Efficacy of categorization of urothelial malignancy in atypical urine samples by the Paris system for reporting urinary cytology

Abstract

Background: Urine cytology is an important screening tool of patients for urothelial carcinoma and follow-up of patients. Ease of procurement, cost-effectiveness, and lower turnaround time are the advantages. Aims and Objectives: The aim of the study was to identify the accuracy of TPS criteria in diagnosing HGUC, considering biopsy as the gold standard and to describe the cytomorphological features in atypical urine specimens and categorization as per reference to TPS of reporting urine cytology. Definition – Atypical urine sample: Urine samples of patients with macroscopic hematuria and other unexplained urinary symptoms, suspicious of urothelial malignancy. Materials and Methods: The study was performed on patients attending urology OPD with macroscopic hematuria and other unexplained urinary symptoms, which were suspicious of urothelial malignancy and whose urine cytology and subsequent biopsy specimens were submitted to the Department of Pathology. Continuous sampling of 56 patients was done. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to compare TPS with histopathology. SPSS was used to assess correlation, done by diagnostic test evaluation. Results: Age group of study population ranges from 40 to 84 years with mean age of population as 62 years. Sensitivity, specificity, PPV, and NPV of TPS for reporting urinary cytology in the investigation were 85%, 75%, 65.38%, and 90%. Combination of elevated nuclear-to-cytoplasmic ratio, irregular nuclear border, and hyperchromasia was predictive of malignancy. Conclusion: The criteria outlined by TPS facilitated the standardization of urine cytology reporting and significantly increased the sensitivity of diagnosing HGUC.

Keywords

• the paris system; urine cytology; bladder biopsy; high grade urothelial carcinoma