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

McIntire, Patrick J.; Snow, Justin T.; Robinson, Brian D.; Rao, Rema; Goyal, Abha; Heymann, Jonas J.; Siddiqui, Momin T.

doi:10.1002/cncy.22005

Cited by 32 publications

(65 citation statements)

References 26 publications

(85 reference statements)

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“…Accordingly, other cytological specimens such as thyroid fine needle aspiration and urine have indeed witnessed a drop in the atypical rate after the broad implementation of terminology systems, with improved overall test performance. [15][16][17] The most common primary site of malignancy in males with pleural effusion was the lung, in agreement with the most recent literature. 18,19 Among women, carcinomas of the breast were the most common epithelial neoplasm, also in accordance with previ- is also a useful marker for the distinction between epithelial and mesothelial lineage and together with Ber-EP4 may serve as a limited yet informative panel for the difficult question of cell origin.…”

Section: Discussionsupporting

confidence: 89%

“…Future studies adopting criteria developed by this international expert community are warranted to evaluate any impact. Accordingly, other cytological specimens such as thyroid fine needle aspiration and urine have indeed witnessed a drop in the atypical rate after the broad implementation of terminology systems, with improved overall test performance …”

Section: Discussionmentioning

confidence: 99%

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A 2‐year retrospective study on pleural effusions: A cancer centre experience

et al. 2019

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Background Cytopathological examination of pleural effusions is a fast and minimally invasive method for verification of the presence of neoplastic cells. We report our 2‐year experience using a categorised diagnostic system and reporting risks of malignancy (ROMs) for each defined category. Methods Cytological reports of patients between November 2016 and October 2018 were collected, with results primarily classified into a five‐tiered classification scheme. Immunohistochemistry markers used in cytology and their results were also recorded. Final agreement to histology and overall test performance was calculated for cases with available concomitant (up to 3 months) pleural biopsies. Results A total of 519 samples from 385 patients were collected, being 29 (5.6%) classified as non‐diagnostic, 291 (56%) as negative, 28 (5.4%) as atypical, 30 (5.8%) as suspicious and 141 (27.2%) as positive. Most requested markers were calretinin, TTF1, Ber‐EP4 and Gata‐3, being conclusive in 45 (76.3%) cases. Total cyto‐histological agreement was achieved in 49 (80.3%) specimens, with an overall sensitivity and specificity of 69.4% and 93.3%, respectively. Positive predictive value was 96.2% and negative predictive value was of 56%. ROM for each diagnostic category was 50% for non‐diagnostic, 44% for negative, 50% for atypical, 83.3% for suspicious and 96.2% for positive. Conclusions Our 2‐year retrospective study has shown a high specificity and positive predictive value for pleural cytology. The use of a five‐tiered system has also shown to be highly effective, with a concordantly progressive higher ROM for the assigned diagnostic categories.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

A 2‐year retrospective study on pleural effusions: A cancer centre experience

et al. 2019

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“…In Hassan et al's study, the rate of AUC cases was diminished by 13% . McIntire et al reported reduced rate of AUC from 29% to 13% of cases (rate 50%) . These findings are parallel with three other studies with diminished rate of AUC category about 26%, 40%, and 57% in Mokhtar et al, Piaton et al and Rosenthal et al's studies, respectively.…”

Section: Discussionmentioning

confidence: 66%

“…VandenBussche et al also reported a 1.2% increase in the rate of HGUC after using TPS . In the study of McIntire et al, the number of LGUN diagnoses was doubled when TPS was applied . Das et al claimed that none of their cases had three‐dimensional papillary clusters, concerning LGUN diagnosis, which could be due to the application of voided urine samples, which causes the cells to shed more individually compared with papillary clusters .…”

Section: Discussionmentioning

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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“…However, similar to our study, the sensitivity significantly increased when both suspicious and positive were considered "positive" (78.6% vs 60%,) and even more so when the atypical diagnostic category is also considered as part of the positive cohort (92.9% vs 85%). In a more recent study by McIntire et al, 19 implementation of TPS criteria also resulted in an improved correlation of upper urinary tract cytology specimens with subsequent biopsies (from 34% to 63%) and a decreased use in of the atypical diagnostic category (from 29% to 13%). However, in contrast to our current study, the pre-TPS original diagnoses were gathered from the prior pathology reports and were not re-reviewed and distinct cytologic features of the urine specimens were not evaluated.…”

Section: Discussionmentioning

confidence: 96%

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

Cited by 32 publications

References 26 publications

A 2‐year retrospective study on pleural effusions: A cancer centre experience

A 2‐year retrospective study on pleural effusions: A cancer centre experience

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

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

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