Diagnostic terminology for urinary cytology reports including the new subcategories ‘atypical urothelial cells of undetermined significance’ (AUC-US) and ‘cannot exclude high grade’ (AUC-H)

Cytopathology ◽  
2013 ◽  
Vol 25 (1) ◽  
pp. 27-38 ◽  
Author(s):  
E. Piaton ◽  
M. Decaussin-Petrucci ◽  
F. Mege-Lechevallier ◽  
A.-S. Advenier ◽  
M. Devonec ◽  
...  
Keyword(s):  
Urinary Cytology ◽  
High Grade ◽  
Urothelial Cells ◽  
Undetermined Significance

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 Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade intraepithelial lesions (ASC-H) cannot be ruled out

2009 ◽  
Vol 127 (5) ◽  
pp. 283-287 ◽  
Author(s):  
Andréa Cytryn ◽  
Fábio Bastos Russomano ◽  
Maria José de Camargo ◽  
Lucília Maria Gama Zardo ◽  
Nilza Maria Sobral Rebelo Horta ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cervical Intraepithelial Neoplasia ◽  
Prevalence Ratio ◽  
Intraepithelial Neoplasia ◽  
Uterine Cervical Cancer ◽  
High Grade ◽  
Cross Sectional ◽  
Squamous Cells ◽  
Bethesda System ◽  
Undetermined Significance

CONTEXT AND OBJECTIVE: The latest update of the Bethesda System divided the category of atypical squamous cells of undetermined significance (ASCUS) into ASC-US (undetermined significance) and ASC-H (high-grade intraepithelial lesion cannot be ruled out). The aims here were to measure the prevalence of pre-invasive lesions (cervical intraepithelial neoplasia, CIN II/III) and cervical cancer among patients referred to Instituto Fernandes Figueira (IFF) with ASC-H cytology, and compare them with ASC-US cases. DESIGN AND SETTING: Cross-sectional study with retrospective data collection, at the IFF Cervical Pathology outpatient clinic. METHODS: ASCUS cases referred to IFF from November 1997 to September 2007 were reviewed according to the 2001 Bethesda System to reach cytological consensus. The resulting ASC-H and ASC-US cases, along with new cases, were analyzed relative to the outcome of interest. The histological diagnosis (or cytocolposcopic follow-up in cases without such diagnosis) was taken as the gold standard. RESULTS: The prevalence of CIN II/III in cases with ASC-H cytology was 19.29% (95% confidence interval, CI, 9.05-29.55%) and the risk of these lesions was greater among patients with ASC-H than with ASC-US cytology (prevalence ratio, PR, 10.42; 95% CI, 2.39-45.47; P = 0.0000764). Pre-invasive lesions were more frequently found in patients under 50 years of age with ASC-H cytology (PR, 2.67; 95% CI, 0.38-18.83); P = 0.2786998). There were no uterine cervical cancer cases. CONCLUSION: The prevalence of CIN II/III in patients with ASC-H cytology was significantly higher than with ASC-US, and division into ASC diagnostic subcategories had good capacity for discriminating the presence of pre-invasive lesions.

Bladder cancer

2017 ◽  
Author(s):  
Richard P. Meijer ◽  
Alexandre R. Zlotta ◽  
Bas W.G. van Rhijn
Keyword(s):  
Bladder Cancer ◽  
High Specificity ◽  
Invasive Bladder Cancer ◽  
Urinary Cytology ◽  
High Grade ◽  
Muscle Invasive Bladder Cancer ◽  
Non Invasive ◽  
Important Diagnostic Tool ◽  
Moderate Sensitivity ◽  
Muscle Invasive

High-grade non-muscle-invasive bladder cancer (HG-NMIBC) represents the most aggressive spectrum of this non-invasive cancer. This collective term includes all high-grade NMI urothelial carcinoma (UC), such as those without invasion (pTa), those with lamina propria invasion (pT1), and those that are only/have concomitant carcinoma in situ (CIS; pTis). These cancers have a high risk for intravesical recurrence (around 46–78% at five years) and progression (between 6–45% at five years) to muscle-invasive bladder cancer (MIBC). As with all UC, their presentation can be with visible haematuria or irritative lower urinary tract symptoms. The latter are common in patients with CIS. CIS may be detected in isolation (so-called primary CIS) or with a coexisting UC elsewhere (termed concomitant CIS). While urinary cytology has a moderate sensitivity and high specificity (>90%) for the detection of HG-NMIBC, cystoscopy is the most important diagnostic tool.

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