Kim Ji Min, Lee Junghye, Sung Sun Hee
Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
Department of Forensic Medicine, Postmortem Investigation Division, National Forensic Service, Wonju, South Korea.
Diagn Cytopathol. 2023 Dec;51(12):744-750. doi: 10.1002/dc.25215. Epub 2023 Aug 23.
In urinary diversion after radical cystectomy, the incidence of recurrent urothelial carcinoma (UC) in upper urinary tract or urethra are reported in 2%-17% of the patients. Urine cytology plays a pivotal role in detecting the recurrence of UC. However, cytologic diagnosis in urinary diversion including neobladder is often challenging due to significant degenerative changes and necro-inflammatory background. Since the proposal of The Paris System (TPS) for reporting cytology, the utility of TPS in urinary diversion specimen has not been studied yet. The objective of this study is to evaluate the diagnostic usefulness of TPS compared with the original diagnosis and correlate with the matched histopathological results.
Urinary diversion cytology specimens with concurrent or subsequent biopsy or resection at EUMC in recent 16 years (from January 2002 to December 2018) are retrospectively reviewed and reclassified according to TPS criteria. The TPS categories and the original diagnoses were compared and correlated with follow-up histology.
Concurrent or subsequent biopsy or resection within a 6-month period was available in 45 cases from 28 patients. When applying TPS, the rate of atypical and suspicious categories decreased by 13.4% and 11.1%. Using TPS increased the value of sensitivity, NPV, and accuracy to 93.75%, 93.75%, and 90.91%, respectively.
Application of TPS reduced the rate of indeterminate diagnoses and moreover, improved the sensitivity and accuracy of urinary diversion cytology. Therefore, we believe that diversion urine cytology diagnosis according to TPS is useful to screen patients for detection of recurrence in routine clinical practice.
在根治性膀胱切除术后尿流改道患者中，上尿路或尿道复发性尿路上皮癌（UC）的发生率报告为2% - 17%。尿液细胞学检查在检测UC复发中起着关键作用。然而，由于显著的退行性改变和坏死性炎症背景，包括新膀胱在内的尿流改道中的细胞学诊断往往具有挑战性。自从提出《巴黎系统》（TPS）用于报告细胞学以来，TPS在尿流改道标本中的应用尚未得到研究。本研究的目的是评估TPS与原诊断相比的诊断效用，并与匹配的组织病理学结果相关联。
回顾性分析2002年1月至2018年12月期间在EUMC进行的16年中同时或随后进行活检或切除的尿流改道细胞学标本，并根据TPS标准重新分类。比较TPS类别和原诊断，并与随访组织学结果相关联。
28例患者中的45例在6个月内进行了同时或随后的活检或切除。应用TPS时，非典型和可疑类别的比例分别下降了13.4%和11.1%。使用TPS将敏感性、阴性预测值和准确性分别提高到93.75%、93.75%和90.91%。
TPS的应用降低了不确定诊断的比例，此外，提高了尿流改道细胞学的敏感性和准确性。因此，我们认为根据TPS进行的尿流改道尿液细胞学诊断有助于在常规临床实践中筛查复发患者。
