The Paris System for urine cytology in upper tract urothelial specimens: A comparative analysis with biopsy and surgical resection

Zheng, Xiaoli; Si, Qiusheng; Du, Dan; Harshan, Manju; Zhang, Z.; Haines, Kenneth; Shi, William Y.; Chhieng, David C.

doi:10.1111/cyt.12505

Cited by 40 publications

(37 citation statements)

References 24 publications

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“…After TPS implementation, the rate of HGUC increased from 7.3% to 13.0%, the sensitivity increased from 68% to 95%, the negative predictive value increased from 46% to 86%, and the diagnostic accuracy increased from 70% to 86% . Many other studies have reported better performance using TPS, with rare exceptions …”

Section: Discussionmentioning

confidence: 94%

“…Currently, many laboratories across the world are implementing TPS. To gauge the efficacy of TPS for diagnosing and reporting urinary cytological samples, numerous articles have retrospectively evaluated the performance of PD against prior methodology …”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have shown that TPS has improved the performance of urinary cytology specimens, with rare exceptions . To the best of our knowledge, the majority of these studies are limited to lower urinary tract carcinomas, and only a single study to date has demonstrated that reclassification with TPS improves performance in identifying upper tract urothelial carcinoma (UTUC) …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improved correlation of urinary cytology specimens using The Paris System in biopsy‐proven upper tract urothelial carcinomas

McIntire

Snow

Robinson

et al. 2018

Cancer Cytopathology

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improved correlation of urinary cytology specimens using The Paris System in biopsy‐proven upper tract urothelial carcinomas

McIntire

Snow

Robinson

et al. 2018

Cancer Cytopathology

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“…Application of TPS diagnostic criteria resulted in a slightly increased use of the suspicious diagnostic category (26% to 36%) with no significant change in the diagnostic rate of the atypical diagnostic category. Zheng et al, also evaluated the effect of utilizing TPS in 125 upper urinary tract urine cytology specimens from 74 patients who had subsequent biopsies or resections within 2 months of upper urinary tract urine collection. In this study, the diagnostic rates in this cohort for non‐diagnostic, negative for HGUC, atypical urothelial cells, low‐grade urothelial neoplasm, suspicious for HGUC, and positive for HGUC were 1.6%, 39.2%, 17.6%, 8.8%, 16.8%, and 16%, respectively.…”

Section: Discussionmentioning

confidence: 99%

The utility of upper urinary tract urine cytology before and after application of the Paris system

Simon

Skala

Magers

et al. 2018

Diagnostic Cytopathology

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Background The Paris System (TPS) introduced diagnostic criteria for urine cytology to improve reproducibility among pathologists. Thus far, most cytology studies have investigated application of TPS on lower urinary tract specimens. Also, it is unclear which cytologic features are most predictive of malignancy, particularly in the upper urinary tract. We evaluate concordance rates of preoperative upper urinary tract cytology specimens before and after application of TPS criteria with surgical resections and assess cytologic features associated with malignancy. Design 54 resections with high‐ and low‐grade urothelial carcinoma (HGUC, LGUC) from 2000‐2016 with available preoperative cytology (n = 61) were identified. Cytology was re‐reviewed to evaluate cytologic features and provide diagnoses before and after TPS implementation. Results The most common cytologic features associated with HGUC were N:C ratios ≥0.7 (88%), hyperchromasia (83%), coarse chromatin distribution (67%), and nuclear pleomorphism in cell clusters (65%). Application of TPS criteria resulted in 10 diagnostic downgrades and 6 diagnostic upgrades. After TPS criteria were applied, the sensitivity of a positive diagnosis decreased from 29% to 19%. The morphologic feature most consistently associated with a downgrade from positive to suspicious was a lack of marked nuclear contour irregularities in atypical urothelial cells. Conclusion Using strict TPS criteria in upper urinary tract cytology specimens may decrease the frequency of positive diagnoses with a concurrent increase in suspicious diagnoses. These findings may indicate that different morphologic features, particularly markedly irregular nuclear contours, may have different predictive values for HGUC in upper urinary tract cytology specimens compared with those from the lower urinary tract.

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“…This system primarily focuses on the detection of high‐grade urothelial carcinoma (HGUC) with a high sensitivity, followed by the detection of low‐grade urothelial neoplasm (LGUN) with a poor recognizing sensitivity . TPS further changes the uncharacteristic category into a reproducible and meaningful category, achieved by the inclusion of the cases having urothelial cells with nuclear atypia associated with HGUC, and exclusion of those with atypia associated with LGUN . 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 .…”

Section: Introductionmentioning

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 Paris System for urine cytology in upper tract urothelial specimens: A comparative analysis with biopsy and surgical resection

Cited by 40 publications

References 24 publications

Improved correlation of urinary cytology specimens using The Paris System in biopsy‐proven upper tract urothelial carcinomas

Improved correlation of urinary cytology specimens using The Paris System in biopsy‐proven upper tract urothelial carcinomas

The utility of upper urinary tract urine cytology before and after application of the Paris system

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

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