The Paris System for Urine Cytology in Upper Tract Urothelial Specimens: A Comparative Analysis with Biopsy and Surgical Resection

Zheng, Xiao-yong; Si, Qiusheng; Du, Diane; Harshan, Manju; Zhang, Zesong; Haines, G. Kenneth; Chhieng, David C.

doi:10.1016/j.jasc.2017.06.203

Cited by 16 publications

(39 citation statements)

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“…By emphasizing the identification of HGUC, multiple studies have demonstrated that TPS has increased the number of Cancer Cytopathology February 2019 "positive for HGUC" diagnoses and reduced the number of "AUC" diagnoses compared with the original diagnoses. [5][6][7][8][9][10][11] Guidelines for HGUC and SHGUC include an N:C ratio ≥0.7 and nuclear hyperchromasia, in addition to the presence of coarse chromatin and/or an irregular nuclear membrane. 3 HGUC diagnoses are applied when criteria are met in ≥10 cells per sample.…”

Section: Discussionmentioning

confidence: 99%

Digital image analysis supports a nuclear‐to‐cytoplasmic ratio cutoff value below 0.7 for positive for high‐grade urothelial carcinoma and suspicious for high‐grade urothelial carcinoma in urine cytology specimens

McIntire

Snow

Elsoukkary

et al. 2018

Cancer Cytopathology

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Background Urinary cytology is sensitive and specific for diagnosing and screening high‐grade urothelial carcinomas (HGUC). The Paris System (TPS) for urinary cytology was introduced in 2016 to standardize reporting. According to TPS diagnostic categories of HGUC and suspicious for HGUC (SHGUC), the average nuclear‐to‐cytoplasm (N:C) ratio of atypical cells should be ≥0.7. The objective of the current study was to measure the N:C ratio of urine cytology specimens with HGUC and SHGUC diagnoses and biopsy‐proven HGUC follow‐up. Methods A cohort of 64 cases (HGUC, 49 cases; SHGUC, 15 cases) from 57 patients was constructed. Urine cytology slides were scanned into whole‐slide digital images. The nuclear and cytoplasmic areas were enumerated by digital image analysis (DIA), and the N:C ratios were measured. Results In total, 640 cells were analyzed by DIA (HGUC, 490 cells; SHGUC, 150 cells). For HGUC and SHGUC, the average N:C ratios were 0.57 and 0.53, respectively. The maximum average N:C ratio was 0.73 for HGUC and 0.68 for SHGUC. HGUC had higher average N:C ratio (P < .001), higher average nuclear area (P < .001), higher average maximum N:C ratio (P = .005), and higher average maximum nuclear area (P = .006) compared with SHGUC. Conclusions The N:C ratios for the HGUC (0.57) and SHGUC (0.53) categories are lower than those previously suggested in TPS. The authors advocate reducing the N:C ratio below the current threshold of 0.7.

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Section: Discussionmentioning

confidence: 99%

Digital image analysis supports a nuclear‐to‐cytoplasmic ratio cutoff value below 0.7 for positive for high‐grade urothelial carcinoma and suspicious for high‐grade urothelial carcinoma in urine cytology specimens

McIntire

Snow

Elsoukkary

et al. 2018

Cancer Cytopathology

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“…4,6 TPS further changes the uncharacteristic category into a reproducible and meaningful category, 7 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. 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.…”

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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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“…Third, because the questionnaire was mailed in July 2014, the data of TPS utilization may not reflect the current situation, at least in certain aspects, because TPS was published in 2016, and since then many institutions have likely implemented it. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Finally, although information about TPS has been widely disseminated, in particular in the cytopathology community, there is still a need for education about TPS, most importantly for our clinical colleagues.…”

Section: Discussionmentioning

confidence: 99%

Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology

Barkan

Tabatabai

Kurtycz

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— The Paris System for Reporting Urinary Cytology has been disseminated since its inception in 2013; however, the daily practice patterns of urinary tract cytopathology are not well known. Objective.— To assess urinary tract cytopathology practice patterns across a variety of pathology laboratories to aid in the implementation and future update of the Paris System for Reporting Urinary Cytology. Design.— A questionnaire was designed to gather information about urinary tract cytopathology practices and mailed in July 2014 to 2116 laboratories participating in the College of American Pathologists interlaboratory comparison program. The participating laboratories' answers were summarized. Results.— Of the 879 of 2116 laboratories (41%) that participated, 745 (84.8%) reported processing urinary tract specimens in house. The laboratories reported processing various specimen types: voided urine, 735 of 738 (99.6%); bladder washing/barbotage, 639 of 738 (86.6%); and catheterized urine specimens, 653 of 738 (88.5%). Some laboratories used multiple preparation methods, but the most commonly used preparation techniques for urinary tract specimens were ThinPrep (57.4%) and Cytospin (45.5%). Eighty-eight of 197 laboratories (44.7%) reported preparing a cell block, but with a low frequency. Adequacy criteria were used by 295 of 707 laboratories (41.7%) for voided urine, and 244 of 707 (34.5%) assessed adequacy for bladder washing/barbotage. More than 95% of the laboratories reported the use of general categories: negative, atypical, suspicious, and positive. Polyomavirus was classified as negative in 408 of 642 laboratories (63.6%) and atypical in 189 of 642 (29.4%). One hundred twenty-eight of 708 laboratories (18.1%) performed ancillary testing, and of these, 102 of 122 (83.6%) reported performing UroVysion. Conclusions.— Most laboratories use the ThinPrep method followed by the Cytospin technique; therefore, the criteria published in The Paris System for Reporting Urinary Cytology, based mostly on ThinPrep and SurePath, should be validated for Cytospin, and relevant information should be included in the revised edition of The Paris System for Reporting Urinary Cytology.

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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 16 publications

References 0 publications

Digital image analysis supports a nuclear‐to‐cytoplasmic ratio cutoff value below 0.7 for positive for high‐grade urothelial carcinoma and suspicious for high‐grade urothelial carcinoma in urine cytology specimens

Digital image analysis supports a nuclear‐to‐cytoplasmic ratio cutoff value below 0.7 for positive for high‐grade urothelial carcinoma and suspicious for high‐grade urothelial carcinoma in urine cytology specimens

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

Practice Patterns in Urinary Cytopathology Prior to the Paris System for Reporting Urinary Cytology

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