scholarly journals Implementing The Paris System for Reporting Urinary Cytology results in a decrease in the rate of the “atypical” category and an increase in its prediction of subsequent high-grade urothelial carcinoma

2017 ◽  
Vol 126 (3) ◽  
pp. 207-214 ◽  
Author(s):  
Yujing Wang ◽  
Manon Auger ◽  
Yonca Kanber ◽  
Derin Caglar ◽  
Fadi Brimo
Keyword(s):  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
High Grade

scholarly journals Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 17 ◽  
Author(s):  
Theresa Long ◽  
Lester J. Layfield ◽  
Magda Esebua ◽  
Shellaine R. Frazier ◽  
D. Tamar Giorgadze ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Urothelial Cells ◽  
Urothelial Carcinomas ◽  
Absolute Agreement ◽  
Potential Impact ◽  
Urine Specimens

Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.

scholarly journals A Diagnostic Nomogram of Pathologic Grade for Preoperative Risk Stratification in Upper Tract Urothelial Carcinoma

2020 ◽  
Vol 14 ◽  
pp. 117955492092766
Author(s):  
Runzhuo Ma ◽  
Haizhui Xia ◽  
Min Qiu ◽  
Liyuan Tao ◽  
Min Lu ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Tumor Grade ◽  
Upper Tract Urothelial Carcinoma ◽  
Calibration Plot ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Pathological Grade ◽  
Upper Tract ◽  
Better Than

Background: To develop a novel nomogram to improve the preoperative diagnosis of pathological grade of upper tract urothelial carcinoma (UTUC). Methods: Retrospective study was conducted with 245 patients with UTUC treated by radical nephroureterectomy from 2002 to 2016. Of the cohort, 57.6% received ureteroscopic (URS) biopsy and 35.9% received urine cytology examination. Preoperative clinical characteristics and examination results were collected. Final pathological grade was diagnosed by postoperative pathology. Univariable and multivariable binary logistic regressions were applied to establish a preoperative predictive model for tumor grade, and significant factors were included in the nomogram. The area under curve (AUC) was used to show the predictive efficacy, and the calibration plot was drawn for validation. Results: Of the 245 patients, 72.7% were diagnosed with pathological high-grade disease. Age (odds ratio [OR] = 1.03, P = .039), sessile (OR = 3.86, P = .021), positive urinary cytology (OR = 6.87, P = .035), and biopsy high-grade result (OR = 10.85, P < .001) were independent predictors for pathological high-grade disease. The predictive nomogram containing these factors achieved an AUC of 0.78, which was significantly better than URS biopsy alone (AUC = 0.62, P = .003) in the whole cohort. In the URS biopsy subgroup, the nomogram achieved an AUC of 0.79, better than biopsy alone (AUC = 0.76), but was not statistically significant ( P = .431). When the cutoff value of the nomogram was set at 0.64, the sensitivity of detecting a high-grade lesion versus low-grade lesion was 80.3%, better than that of URS biopsy alone (sensitivity = 65.7%). Conclusions: Advanced age, sessile, positive urinary cytology, and biopsy high-grade were independent predictors of pathological high-grade disease in patients with UTUC. A nomogram containing these factors can improve diagnostic accuracy, potentially reducing the risk of “undergrading” by URS biopsy.

Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma

2011 ◽  
pp. no-no ◽  
Author(s):  
Jamie Messer ◽  
Shahrokh F. Shariat ◽  
James C. Brien ◽  
Michael P. Herman ◽  
Casey K. Ng ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Poor Performance ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
High Grade ◽  
Upper Tract

scholarly journals Urinary Cytology in the Diagnosis of Bladder Cancer

2021 ◽  
pp. 1-5
Author(s):  
R. B. Nerli ◽  
R. B. Nerli ◽  
Shadab Rangrez ◽  
Saziya Bidi ◽  
Shridhar C. Ghagane ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Specific Method ◽  
Low Grade ◽  
Medical Procedure ◽  
High Grade ◽  
Exfoliated Cells ◽  
Criteria For Diagnosis

The examination of urine is an ancient medical procedure dating back thousands of years. Microscopic examination of cells in the urine is being done since the invention of microscope. Presently the cytological examination of urine or other fluid samples from the urinary tract is a routine non-invasive diagnostic procedure to detect cancer of the urinary tract, especially in patients with painless haematuria. It is also used in the follow-up of patients previously treated for bladder cancer to detect recurrence or a new primary. It is a highly specific method for the diagnosis of invasive and in situ urothelial carcinoma and high-grade papillary carcinoma. However, it is unreliable for the detection of low-grade papillary neoplasms. Malignant cytomorphological characteristics of the exfoliated cells in urine or bladder washing can facilitate the diagnosis of bladder cancer. The Paris System (TPS) Working Group has proposed. The Paris System (TPS) authorities have proposed a standard reporting stem which includes specified diagnostic categories and cytomorphologic criteria for diagnosis of High-grade Urothelial Carcinoma (HGUC).

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