Application of the Paris Reporting System for Urine Cytology: The Three-Year Experience of a Single Tertiary Care Institute in Thailand

Abstract

<b><i>Introduction:</i></b> Urothelial carcinoma is one of the most common human cancers, both in Thailand and worldwide. Urine cytology is a screening tool used to detect urothelial carcinoma. The Paris System for Reporting Urinary Cytology (TPSRUC) was first published in 2016 to standardize the procedures, reporting, and management of urothelial carcinoma. Diagnostic categories include negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUCs), suspicious for HGUC (SHGUC), HGUC, low-grade urothelial neoplasm, and other malignancies. <b><i>Material and Methods:</i></b> In a retrospective review, urine cytology specimens from 2016 to 2019 were reevaluated using the TPSRUC. The risk of high-grade malignant neoplasm (ROHM) for each diagnostic category was calculated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of prediction of high-grade malignant neoplasms were evaluated for cases with histological follow-up specimens. <b><i>Results:</i></b> In total, 2,178 urine cytology specimens were evaluated, of which 456 cases had follow-up histological specimens. The ROHM in each diagnostic category was as follows: NHGUC, 17.4%; AUC, 49.9%; SHGUC, 81.2%; HGUC, 91.3%; and other malignant neoplasms, 87.5%. The sensitivity, specificity, PPV, NPV, and accuracy for high-grade malignant neoplasm prediction were 63%, 92.8%, 89%, 73.1%, and 78.5% when AUC was included as malignant in the comparison and 82.6%, 74.7%, 75.1%, 82.3%, and 78.5% when AUC was not considered malignant. <b><i>Conclusions:</i></b> TPSRUC provides reliable results that are reproducible by different interpreters and is a helpful tool for the detection of HGUC.

International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 1

“…A systematic review of reports pertaining to TPS was performed with 27 studies included in the literature review (Table 3). 27–53 The studies which compared the cytology findings against tumor grade used the designation of “low” or “high” grade similar to WHO 2004. The cohort size was variable in each study (median: 149, range: 57 to 3900).…”

Are we on track for diagnosing high‐grade urothelial carcinoma with a minimum quantity of five malignant cells in lower tract specimens? Critical analysis of The Paris System Quantitation Criteria

“…Our findings further validate that at least five HGCs quantitation requirements per the TPS. More so, the strict application of TPS understandably comes with a low‐to‐moderate sensitivity value (38%–56%) as reported in studies analyzing the impact of TPS, with specificity (97%–100%), PPV (93%–100%), and a NPV as high as 90% 21–24 . We used ThinPrep, and studies have shown that the use of the liquid‐based preparations is reliable, with high ROHM and high concordance among interpreters in detecting HGUC by application of TPS in lower urinary; the rate of detection of HGUC is not affected by the method of specimen collection (voided or collected by bladder washings) 10,20,25,26 …”

“…More so, the strict application of TPS understandably comes with a low-to-moderate sensitivity value (38%-56%) as reported in studies analyzing the impact of TPS, with specificity (97%-100%), PPV (93%-100%), and a NPV as high as 90%. [21][22][23][24] We used ThinPrep, and studies have shown that the use of the liquidbased preparations is reliable, with high ROHM and high concordance among interpreters in detecting HGUC by application of TPS in lower urinary; the rate of detection of HGUC is not affected by the method of specimen collection (voided or collected by bladder washings). 10,20,25,26 Following review of the 36 cases of HGUC (from 22 patients) with negative histology (Cohort 2) on concurrent biopsy, we found all cases meeting the criteria for diagnosing HGUC in lower urinary tract specimens as outlined by TPS.…”

Evaluation of the Implementation and Diagnostic Accuracy of the Paris Classification for Reporting Urinary Cytology in Voided Urine Specimens: A Cyto-Histological Correlation Study in a Cancer Center

“…The ROHM, defined as the risk of detecting biopsy-proven HGUC histologies (high-grade papillary urothelial carcinoma with or without invasion, and urothelial carcinoma in situ), was calculated for each diagnostic category of the Paris system as discussed in the 2nd Edition of the Paris classification [14] and also as reported in [12, 15].…”