Abstract
The Paris System (TPS) for Reporting Urinary Cytology is a standardized, evidence-based reporting system, comprising seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other malignancies. This study aimed to calculate the pooled risk of high-grade malignancy (ROHM) of each category and demonstrate the diagnostic accuracy of urine cytology reported with TPS. Four databases (PubMed, Embase, Scopus, Web of Science) were searched. Specific inclusion and exclusion criteria were applied, while data were extracted and analyzed both qualitatively and quantitatively. The pooled ROHM was 17.70% for the nondiagnostic category (95% CI, 0.0650; 0.3997), 13.04% for the NHGUC (95% CI, 0.0932; 0.1796), 38.65% for the AUC (95% CI, 0.3042; 0.4759), 12.45% for the LGUN (95% CI, 0.0431; 0.3101), 76.89 for the SHGUC (95% CI, 0.7063; 0.8216), and 91.79% for the HGUC and other malignancies (95% CI, 0.8722; 0.9482). A summary ROC curve was created and the Area Under the Curve (AUC) was 0.849, while the pooled sensitivity was 0.669 (95% CI, 0.589; 0.741) and false-positive rate was 0.101 (95% CI, 0.063; 0.158). In addition, the pooled DOR of the included studies was 21.258 (95% CI, 14.336; 31.522). TPS assigns each sample into a diagnostic category linked with a specific ROHM, guiding clinical management.
Highlights
Urine cytology is a safe and cost-effective diagnostic test showing suboptimal sensitivity yet high specificity to diagnose urothelial cancer [1]
The Paris System (TPS) focuses on the diagnosis that is the most clinically important, the high-grade urothelial carcinoma (HGUC)
TPS haswith reduced the rate of atypical interpretations reported has been shown to enhancethat correlation histology, especially when the low urinary their departments
Summary
Urine cytology is a safe and cost-effective diagnostic test showing suboptimal sensitivity yet high specificity to diagnose urothelial cancer [1]. Reasons to perform it include the initial evaluation of unexplained hematuria, a history of occupational exposure, or the follow-up of patients with previous diagnosis of urothelial cancer [2]. Bladder cancer is the most prevalent urothelial malignancy, whereas upper urinary tract cancers are relatively rare [3,4]. The former most often presents as a non-muscle invasive disease, either of low or high grade. It comprises seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other primary or secondary malignancies [7]
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