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

Abstract

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.

Split‐sample comparison of urothelial cells in ThinPrep and cytospin preparations in urinary cytology: Do we need to adjust The Paris System for Reporting Urinary Cytology criteria?

“…The criteria that TPS put forth was based on the evidence that was derived from studies using the liquid‐based ThinPrep (Hologic Inc, Marlborough, Massachusetts) and SurePath (Becton‐Dickinson, Franklin Lakes, New Jersey) preparation methods. However, a recent College of American Pathologists survey found that approximately 40% and 30%, respectively, of US pathology laboratories use ThinPrep and cytospin (Thermo Fisher Scientific, Waltham, Massachusetts) . Several studies in urinary cytology have noted subtle differences in cytological features between aliquots from the same sample processed using both methods .…”

Cytospin performance when using Paris system for reporting urinary cytology

“…[ 6 ] However; a considerable number of laboratories have maintained the conventional cytospin technique according to the College of American Pathologists Survey. [ 5 ] In this study, we demonstrated the performance characteristics of the second most popular type of preparation in urine cytology.…”

“…The Paris Working Committee concluded at their first meeting that TPS has a high sensitivity to HGUC. [ 5 ]…”

“…Therefore, the cytospin preparation needs to be assessed and validated for the applicability of morphological standards indicated in the TPS. [ 5 ]…”

Current classification systems and standardized terminology in cytopathology

“…These classification systems emerged in harmony with the histological classification used for bladder tumors. It is well known that some of the shortcomings of urinary cytopathology, particularly low sensitivity in detecting low-grade non-invasive lesions, make urinary cytology samples one of the more difficult specimens encountered in cytopathology [ 38 , 39 , 40 ]. Difficulties also arise from low cellularity of smears and pre-fixation cellular deterioration.…”