Hypochromatic large urothelial cells in urine cytology are indicative of high grade urothelial carcinoma

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.

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High apoptotic index in urine cytology is associated with high-grade urothelial carcinoma

Cancer Cytopathology ◽

10.1002/cncy.21723 ◽

2016 ◽

Vol 124 (8) ◽

pp. 538-539

Author(s):

Dorothy L. Rosenthal

Keyword(s):

Urothelial Carcinoma ◽

Apoptotic Index ◽

Urine Cytology ◽

High Grade

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High-grade urothelial carcinoma in urine cytology with jet black and smooth or glassy chromatin

Cancer Cytopathology ◽

10.1002/cncy.21947 ◽

2017 ◽

Vol 126 (1) ◽

pp. 64-68 ◽

Cited By ~ 5

Author(s):

Andrew A. Renshaw ◽

Edwin W. Gould

Keyword(s):

Urothelial Carcinoma ◽

Urine Cytology ◽

High Grade

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Utility of the Paris System in Reporting Urine Cytology

Acta Cytologica ◽

10.1159/000464270 ◽

2017 ◽

Vol 61 (2) ◽

pp. 145-152 ◽

Cited By ~ 28

Author(s):

Kiran Malviya ◽

Gwendolyn Fernandes ◽

Leena Naik ◽

Kanchan Kothari ◽

Mona Agnihotri

Keyword(s):

Retrospective Study ◽

Reporting System ◽

Urine Cytology ◽

High Grade ◽

Urothelial Cells ◽

Cytological Examination ◽

Filling System ◽

The Mean ◽

Urine Specimens

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.

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Comparative Evaluation of ProEx C and ImmunoCyt/uCyt Assays in Atypical Urine Cytology

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2013-0433-oa ◽

2014 ◽

Vol 138 (9) ◽

pp. 1215-1222 ◽

Cited By ~ 8

Author(s):

Maria E. Vergara-Lluri ◽

Eugenia Hu ◽

Jian-Yu Rao ◽

Mary Levin ◽

Sophia K. Apple ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Topoisomerase Ii ◽

High Sensitivity ◽

Urine Cytology ◽

Urothelial Cell ◽

Low Grade ◽

Nuclear Staining ◽

High Grade ◽

Surgical Biopsy ◽

Papillary Urothelial Carcinoma

Context.—Detection of urothelial carcinoma by urine cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of urothelial carcinoma. ProEx C is an assay targeting expression of topoisomerase II-α and the minichromosome maintenance protein-2 and is used to assist in diagnoses of gynecologic specimens. Objective.—To evaluate the utility of ProEx C and uCyt in atypical urine cytology. Design.—Sixty-eight specimens with a diagnosis of atypical urine cytology, concurrent uCyt testing, and surgical biopsy follow-up were included. Slides were restained with ProEx C. ProEx C was recorded as positive when nuclear staining was seen in at least one morphologically atypical urothelial cell. The uCyt was scored as positive if at least one morphologically atypical urothelial cell showed positive fluorescence staining. Thirteen cases (19%) had benign histologic diagnoses, 18 (26%) had low-grade papillary urothelial carcinoma, and 37 (54%) had high-grade urothelial carcinoma. Results.—The overall sensitivity was 85% for ProEx C, 85% for uCyt, and 93% for the combination of the 2 assays. The overall specificity was 69% for ProEx C, 31% for uCyt, and 23% for the combination of the 2 tests. In predicting high-grade urothelial carcinoma, sensitivity was 92% for ProEx C, 86% for uCyt, and 92% for both tests. In predicting low-grade papillary urothelial carcinoma, sensitivity was best with the combination of the 2 tests at 94%. Conclusion.—ProEx C has superior specificity to uCyt. The combination of the 2 tests yielded high sensitivity not only for high-grade urothelial carcinoma but also for low-grade papillary urothelial carcinoma.

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Micropapillary urothelial carcinoma: Cytologic features in a retrospective series of urine specimens

CytoJournal ◽

10.4103/1742-6413.107986 ◽

2013 ◽

Vol 10 ◽

pp. 4 ◽

Cited By ~ 5

Author(s):

Jonas John Heymann ◽

Anjali Saqi ◽

Andrew Thomas Turk ◽

John Crapanzano

Keyword(s):

Urothelial Carcinoma ◽

Urine Cytology ◽

High Grade ◽

Micropapillary Carcinoma ◽

Cell Clusters ◽

Tract Cancer ◽

Urinary Tract Cancer ◽

Definitive Surgery ◽

Criteria For Diagnosis ◽

Urine Specimens

Background: The micropapillary variant of urothelial carcinoma (uPC) is a rare variant of urothelial carcinoma that carries a poor prognosis. Definitive surgery may represent optimal management of low stage tumors. Urine cytology is indispensable in the screening and follow-up of urinary tract cancer. However, cytopathological criteria for diagnosis of uPC and its differentiation from conventional urothelial carcinoma (CUC) are not well-defined. Materials and Methods: Twenty-five cases of histologically confirmed micropapillary uPC from 21 patients were compared to 25 cases of histologically confirmed high-grade CUC. Results: In uPC cases, cell clusters were identified in 13 of 25 specimens from 10 patients. Six of the 13 specimens containing cell clusters corresponded to surgical pathology specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. In contrast, only 1 of the 12 urine specimens devoid of cell clusters corresponded to surgical specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. Cytomorphologic features of urinary specimens from patients with histologically confirmed micropapillary carcinoma were generally similar to those from patients with high-grade CUC, making it difficult to distinguish these entities in exfoliative urine specimens. Conclusions and Summary: Further investigation of the core cytopathological characteristics of uPC is warranted to refine its diagnostic criteria by exfoliative urine cytology.

