Utility of the Paris System in Reporting Urine Cytology

Abstract

Objective: To find out the utility of The Paris System (TPS) in reporting urine cytology and to compare it with the reporting system currently used in our laboratory. Study Design: This retrospective study was undertaken over a period of 1 year during which slides of all the urine specimens sent for cytological examination were retrieved from our laboratory filling system. They were blindly reviewed and reclassified according to TPS. Surgical follow-up was obtained from the uropathology services of our department. Results: A total of 176 cases were meticulously reviewed. The mean age of the patients was 52 years, and 71% of cases presented with hematuria. Histopathological follow-up was available in 34 cases. Reporting by TPS detected 13.0% high-grade urothelial carcinoma (HGUC) and 5.1% atypical urothelial cells versus 7.3 and 11.9% by the current reporting system, respectively. The sensitivity and diagnostic accuracy for detecting HGUC of TPS were higher than those of our reporting system. Conclusion: TPS has increased the rate of detection of HGUC and reduced the rate of reporting “atypical” urothelial cells. TPS has also standardized the diagnostic criteria, thereby bringing uniformity and reproducibility into the system of reporting for urine cytology.

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 …”

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

“…After implementation of TPS, the equivocal or “atypical” category was reduced from 29% to 13% of cases (a reduction of 55%). These findings are in keeping with data from 3 other studies that demonstrated reductions in the “atypical” category of 26%, 40%, and 57%, respectively . In addition, Hassan et al demonstrated not only a 25% reduction in “atypical” diagnoses but also a higher positive predictive value of HGUC for AUC after implementation of TPS .…”

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

“…This system further alters the sensitivity and specificity of urine cytology evaluations. For example, in the study of Malviya et al, using TPS, the rate of HGUC increased from 7.3% to 13%, the sensitivity rose from 68% to 95%, and the negative predictive value increased from 46% to 86% . In Das et al's study, the measured sensitivity and positive predictive value were 86.95% and 83.3%, respectively .…”