Implementation of The Paris System for Reporting Urine Cytology improves diagnostic accuracy of selective upper urinary tract cytology

IF 2.6 3区医学 Q3 ONCOLOGY

Cancer Cytopathology Pub Date : 2024-01-31 DOI:10.1002/cncy.22792

Kosuke Miyai MD, PhD, Misaki Nakayama CT, Shinya Minabe CT, Sho Ogata MD, PhD, Keiichi Ito MD, PhD, Susumu Matsukuma MD, PhD

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引用次数: 0

Abstract

Background

The Paris System for Reporting Urine Cytology (TPS) recommends diagnostic criteria for urinary tract cytology, focusing primarily on the detection of high-grade urothelial carcinoma (HGUC) in the lower urinary tract. The second edition of TPS (TPS 2.0), published in 2022, extends these recommendations to the upper urinary tract (UUT); however, there is a lack of comprehensive data on this subject.

Methods

In total, 223 consecutive UUT cytology specimens from 137 patients were retrieved and reclassified according to TPS 2.0 criteria and were compared with the original diagnosis based on the conventional system (CS). Histologic follow-up within a 3-month period was conducted for 43 patients.

Results

Histologic follow-up revealed 30 HGUCs, five low-grade urothelial carcinomas (LGUCs), and eight nonneoplastic fibrotic tissues. The risk of high-grade malignancy for each TPS diagnostic category was 16.7% for nondiagnostic/unsatisfactory, 2.3% for negative for HGUC (NHGUC), 42.1% for atypical urothelial cells, 50.0% for suspicious for HGUC (SHGUC), and 81.8% for HGUC. In all five cases of histologically diagnosed LGUC, the cytologic diagnosis was NHGUC. When SHGUC/HGUC was considered positive, the diagnostic accuracy of TPS had 63% sensitivity, 95% specificity, a 90% negative predictive value, and a 79% positive predictive value, which were better than those of CS. In addition, the TPS indices did not differ significantly between the specimens obtained before and after the application of contrast reagents.

Conclusions

TPS implementation improved the accuracy of UUT cytology in predicting histologic HGUC, which was unaffected by the application of contrast reagents. These data indicate the usefulness of TPS for UUT cytology in routine clinical settings.

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巴黎尿液细胞学报告系统的实施提高了选择性上尿路细胞学检查的诊断准确性。

背景：巴黎尿液细胞学报告系统（TPS）推荐了尿路细胞学诊断标准，主要侧重于检测下尿路的高级别尿路上皮癌（HGUC）。2022 年出版的第二版 TPS（TPS 2.0）将这些建议扩展到了上尿路（UUT）；但目前还缺乏这方面的全面数据：方法：共检索了137名患者的223份连续UUT细胞学标本，并根据TPS 2.0标准进行了重新分类，与基于传统系统（CS）的原始诊断进行了比较。对 43 名患者进行了为期 3 个月的组织学随访：组织学随访结果显示：30 例 HGUC、5 例低度尿路上皮癌 (LGUC) 和 8 例非肿瘤性纤维组织。在每个 TPS 诊断类别中，非诊断/不满意的高级别恶性肿瘤风险为 16.7%，阴性 HGUC（NHGUC）为 2.3%，非典型尿路上皮细胞为 42.1%，可疑 HGUC（SHGUC）为 50.0%，HGUC 为 81.8%。在所有五例组织学诊断为 LGUC 的病例中，细胞学诊断均为 NHGUC。当SHGUC/HGUC被认为是阳性时，TPS的诊断准确性具有63%的敏感性、95%的特异性、90%的阴性预测值和79%的阳性预测值，均优于CS。此外，在使用造影剂前后获得的标本之间，TPS 指数没有明显差异：结论：TPS的实施提高了UUT细胞学在预测组织学HGUC方面的准确性，而这一准确性不受造影剂应用的影响。这些数据表明，TPS 对常规临床环境中的 UUT 细胞学检查非常有用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Cytopathology 医学-病理学

CiteScore

7.00

自引率

17.60%

发文量

130

审稿时长

1 months

期刊介绍： Cancer Cytopathology provides a unique forum for interaction and dissemination of original research and educational information relevant to the practice of cytopathology and its related oncologic disciplines. The journal strives to have a positive effect on cancer prevention, early detection, diagnosis, and cure by the publication of high-quality content. The mission of Cancer Cytopathology is to present and inform readers of new applications, technological advances, cutting-edge research, novel applications of molecular techniques, and relevant review articles related to cytopathology.