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Paris System Has A Higher Cytohistologic Correlation And Reproducibility Than Traditional Urine Cytology Method

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.206 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S94-S94

Author(s):

R P Mendoza ◽

T Haidary ◽

R Gupta

Keyword(s):

Urothelial Carcinoma ◽

Traditional Method ◽

Urine Cytology ◽

Low Grade ◽

High Grade ◽

Cytologic Diagnosis ◽

Histologic Diagnosis ◽

Negative Results ◽

The Mean ◽

Cytology Result

Abstract Introduction/Objective The major limitation of urine cytology is the lack of consensus regarding the terminology and diagnostic criteria that should be used for urothelial atypia. The main goal of the newly proposed Paris System for Reporting Urine Cytology is to concentrate primarily on the detection of high grade urothelial carcinoma while minimizing the detection of low grade lesions. This study aimed to apply the criteria and categories of the Paris system in retrospectively collected urine cytology specimens and assess histologic correlation and reproducibility. Methods Two senior pathologists independently reviewed retrospectively collected urine cytology specimens strictly following the Paris system criteria for categorization. Cytologic diagnosis were compared with previous cytology result and histologic diagnosis. Results A total of 67 patients were included in the study. The mean age is 65.8 years (36-89 years), majority were males (73.1%) and African American (89.6%). Urine cytology using traditional method showed mostly atypical results (58.2%), followed by reactive (26.9%), high-grade urothelial carcinoma (11.9%) and suspicious (3.0%). On the other hand, the Paris system had more negative results (62.7%), followed by atypical (19.4%), high-grade urothelial carcinoma (11.9%) and lastly suspicious (6.0%). All of negative cases (18 out of 18) and majority of HGUC cases (7 out of 8) were concordant between the two cytology methods. Traditional urine cytology method only yielded 71.4% histologic concordance, while 100% Paris system results were concordant with bladder histology. Majority of the atypical cases using traditional method were converted to negative, and a few atypical cases were converted to suspicious and high-grade. All results using Paris system were concordant between two general pathologists. Conclusion Using the Paris system in analyzing urine cytology resulted to higher cytohistologic concordance than traditional method. Majority of atypical cases from traditional method were converted to more definitive categories. The cytopathologic analyses from two general pathologists applying the criteria of Paris system had superior reproducibility. Applying the Paris system, therefore, can significantly improve the performance of urine cytopathology.

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Application of the Paris Reporting System for Urine Cytology: The Three-Year Experience of a Single Tertiary Care Institute in Thailand

Acta Cytologica ◽

10.1159/000521139 ◽

2022 ◽

pp. 1-8

Author(s):

Bantita Phruttinarakorn ◽

Sirithep Plumworasawat ◽

Jitchai Kayankarnnavee ◽

Jirasit Lualon ◽

Atcharaporn Pongtippan

Keyword(s):

Urothelial Carcinoma ◽

Predictive Value ◽

Diagnostic Category ◽

Malignant Neoplasm ◽

Urine Cytology ◽

Malignant Neoplasms ◽

Low Grade ◽

High Grade ◽

Sensitivity Specificity

Introduction: Urothelial carcinoma is one of the most common human cancers, both in Thailand and worldwide. Urine cytology is a screening tool used to detect urothelial carcinoma. The Paris System for Reporting Urinary Cytology (TPSRUC) was first published in 2016 to standardize the procedures, reporting, and management of urothelial carcinoma. Diagnostic categories include negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUCs), suspicious for HGUC (SHGUC), HGUC, low-grade urothelial neoplasm, and other malignancies. Material and Methods: In a retrospective review, urine cytology specimens from 2016 to 2019 were reevaluated using the TPSRUC. The risk of high-grade malignant neoplasm (ROHM) for each diagnostic category was calculated. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of prediction of high-grade malignant neoplasms were evaluated for cases with histological follow-up specimens. Results: In total, 2,178 urine cytology specimens were evaluated, of which 456 cases had follow-up histological specimens. The ROHM in each diagnostic category was as follows: NHGUC, 17.4%; AUC, 49.9%; SHGUC, 81.2%; HGUC, 91.3%; and other malignant neoplasms, 87.5%. The sensitivity, specificity, PPV, NPV, and accuracy for high-grade malignant neoplasm prediction were 63%, 92.8%, 89%, 73.1%, and 78.5% when AUC was included as malignant in the comparison and 82.6%, 74.7%, 75.1%, 82.3%, and 78.5% when AUC was not considered malignant. Conclusions: TPSRUC provides reliable results that are reproducible by different interpreters and is a helpful tool for the detection of HGUC.

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