Risk of High-Grade Malignancy (ROHM)

Saieg, Mauro; Barkan, Güliz A.; Brimo, Fadi; Chandra, Ashish; Elsheikh, Tarik M.; Pastorello, Ricardo; Quek, Marcus L.; Rao, Jianyu; Siddiqui, Momin T.; Tabatabai, Z. Laura; VandenBussche, Christopher; Vielh, Philippe

doi:10.1007/978-3-030-88686-8_11

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Accordingly, the latest edition of The Paris System for Reporting Urinary Cytopathology already has addressed this issue, incorporating the term high-grade into the usual ROM reporting. 33 Categories now indicate the risk of high-grade malignancies instead of the ROM because the management for low-grade and high-grade lesions of the urinary tract differs, and the sensitivity of urinary cytology for the diagnosis of low-grade neoplasms is very low. In contrast, the WHO PB uses high-grade dysplasia or malignancy as the threshold, which correlates with high ROMs in the indeterminate categories (Table 1).…”

Section: Notementioning

confidence: 99%

“…Therefore, ideally, the ROM should also be supplemented by the risk of neoplasm and low‐risk versus high‐risk malignancy. Accordingly, the latest edition of The Paris System for Reporting Urinary Cytopathology already has addressed this issue, incorporating the term high‐grade into the usual ROM reporting 33 . Categories now indicate the risk of high‐grade malignancies instead of the ROM because the management for low‐grade and high‐grade lesions of the urinary tract differs, and the sensitivity of urinary cytology for the diagnosis of low‐grade neoplasms is very low.…”

Section: Introductionmentioning

confidence: 99%

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Risks of malignancy in the major nongynecologic cytopathology reporting systems: Critiques and discussions

Pusztaszeri,

Saieg,

Baloch

2024

Cancer Cytopathology

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The ever‐increasing popularity of standardized systems for reporting cytopathology has led in part to much attention to and importance of the risk stratification schemes, especially the risks of malignancy (ROMs), which are associated with the different diagnostic categories and upon which recommendations for clinical management are based. However, it is well known that the ROM calculations are based on retrospective reviews of the existing literature, representing a heterogeneous patient population, and are plagued by significant biases and variations. Statistically, the ROM represents the post‐test probability of malignancy, which changes with the test result and with the prevalence of malignancy (or pretest probability) in an individual practice setting and individual patient presentation. Therefore, the clinical utility of the ROM is questioned and likely needs a second look in the nongynecologic cytopathology reporting systems. In this communication, the authors discuss the status of the ROM estimates according to the most commonly used nongynecologic reporting systems, including for thyroid, salivary glands, and others, highlighting similarities and differences with a focus on the limitations of ROM estimates and their application in clinical practice.

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Section: Notementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risks of malignancy in the major nongynecologic cytopathology reporting systems: Critiques and discussions

Pusztaszeri,

Saieg,

Baloch

2024

Cancer Cytopathology

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“…Another concern associated with available ROM data lies on the wide range of estimates associated with each category, often rendering them insufficiently informative. For instance, the benign category of the World Health Organization reporting system for lung cytopathology on fine‐needle aspiration biopsy has an estimated ROM of 19% to 64% 17 and the high‐grade urothelial carcinoma category of TPS a 76% to 100% risk of high‐grade malignancy 12,13 . This may reflect (1) that data have often come from populations with different cancer prevalence, (2) a diversity in cytopathology practices and applied terminology, and (3) the nonsystematic approach to literature review taken by some systems when compiling their ROMs (systematic reviews are essential not only to synthesize, but also to analyze the quality of available evidence, allowing for the identification of estimates obtained in studies with higher methodological quality).…”

Section: Problems Of Rom Terminology and Estimates In Nongynecologica...mentioning

confidence: 99%

Challenging the concept of “risk of malignancy” in cytology

Nikas,

Souza da Silva,

Sousa‐Pinto

et al. 2023

Cancer Cytopathology

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Several standardized systems for nongynecological cytopathology have been published following the successful implementation of The Bethesda System for Reporting Cervical Cytology. Each of these systems comprises a set of reporting categories accompanied by a risk of malignancy. However, in most cases, these risk of malignancy estimates have not been based on high‐quality evidence and often may not be consider proper “risks” (because they have been estimated based on cross‐sectional studies). This commentary discusses the problems related to the data used to generate these risks. To make nongynecological cytopathology reporting more evidence‐based, large‐scale prospective cohort studies and randomized trials, in addition to high‐quality systematic reviews and meta‐analyses, should be performed.

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Is prostatic adenocarcinoma detectable by urine cytology—A multicenter retrospective review

Tang,

Li,

Leung

et al. 2024

The Prostate

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IntroductionUrine cytology is robust for the diagnosis of urothelial lesions, but data on the detection rates of prostatic adenocarcinoma in urine cytology is limited. In this study, a multicenter review was performed to define the clinical role of urine cytology in diagnosis of prostatic adenocarcinoma.MethodsCytologic diagnoses of lower tract urine cytology specimens with histology‐proven prostatic adenocarcinoma from three institutions, from a period of over two decades, were reviewed. Clinicopathological parameters—tumor grade, stage, histologic features, and preanalytical factors—prostate‐specific antigen (PSA) level and lesion size, were retrieved and compared with cytologic diagnoses.ResultsIn total, 2115 urine cytology specimens from 1119 patients were retrieved. The atypia (or above/C3+) and suspicious (or above/C4+) rates were 19.48% and 3.36%. Bilobar and extracapsular involvement, lymphovascular invasion, Gleason score, and International Society of Urological Pathology grade were associated with a positive urine diagnosis (p < 0.05). The atypia (C3+) and suspicious (C4+) rates of urine cytology in patients with a PSA level of ≤4.0 ng/mL was paradoxically higher (p < 0.01), but PSA levels correlated positively with urine diagnosis at higher cutoffs (>10, >20, >50, >100 ng/mL). All these factors remained significant on multivariate analysis (p < 0.05), including a negative correlation with low‐PSA (≤4.0 ng/mL, p = 0.001) and positive correlation with high‐PSA (>20 ng/mL, p = 0.020). Lesion size and multifocality were not associated with urine cytology diagnosis (p > 0.05).ConclusionUrine cytology showed low sensitivity in detection of prostatic adenocarcinoma. Detection rates were largely positively correlated with PSA levels but not for lesion size nor multifocality, limiting its clinical utility.

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Risk of High-Grade Malignancy (ROHM)

Cited by 3 publications

References 22 publications

Risks of malignancy in the major nongynecologic cytopathology reporting systems: Critiques and discussions

Risks of malignancy in the major nongynecologic cytopathology reporting systems: Critiques and discussions

Challenging the concept of “risk of malignancy” in cytology

Is prostatic adenocarcinoma detectable by urine cytology—A multicenter retrospective review

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