yet informative panel for the difficult question of cell origin.…”

Section: Discussionsupporting

confidence: 89%

“…Future studies adopting criteria developed by this international expert community are warranted to evaluate any impact. Accordingly, other cytological specimens such as thyroid fine needle aspiration and urine have indeed witnessed a drop in the atypical rate after the broad implementation of terminology systems, with improved overall test performance …”

Section: Discussionmentioning

confidence: 99%

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A 2‐year retrospective study on pleural effusions: A cancer centre experience

et al. 2019

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Background Cytopathological examination of pleural effusions is a fast and minimally invasive method for verification of the presence of neoplastic cells. We report our 2‐year experience using a categorised diagnostic system and reporting risks of malignancy (ROMs) for each defined category. Methods Cytological reports of patients between November 2016 and October 2018 were collected, with results primarily classified into a five‐tiered classification scheme. Immunohistochemistry markers used in cytology and their results were also recorded. Final agreement to histology and overall test performance was calculated for cases with available concomitant (up to 3 months) pleural biopsies. Results A total of 519 samples from 385 patients were collected, being 29 (5.6%) classified as non‐diagnostic, 291 (56%) as negative, 28 (5.4%) as atypical, 30 (5.8%) as suspicious and 141 (27.2%) as positive. Most requested markers were calretinin, TTF1, Ber‐EP4 and Gata‐3, being conclusive in 45 (76.3%) cases. Total cyto‐histological agreement was achieved in 49 (80.3%) specimens, with an overall sensitivity and specificity of 69.4% and 93.3%, respectively. Positive predictive value was 96.2% and negative predictive value was of 56%. ROM for each diagnostic category was 50% for non‐diagnostic, 44% for negative, 50% for atypical, 83.3% for suspicious and 96.2% for positive. Conclusions Our 2‐year retrospective study has shown a high specificity and positive predictive value for pleural cytology. The use of a five‐tiered system has also shown to be highly effective, with a concordantly progressive higher ROM for the assigned diagnostic categories.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A 2‐year retrospective study on pleural effusions: A cancer centre experience

et al. 2019

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“…Northrup et al also showed the rate of AUC reduced from 18.5% to 26.5% with TPS, where 47.4% of AUC cases were reclassified into NHGUC and 2.9% of them upgraded to SHGUC . Chan et al study also showed TPS criteria improves the value of an AUC diagnosis by lowering the AUC rate and increasing the positive predictive value of AUC diagnosis for high‐grade urothelial carcinoma. However, in the study of Granados et al, there was an increase in the AUC category .…”

Section: Discussionmentioning

confidence: 95%

“…8 So far, several studies have assessed the efficacy of TPS in urine cytology evaluations, in most of which TPS has been introduced as a reporting urine cytology template which has increased the detection rate of HGUC and reduced the rate of equivocal diagnoses. [9][10][11] In one study by Cowan et al, 40% of the cases with confusing diagnosis were reclassified into a higher risk category, while 25% of the cases with positive HGUC were categorized into a lower risk group using TPS criteria. 12 In another study, the frequency of AUC cases declined, and their rate was associated with a subsequent histological diagnosis of increased HGUC.…”

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confidence: 99%

Reclassification of urinary cytology regarding The Paris System for Reporting Urinary Cytology with cytohistological correlation demonstrates high sensitivity for high‐grade urothelial carcinoma

Anbardar

Monjazeb

2020

Diagnostic Cytopathology

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Background Recently, The Paris System for Reporting Urinary Cytology (TPS) has led to major changes in the approach to evaluate urine cytology and pattern of reporting. The aim of this study was to reclassify urine cytology reports with TPS in order to determine the frequency of abnormal results compared with the previous system; also, we performed cytohistological correlation in abnormal cytological results. Methods In this study, the voided urine specimens from the patients referred to Shiraz University of Medical Sciences affiliated laboratories were retrieved and analyzed using the laboratory's electronic records system; slides prepared from the samples were reviewed by single cytopathologist blindly according to the proposed criteria of TPS. Results Totally, 1842 urine cytology slides from 828 patients were blindly evaluated by TPS criteria and compared with routine urine cytology classification. Then, available cytohistological correlation was done on 99 abnormal urine cytological results from 58 patients. Among the 26 cytology slides with atypical urothelial cell (AUC) in the previous classification, eight (30.70%) slides were downgraded to negative results, and four (15.30%) were upgraded to higher groups. Therefore, through the reclassification of the slides with TPS, 46% of the AUC changed to other groups. Diagnostic accuracy of the TPS classified urine cytology was 78%, including 87.88% sensitivity, 27.27% specificity, 64.44% positive predictive value, and 60% negative predictive value. Conclusion The findings of the present study confirmed the importance and utility of TPS regarding the reclassification of AUC to other groups and its high sensitivity for detecting high‐grade urothelial carcinoma (HGUC).

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“…The most significant decreases in AUC rates were seen in institutions with previous high AUC rates. In addition, publications on adoption of the Paris system not only indicate a decrease in the rates of AUC, but also improvements in the specificity of AUC for the detection of HGUC 20 …”

Section: Strengthsmentioning

confidence: 99%

The Paris system of Reporting Urinary Cytology: Strengths and opportunities

Kurtycz

Sundling

Barkan

2020

Diagnostic Cytopathology

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The Paris system for reporting urinary cytopathology (TPS) was created to address inherent weaknesses inherent in the practice of urinary cytopathology. While urothelial cytology has always performed well at finding high grade, genetically unstable urothelial carcinoma, it performs poorly when it comes to detecting low‐grade urothelial neoplasia. TPS intends to improve the utility of urothelial cytology by focusing on what is important, high‐grade urothelial carcinoma. This article is a snapshot of the current state of TPS as it heads into its second edition. Successes are described and further developments are considered.

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Improved diagnostic precision of urine cytology by implementation of The Paris System and the use of cell blocks

Cited by 32 publications

References 21 publications

A 2‐year retrospective study on pleural effusions: A cancer centre experience

A 2‐year retrospective study on pleural effusions: A cancer centre experience

Reclassification of urinary cytology regarding The Paris System for Reporting Urinary Cytology with cytohistological correlation demonstrates high sensitivity for high‐grade urothelial carcinoma

The Paris system of Reporting Urinary Cytology: Strengths and opportunities

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