Xing Juan, Monaco Sara E, Pantanowitz Liron
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Am Soc Cytopathol. 2018 Nov-Dec;7(6):311-317. doi: 10.1016/j.jasc.2018.07.006. Epub 2018 Jul 25.
Diagnosing upper urinary tract (UUT) lesions using cytology has been historically difficult because of a lack of standardized terminology, cytomorphologic criteria, and the presence of instrumentation artifact. The goal of The Paris System for Reporting Urinary Cytology (TPSRUC) was to provide standardized terminology and cytomorphologic criteria. The aim of this study was to evaluate the utility of TPSRUC in UUT cytology specimens at our institution.
Single ThinPrep archival slides from 30 UUT cytology cases with corresponding histological follow-up were reviewed using TPSRUC. Those results were compared with the original cytology diagnoses.
The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for high-grade urothelial carcinoma (HGUC) using TPSRUC were 71%, 100%, 100%, and 71%.
The TPSRUC was reliable at identifying HGUC. These data showed that this system had a lower sensitivity (71% versus 100%) and NPV (71% versus 100%) for UUT specimens compared with original cytology diagnoses. TPSRUC had a sensitivity and specificity that were comparable to reported overall sensitivity and specificity of UUT cytology for detection of HGUC. A major cause of discrepancy with TPSRUC was the classification of urine samples (n = 8) from histologically proven HGUC cases as only atypical (n = 6) or negative (n = 2), mainly owing to nuclear hypochromasia rather than hyperchromasia. Thus, hyperchromasia, a criteria used in TPSRUC, may not be as relevant in UUT specimens.
由于缺乏标准化术语、细胞形态学标准以及存在器械假象，利用细胞学诊断上尿路（UUT）病变在历史上一直很困难。《巴黎报告尿路细胞学系统》（TPSRUC）的目标是提供标准化术语和细胞形态学标准。本研究的目的是评估TPSRUC在我们机构的UUT细胞学标本中的实用性。
使用TPSRUC对来自30例UUT细胞学病例的单张ThinPrep存档玻片以及相应的组织学随访结果进行回顾。将这些结果与原始细胞学诊断进行比较。
使用TPSRUC诊断高级别尿路上皮癌（HGUC）的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为71%、100%、100%和71%。
TPSRUC在识别HGUC方面是可靠的。这些数据表明，与原始细胞学诊断相比，该系统对UUT标本的敏感性（71%对100%）和NPV（71%对100%）较低。TPSRUC的敏感性和特异性与报道的UUT细胞学检测HGUC的总体敏感性和特异性相当。与TPSRUC存在差异的一个主要原因是，组织学证实为HGUC病例的尿液样本（n = 8）仅被分类为非典型（n = 6）或阴性（n = 2），主要是由于细胞核淡染而非深染。因此，TPSRUC中使用的深染标准在UUT标本中可能不那么相关。
