Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Pathology, University of California Los Angeles, Los Angeles, California.
Cancer Cytopathol. 2021 Feb;129(2):156-163. doi: 10.1002/cncy.22357. Epub 2020 Oct 9.
The Paris System (TPS) for Reporting Urinary Cytology aims to standardize urine cytology reporting. Per TPS, the diagnosis of "suspicious for high-grade urothelial carcinoma (SHGUC)" is applied in cases that have few urothelial cells with severe atypia but are quantitatively insufficient for a diagnosis of "high-grade urothelial carcinoma (HGUC)." In our study, we compared the diagnostic accuracy and risk of malignancy (ROM) of these 2 categories to assess whether they could be combined in clinical practice to perhaps improve overall interobserver variability.
All urine specimens with a diagnosis of either SHGUC or HGUC from January 2016 to July 2019 were retrieved from the pathology database of 2 large academic institutions. Only cases with follow-up biopsies within 6 months were included.
One hundred eighty-nine cases met the study criteria. Of these, 122 had a cytologic diagnosis of SHGUC, and 67 had a diagnosis of HGUC. Ninety-five (78%) cases from the SHGUC group and 64 (96%) cases from the HGUC group had biopsy-proven HGUC. The majority of cases with discordance had a history of treatment with either intravesical bacillus Calmette-Guérin or mitomycin. The difference in the rate of biopsy-proven HGUC between the SHGUC category and the HGUC category (95/122 vs 64/67, respectively) was statistically significant (P < .001).
The difference in ROM between SHGUC and HGUC was statistically significant in our study cohort. Intravesical chemotherapy was frequently observed in negative biopsy cases in both groups. Our preliminary findings suggest that the 2 TPS categories should remain separate.
巴黎系统（TPS）用于报告尿细胞学，旨在使尿细胞学报告标准化。根据 TPS，在存在少数具有严重异型性但数量不足以诊断为“高级别尿路上皮癌（HGUC）”的尿路上皮细胞的情况下，诊断为“疑似高级别尿路上皮癌（SHGUC）”。在我们的研究中，我们比较了这两个类别的诊断准确性和恶性风险（ROM），以评估它们是否可以在临床上合并，以提高整体观察者间的变异性。
从 2 家大型学术机构的病理学数据库中检索了 2016 年 1 月至 2019 年 7 月所有诊断为 SHGUC 或 HGUC 的尿液标本。仅纳入在 6 个月内有活检随访的病例。
189 例符合研究标准。其中 122 例细胞学诊断为 SHGUC，67 例诊断为 HGUC。SHGUC 组的 95 例（78%）和 HGUC 组的 64 例（96%）病例经活检证实为 HGUC。大多数不一致的病例均有经膀胱内卡介苗或丝裂霉素治疗史。SHGUC 组和 HGUC 组活检证实 HGUC 的比例（95/122 与 64/67）存在统计学差异（P<.001）。
在我们的研究队列中，SHGUC 和 HGUC 的 ROM 差异具有统计学意义。两组的阴性活检病例中均频繁观察到膀胱内化疗。我们的初步研究结果表明，这两个 TPS 类别应保持独立。
