An institutional experience with The Paris System: A paradigm shift from ambiguous terminology to more objective criteria for reporting urine cytology

Abstract

The criteria outlined by TPS facilitated the standardisation of urine cytology reporting and significantly increased the sensitivity of diagnosing HGUC.

Clinical follow up and the impact of the Paris system in the assessment of patients with atypical urine cytology

“…One of the objectives of this study was to examine the rate of atypia between the SJRH system, which was in use during the study period, and TPS which was implemented at our institution in February of 2017 (during the time of case review). A few other recent studies have examined TPS and have reported a reduction in cases reported as atypical . Our results are in agreement with these studies with almost a 50% reduction in AUC compared with AUS.…”

“…In examining TPS, we are only evaluating cases that were previously diagnosed as AUS and are therefore not assessing the full scope of TPS. This might explain why sensitivity of AUC is decreased as compared with the former AUS category, whereas it is increased in other studies . Although the retrospective pathology review gives a relatively good approximation of diagnosis, it may not always be predictive of how the case would have been signed out.…”

“…It is argued that the use of a well‐defined and consistent reporting system could lead to greater consistency and potentially fewer atypical cases in urinary cytology. A few studies examining TPS that have recently been published have found the system to have greater predictive value and to have reduced rates of atypia …”

“…A few studies examining TPS that have recently been published have found the system to have greater predictive value and to have reduced rates of atypia. [13][14][15] In an effort to develop suggestions for clinicians towards best practices in patient management, we endeavored to retrospectively determine the clinical and pathological significance of atypia in urine cytology, both based on the former 5-category system (ie, the SJRH system), which was in use in our institution until February 2017, and TPS which replaced it. More specifically, we attempt to compare the sensitivity and specificity of both systems, for cases previously reported as AUS and reclassified according to TPS.…”

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

“…A major concern of TPS is the potential to miss cases of HGUC. The reported effect on sensitivity for diagnosing HGUC has also varied among studies, with some studies reporting an increase in sensitivity 15 and others reporting a decrease in sensitivity. 16 At our institution, the baseline sensitivity, at >80%, is higher than that of the pre-TPS classification in most other studies, which report 60% to 70% sensitivity for HGUC.…”