scholarly journals The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology

2016 ◽  
Vol 60 (3) ◽  
pp. 185-197 ◽  
Author(s):  
Güliz A. Barkan ◽  
Eva M. Wojcik ◽  
Ritu Nayar ◽  
Spasenija Savic-Prince ◽  
Marcus L. Quek ◽  
...  
Keyword(s):  
Working Group ◽  
Reporting System ◽  
Essential Elements ◽  
Urine Cytology ◽  
Urinary Cytology ◽  
Cytologic Examination ◽  
Diagnostic Categories ◽  
Standardized Reporting ◽  
Standardized Terminology ◽  
The Impact

The main purpose of urine cytology is to detect high-grade urothelial carcinoma (HGUC). With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC. This paper outlines the essential elements of TPS and the process that led to the formation and rationale of the reporting system. The Paris System Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme's universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and the limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner. This is the first international/inclusive attempt at standardizing urinary cytology. The success of TPS will depend on the pathology and urology communities working collectively to improve this seminal paradigm shift, and optimize the impact on patient care.

scholarly journals The Paris System – A new insight into reporting urine cytology

2016 ◽  
Vol 6 (11) ◽  
pp. 953-958 ◽  
Author(s):  
A Ghosh
Keyword(s):  
Urothelial Carcinoma ◽  
Working Group ◽  
Reporting System ◽  
Urine Cytology ◽  
High Grade ◽  
Diagnostic Categories ◽  
The Past ◽  
System A ◽  
Morphological Criteria ◽  
Insight Into

Urine cytology helps in the diagnosis of urothelial malignancies. There were no universally accepted reporting system despite several systems were suggested in the past. As a part of irst international effort to standardize urine cytology, The Paris System Working Group was formed comprising pathologists and urologists who met in 2013 at the International Congress of Cytology in Paris and proposed The Paris System (TPS). It was unanimously decided that the main aim of urine cytology was to detect high grade urothelial carcinoma. TPS consists of 7 diagnostic categories and also tries to deine several morphological criteria. TPS Atlas was published in 2016. This article tries to summarize and highlight essential points of The Paris System.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU). Methods Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade. Results Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52). Conclusion Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

Applying the Paris System for Reporting Urine Cytology Increases the Rate of Atypical Urothelial Cells in Benign Cases: A Need for Patient Management Recommendations

2016 ◽  
Vol 61 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Rosario Granados ◽  
Joanny A. Duarte ◽  
Teresa Corrales ◽  
Encarnación Camarmo ◽  
Paloma Bajo
Keyword(s):  
False Positive Rate ◽  
Urine Cytology ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Abnormal Cytology ◽  
Positive Rate ◽  
High Grade Carcinoma ◽  
Management Recommendations ◽  
The Impact

The Paris System (TPS) for reporting urinary cytology attempts to unify the terminology in this field. Objectives: To analyze the impact of adopting TPS by measuring nomenclature agreement and cytohistological correlation. Materials and Methods: Voided urine liquid-based cytology samples corresponding to 149 biopsy-proven cases (76 high-grade carcinomas, 40 low-grade carcinomas, and 33 benign lesions), were reclassified by the same pathologist using TPS. Diagnostic agreement and sensitivity for both nomenclature systems was measured. Results: When using TPS, the rate of atypical samples increased 8 times (from 3 to 24.2%) in benign cases, 10 times (from 2.5 to 25%) in low-grade carcinomas, and 2.4 times (from 6.6 to 15.8%) in high-grade carcinomas. The false-positive rate (abnormal cytology in negative or low-grade carcinoma cases) increased from 11 to 34.2%. Sensitivity was higher (63 vs. 49%) with TPS at the expense of a lower specificity (73 vs. 91%). The agreement between both nomenclatures was moderate for negative and high-grade carcinoma cases (k = 0.42 and 0.56, respectively) and weak for low-grade tumors (k = 0.35). Conclusions: Adopting TPS for reporting urine cytology results in a considerable increase in atypical diagnoses, improving sensitivity but lowering specificity. Appropriate management recommendations for patients with an atypical cytological diagnosis are required.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

2020 ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.Results: Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52).Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

2020 ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.Results: Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P=0.017) and higher tumor grade (P=0.010). On multivariate Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR]=2.21, 95% confidence interval [CI] 1.06–4.64; P=0.035), RFS (HR=1.80, 95% CI 1.08–2.99; P=0.023), and cancer-specific survival (CSS) (HR=1.87, 95% CI 1.10–3.18; P=0.020), but not overall survival (HR=1.32, 95% CI 0.80–2.18; P=0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio=2.23, 95%CI 1.15–4.52).Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

2020 ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.Results: Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P=0.017) and higher tumor grade (P=0.010). On multivariate Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR]=2.21, 95% confidence interval [CI] 1.06–4.64; P=0.035), RFS (HR=1.80, 95% CI 1.08–2.99; P=0.023), and cancer-specific survival (CSS) (HR=1.87, 95% CI 1.10–3.18; P=0.020), but not overall survival (HR=1.32, 95% CI 0.80–2.18; P=0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio=2.23, 95%CI 1.15–4.52).Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

