Department of Urology, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan.
Department of Diagnostic Pathology, University Hospital, Faculty of Medicine, Kagawa University, Japan, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, Japan.
BMC Urol. 2022 Apr 5;22(1):51. doi: 10.1186/s12894-022-01005-8.
The Paris System (TPS) for reporting urinary cytology differs from conventional systems (CS) in that it focuses on the diagnosis of high-grade urothelial carcinoma (HGUC). This study investigated the impact of TPS implementation on the diagnostic accuracy of HGUC by comparing it with our institutional CS.
A total of 649 patients who underwent transurethral resection of bladder tumor (TURBT) between January 2009 and December 2020 were included in this study. Our institution adopted TPS to report urinary cytology in February 2020. The diagnostic accuracy of HGUC in preoperative urinary cytology was compared with the presence or absence of HGUC in resected specimens of TURBT before and after TPS implementation.
After implementing TPS in urinary cytology, 89 patients were reviewed and compared with 560 patients whose urinary cytology was diagnosed by CS. TPS and CS for detecting HGUC had 56.0% and 58.2% sensitivity, 97.8% and 91.2% specificity, and 93.3% and 87.9% positive predictive values, respectively. There were no significant differences between TPS and CS in terms of sensitivity, specificity, and positive predictive value for HGUC (P = 0.83, 0.21, 1.00). On the other hand, the negative predictive value for HGUC using TPS was 80.0%, which was significantly higher than that of CS (66.4%, P = 0.04) The multivariate logistic regression analysis indicated that not using TPS was one of the independent predictive factors associated with false-negative results for HGUC (odds ratio, 2.26; 95% confidence interval, 1.08-4.77; P = 0.03).
In instances where urinary cytology is reported as negative for HGUC by TPS, there is a low probability of HGUC, indicating that TPS has a potential diagnostic benefit.
与传统系统（CS）相比，巴黎系统（TPS）在报告尿细胞学时更侧重于高级别尿路上皮癌（HGUC）的诊断。本研究通过比较 TPS 与我们机构的 CS，探讨了 TPS 实施对 HGUC 诊断准确性的影响。
本研究纳入了 2009 年 1 月至 2020 年 12 月期间接受经尿道膀胱肿瘤切除术（TURBT）的 649 例患者。我们机构于 2020 年 2 月采用 TPS 报告尿细胞学。比较 TPS 实施前后术前尿细胞学诊断 HGUC 的准确性与 TURBT 切除标本中 HGUC 的存在情况。
在尿细胞学中实施 TPS 后，回顾了 89 例患者，并与采用 CS 诊断的 560 例患者进行了比较。TPS 和 CS 检测 HGUC 的敏感性分别为 56.0%和 58.2%，特异性分别为 97.8%和 91.2%，阳性预测值分别为 93.3%和 87.9%。TPS 和 CS 在 HGUC 的敏感性、特异性和阳性预测值方面无显著差异（P=0.83、0.21、1.00）。另一方面，TPS 用于 HGUC 的阴性预测值为 80.0%，显著高于 CS（66.4%，P=0.04）。多变量逻辑回归分析表明，未使用 TPS 是与 HGUC 假阴性结果相关的独立预测因素之一（优势比，2.26；95%置信区间，1.08-4.77；P=0.03）。
当 TPS 报告 HGUC 为阴性时，HGUC 的可能性较低，表明 TPS 具有潜在的诊断益处。
