Document Type : Original Research

Authors

1 Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Pathology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Department of Urology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Biostatics, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background & Objective: The Paris System for Reporting Urinary Cytology (TPS) is a new method for evaluating urinary cytology designed to reduce unreproducible reports. The aim of this study was to reclassify and compare urinary cytology reports with TPS criteria to determine the frequency of unreproducible reports compared to the previous system.
Methods: In this study, the laboratory electronic registration system analyzed patients' urine samples taken by voided or washing and brushing methods. The cytological evaluation was performed considering the previous system and TPS by a pathologist. The results of the two systems were compared, and the sensitivity and specificity of TPS were calculated.
Results: Urine samples were taken from 876 patients. The mean age of patients was 63.36 ± 12.62. Comparing the routine classification system and TPS, it was observed that the number of atypical reports in the TPS system decreased by 12%, and all of these cases were downgraded to the negative group in the new classification. The sensitivity and specificity of TPS were 29.4% and 95.1%, respectively, if suspected malignancy and positive reports for malignancy were considered. Finally, if positive reports for malignancy were selected, sensitivity and specificity changed to 11.8% and 100%, respectively.
Conclusion: Although the TPS system has low sensitivity for the diagnosis of urothelial malignancies, due to its high specificity, it is possible to consider and use this classification for screening patients.

