The Paris System for Reporting Urinary Cytology (TPS) was published in order to provide clear cytomorphologic criteria for urine cytology specimens, focusing on high-grade urothelial lesions. The aim of this study was to evaluate the impact of implementing TPS and to correlate with available concomitant histological samples, accessing overall sensitivity and specificity.
A retrospective analysis of urine cytology reports from 2017 to 2018 using TPS was carried out, with histological correlation to concomitant samples (up to three months). Statistical analysis was performed with calculation of sensitivity and specificity, positive and negative predictive values and risk of malignancy (ROM) for all TPS categories.
A total of 1660 specimens were evaluated. Histological specimens were available for 611 (36.8%) cases. Urine cytology categorized by TPS had 2.4% nondiagnostic cases, 87.1% negative for HGUC, 4.6% atypical urothelial cells, 2.7% suspicious for HGUC, 2.7% HGUC and 0.5% cases of other malignancies. Sensitivity, specificity, NPV and PPV were 40.0%, 99.3%, 88.2%, 92.3%, respectively. ROM of each category was 0% for nondiagnostic, 11.1% for negative for HGUC, 32.4% for atypical, 64.9% for suspicious for HGUC and 87.9% for HGUC and other malignancies.
Our findings indicated that implementation of TPS provided a high specificity and predictive positive value for the detection of high-grade urothelial lesions, with proportionally increasing ROMs as categories progress from negative to positive.
Cytopathology : official journal of the British Society for Clinical Cytology. 2019 Oct 26 [Epub ahead of print]
Rafaela de Paula, Andrea Oliveira, Warley Nunes, Graziele Bovolim, Tabata Domingos, Louise De Brot, Stephania Bezerra, Isabela Cunha, Mariane Morini, Mauro Saieg
Department of Pathology, AC Camargo Cancer Center, São Paulo, Brazil., Department of Pathology, Rede D'OR- São Luiz, São Paulo, Brazil.