2020 ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU). Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade. Results: Preoperative positive VUC, presenting in 101 patients (32.1%), was significantly associated with tumor multifocality (P=0.02) and higher tumor grade (P=0.01). On multivariate Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR]=2.21, 95% confidence interval [CI] 1.06–4.64; P=0.03), RFS (HR=1.80, 95% CI 1.08–2.99; P=0.02), and cancer-specific survival (CSS) (HR=1.87, 95% CI 1.10–3.18; P=0.02), but not overall survival (HR=1.32, 95% CI 0.80–2.18; P=0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio=2.23, 95%CI 1.15–4.52). Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

scholarly journals Preoperative positive voided urine cytology predicts poor clinical outcomes in patients with upper tract urothelial carcinoma undergoing nephroureterectomy

2020 ◽  
Author(s):  
Wen Liu ◽  
Zhankun Wang ◽  
Shuai Liu ◽  
Yu Yao ◽  
Yong Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urothelial Carcinoma ◽  
Logistic Regression Analysis ◽  
Tumor Grade ◽  
Urine Cytology ◽  
Upper Tract Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Upper Tract ◽  
The Impact

Abstract Background: Performance of urinary cytology is recommended as the part of a standard diagnostic workup and base surveillance regimens in upper tract urothelial carcinoma (UTUC). However, the effect of positive voided urine cytology (VUC) on UTUC prognosis, compared with negative VUC, has not been fully demonstrated. This study aimed to evaluate the impact of preoperative VUC on predicting intravesical recurrence, disease recurrence, and mortality in patients with UTUC who underwent nephroureterectomy (RNU).Methods: Clinicopathological information was collected from 315 UTUC patients treated with RNU. The association between VUC and oncological outcomes was analyzed using the Kaplan–Meier method with log-rank test and Cox proportional hazards regression models. Multiple logistic regression analysis was performed to identify the influence of VUC on tumor grade.Results: Preoperative positive VUC, presenting in 101 patients (32%), was significantly associated with tumor multifocality (P = 0.017) and higher tumor grade (P = 0.010). On multivariable Cox regression analyses, preoperative positive VUC was an independent prognostic factor of intravesical recurrence-free survival (RFS) (hazard ratio [HR] = 2.21, 95% confidence interval [CI] 1.06–4.64; P = 0.035), RFS (HR = 1.80, 95% CI 1.08–2.99; P = 0.023), and cancer-specific survival (CSS) (HR = 1.87, 95% CI 1.10–3.18; P = 0.020), but not overall survival (HR = 1.32, 95% CI 0.80–2.18; P = 0.28). Logistic regression analysis revealed that VUC was related to high tumor grade in UTUC (odds ratio = 2.23, 95%CI 1.15–4.52).Conclusion: Preoperative positive VUC significantly increases the risk of intravesical recurrence in UTUC patients undergoing RNU. In addition, positive VUC is an adverse predictor of RFS and CSS, which might be due to the association between positive VUC and high tumor grade.

What Gives a Diagnostic Label Value? Common Use Over Informativeness

2019 ◽  
Author(s):  
Babak Hemmatian ◽  
Sze Yu Yu Chan ◽  
Steven A. Sloman
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Causal Relation ◽  
Causal Beliefs ◽  
Diagnostic Categories ◽  
Diagnostic Labels ◽  
Diagnostic Label ◽  
The Impact ◽  
Practical Implications

A label’s entrenchment, its degree of use by members of a community, affects its perceived explanatory value even if the label provides no substantive information (Hemmatian & Sloman, 2018). In three experiments, we show that laypersons and mental health professionals see entrenched psychiatric and non-psychiatric diagnostic labels as better explanations than non-entrenched labels even if they are circular. Using scenarios involving experts who discuss unfamiliar diagnostic categories, we show that this preference is not due to violations of conversational norms, lack of reflectiveness or attentiveness, and the characters’ familiarity or unfamiliarity with the label. In Experiment 1, whether a label provided novel symptom information or not had no impact on lay responses, while its entrenchment enhanced ratings of explanation quality. The effect persisted in Experiment 2 for causally incoherent categories and regardless of direct provision of mechanistic information. The effect of entrenchment was partly related to induced causal beliefs about the category, even when participants were informed there is no causal relation. Most participants in both experiments did not report any effect of entrenchment and the effect was present for those who did not. In Experiment 3, mental health professionals showed the effect using diagnoses that were mere shorthands for symptoms, despite a tendency to rate all explanations as unsatisfactory. The data suggest that bringing experts’ attention to the manipulation eliminates the effect. We discuss practical implications for mental health disciplines and potential ways to mitigate the impact of entrenchment.

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