Keywords

Main Subjects

  1. Comploj E, Trenti E, Palermo S, Pycha A, Mian C. Urinary cytology in bladder cancer: why is it still relevant?. Urologia. 2015;82(4):203-5. [DOI:10.5301/uro.5000129] [PMID]
  2. Sirousbakht S, Rezakhaniha B. Effect of colonoscopy on prostate-specific antigen; new words about an old subject. Int J Cancer Manag. 2018;11(7). [DOI:10.5812/ijcm.68919]
  3. Rezakhaniha B, Arian Pour N, Siroosbakhat S. Effect of Cystoscopy on Prostate-Specific Antigen, New Words about Old Subject. Int J Cancer Manag. 2010;3(4):e80717.
  4. Chou R, Selph SS, Buckley DI, Gustafson KS, Griffin JC, Grusing SE, Gore JL. Treatment of muscle‐invasive bladder cancer: a systematic review. Cancer. 2016;122(6):842-51. [DOI: 1002/cncr.29843] [PMID]
  5. Allameh F, Sangian A, Razaghi M, Razzaghi Z, Alahyari S, Amini A. Comparison of various types of lasers and transurethral resection in the treatment of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci. 2022:1-7. [DOI: 1007/s10103-021-03479-8] [PMID]
  6. Mitra S, Chatterjee D, Gupta K, Dass Radotra B, Dey P. Urine cytology of urothelial carcinoma with villoglandular differentiation. Cytopathology. 2016;44(7):653-6. [DOI:10.1002/dc.23487] [PMID]
  7. Schrag D, Hsieh LJ, Rabbani F, Bach PB, Herr H, Begg CB. Adherence to surveillance among patients with superficial bladder cancer. J Natl Cancer Inst. 2003;95(8):588-97. [DOI:10.1093/jnci/95.8.588] [PMID]
  8. Pan T, Lehman E, Raman JD. Performance characteristics of urinary cytology in patients presenting with gross and microscopic hematuria. Am J Clin Exp Urol. 2021; 9(5):384-9.
  9. Khayamzadeh, M., Aliakbari, F., Zolghadr, Z., Emadeddin, M., Ahadi, M., Akbari, M., Abedi, A., Nematollahi, S., Hosseini, S. Five-year Survival Rate of Bladder Cancer in Iran during 2001-2007. Iran J Pathol. 2021; 16(1): 69-74  . [DOI:10.30699/ijp.2020.118375.2287] [PMID] [PMCID]
  10. Guo A, Wang X, Gao L, Shi J, Sun C, Wan Z. Bladder tumour antigen (BTA stat) test compared to the urine cytology in the diagnosis of bladder cancer: A meta-analysis. Can Urol Assoc J. 2014;8(5-6):E347. [DOI:10.5489/cuaj.1668] [PMID] [PMCID]
  11. Yafi FA, Brimo F, Steinberg J, Aprikian AG, Tanguay S, Kassouf W. Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer. Urol Oncol. 2015;33(2):66.e25-31. [PMID] [DOI: 1016/j.urolonc.2014.06.008]
  12. Barkan GA, Wojcik EM, Nayar R, Savic-Prince S, Quek ML, Kurtycz DF, Rosenthal DL. The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology. Adv Anat Pathol. 2016; 23(4):193-201. [DOI:10.1097/PAP.0000000000000118] [PMID]
  13. Fankhauser CD, Waisbrod S, Fierz C, Becker AS, Kranzbühler B, Eberli D, Sulser T, Mostafid H, Hermanns T. Diagnostic accuracy of ultrasonography, computed tomography, cystoscopy and cytology to detect urinary tract malignancies in patients with asymptomatic hematuria. World J Urol. 2021;39(1):97-103. [DOI:10.1007/s00345-020-03171-6] [PMID]
  14. Cowan ML, VandenBussche CJ. The Paris System for Reporting Urinary Cytology: early review of the literature reveals successes and rare shortcomings. J Am Soc Cytopathol. 2018;7(4): 185-94. [DOI:10.1016/j.jasc.2018.04.001] [PMID]
  15. Wang Y, Auger M, Kanber Y, Caglar D, Brimo F. 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. Cancer cytopathology. 2018;126(3): 207-14. [DOI:10.1002/cncy.21958] [PMID]
  16. Hassan M, Solanki S, Kassouf W, Kanber Y, Caglar D, Auger M, Brimo F. Impact of implementing the Paris System for Reporting Urine Cytology in the performance of urine cytology: a correlative study of 124 cases. Am J Clin Pathol. 2016;146(3):384-90. [DOI:10.1093/ajcp/aqw127] [PMID]
  17. Meilleroux J, Daniel G, Aziza J, d'Aure DM, Quintyn‐Ranty ML, Basset CM, Evrard SM, Courtade‐Saidi MM. One year of experience using the Paris system for reporting urinary cytology. Cancer Cytopathology. 2018;126(6):430-6. [DOI:10.1002/cncy.21999] [PMID]
  18. Granados R, Duarte JA, Corrales T, Camarmo E, Bajo P. Applying the Paris System for Reporting Urine Cytology increases the rate of atypical urothelial cells in benign cases: a need for patient management recommendations. Acta Cytol. 2017;61(1):71-6. [DOI:10.1159/000452092] [PMID]
  19. Bakkar R, Mirocha J, Fan X, Frishberg DP, de Peralta-Venturina M, Zhai J, Bose S. Impact of the Paris system for reporting urine cytopathology on predictive values of the equivocal diagnostic categories and interobserver agreement. Cytojournal. 2019;16. [PMID] [PMCID] [DOI:10.4103/cytojournal.cytojournal_30_19]
  20. Brimo F, Vollmer RT, Case B, Aprikian A, Kassouf W, Auger M. Accuracy of urine cytology and the significance of an atypical category. Am J Clin Pathol. 2009;132(5):785-93. [DOI:10.1309/AJCPPRZLG9KT9AXL] [PMID]
  21. Wang Y, Auger M, Kanber Y, Caglar D, Brimo F. 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. Cancer cytopathology. 2018;126(3): 207-14. [DOI:10.1002/cncy.21958] [PMID]
  22. Vlajnic T, Gut A, Savic S, Bubendorf L. The Paris System for reporting urinary cytology in daily practice with emphasis on ancillary testing by multiprobe FISH. J Clin Pathol. 2020;73(2):90-5. [DOI:10.1136/jclinpath-2019-206109] [PMID]
  23. Rai S, Lali BS, Venkataramana CG, Philipose CS, Rao R, Prabhu GL. A quest for accuracy: evaluation of the Paris system in diagnosis of urothelial carcinomas. J Cytol. 2019;36(3):169. [DOI:10.4103/JOC.JOC_67_18] [PMID] [PMCID]
  24. Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, Kakkar N. Cytohistological correlation of urine cytology in a tertiary centre with application of the Paris system. Cytopathology. 2018;29(5):436-43. [DOI:10.1111/cyt.12604] [PMID]
  25. Ton Nu TN, Kassouf W, Ahmadi‐Kaliji B, Charbonneau M, Auger M, Brimo F. The value of the “suspicious for urothelial carcinoma” cytology category: a correlative study of 4 years including 337 patients. Cancer cytopathology. 2014;122 (11):796-803. [DOI:10.1002/cncy.21449] [PMID]
  26. Piaton E, Decaussin‐Petrucci M, Mege‐Lechevallier F, Advenier AS, Devonec M, Ruffion A. Diagnostic terminology for urinary cytology reports including the new subcategories ‘atypical urothelial cells of undetermined signi-ficance’(AUC‐US) and ‘cannot exclude high grade’(AUC‐H). Cytopathology. 2014;25(1):27-38. [DOI:10.1111/cyt.12050] [PMID]
  27. Rosenthal DL, VandenBussche CJ, Burroughs FH, Sathiyamoorthy S, Guan H, Owens C. The Johns Hopkins Hospital template for urologic cytology samples: part I-creating the template. Cancer Cytopathol. 2013;121:15-20. [DOI:10.1002/cncy.21255] [PMID]
  28. Mokhtar GA, Al-Dousari M, Al-Ghamedi D. Diagnostic significance of atypical category in the voided urine samples: a retrospective study in a tertiary care center. Urol Ann. 2010;2(3):100. [DOI:10.4103/0974-7796.68857] [PMID] [PMCID]
  29. Brimo F, Vollmer RT, Case B, Aprikian A, Kassouf W, Auger M. Accuracy of urine cytology and the significance of an atypical category. Am J Clin Pathol. 2009;132(5):785-93. [DOI:10.1309/AJCPPRZLG9KT9AXL] [PMID]
  30. de Paula R, Oliveira A, Nunes W, Bovolim G, Domingos T, De Brot L, Bezerra S, Cunha I, Morini M, Saieg M. Two‐year study on the application of the Paris system for urinary cytology in a cancer Centre. Cytopathology. 2020;31(1):41-6. [DOI:10.1111/cyt.12780] [PMID]
  31. Pastorello RG, Barkan GA, Saieg M. Experience on the use of The Paris System for Reporting Urinary Cytopathology: review of the published literature. J Am Soc Cytopathol. 2021;10(1):79-87. [DOI:10.1016/j.jasc.2020.10.002] [PMID]
  32. Anbardar MH, Monjazeb R. Reclassification of urinary cytology regarding The Paris System for Reporting Urinary Cytology with cytohistological correlation demonstrates high sensitivity for high‐grade urothelial carcinoma. Diagn Cytopathol. 2020;48(5):446-52. [DOI:10.1002/dc.24387] [PMID]