How effective the Paris system in urinary cytology reporting?

Öz

Background: The Paris System in urinary cytopathology (PRSUC) has been published in 2016 as a result of a 2 years study contributed by pathologists and urologists. This system, which aims to detect high grade urothelial carcinoma (HG-UC) and define the atypical urothelial cell category in detail, is now internationally accepted and widely used in urinary system cytology reporting. The purpose of this study is to determine the efficacy of PRSUC in bladder washing specimens that are submitted to our department for 2 years duration.

Material and Methods: Among all the bladder washing cases submitted in 2011 and 2012 to Ankara Yildirim Beyazit University Atatürk Training and Research Hospital, 44 of them with subsequent transuretral biopsies included in this study.

Results: According to PRSUC, 18 (41%) HG-UC negative, 4 (9%) atypical urothelial cell (AUC), 12 (27%) suspicious for HGUC, 10 (23%) HG-UC cases were detected. Nine (20.5%) of the bladder biopsies were diagnosed as benign, 10 (22.7%) as non-invasive low grade urothelial carcinoma (noninv LG-UC), 2 (4.5%) as papillary urothelial neoplasia of low malignant potential (PUNLUMP), 8 (18.2%) as non-invasive high grade urothelial carcinoma (noninv HG-UC), and 15 (34.1%) as invasive urothelial carcinoma (IUC). When the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated, the results were as follows; 86.9%, 90%, 91%, 82%, and 86.4%, accordingly.

Conclusions: PRSUC is a highly sensitive and specific reporting system of urinary cytology for detecting HG-UC. Integrating this system to daily practice is highly beneficial for the urothelial carcinoma paients’ diagnosis and follow-up.

Anahtar Kelimeler

• Urinary Cytology
• Urothelial
• Carcinoma

Üriner Sitoloji Raporlamasında Paris Sistemi Ne Kadar Etkin?

Öz

Amaç: Üriner Sitoloji Raporlamasında Paris Sistemi (ÜSRPS) patolog ve ürologların bulunduğu 2 yılllık bir çalışmanın sonucunda 2016 yılında basılı kitap haline getirilmiştir. Yüksek dereceli ürotelyal karsinomları (YDÜK) saptamayı amaçlayan ve atipik ürotelyal hücre katergorisini detaylı tanımlayan bu raporlama sistemi üriner sistem sitolojisinde uluslararası kabul gören ve yaygın kullanılmaya başlamış bir raporlama sistemidir. Bu çalışmada 2 yıllık bir sürede gerçekleştirilen mesane yıkama sıvılarında bu yeni raporlama sisteminin etkinliğinin saptanması amaçlanmıştır. Materyal Ve Metod: 2011-2012 yılları arasında mesane tümörü kuşkusu nedeni ile mesane yıkama sıvısı alınan, ardından mesanedeki şüpheli lezyona transüretral rezeksiyon yapılan 44 olgu bu çalışmaya dahil edilmiştir.

Bulgular: ÜSRPS’e göre 18’i (%41) YDÜK-negatif, 4’ü (%9) atipik ürotelyal hücre (AÜH), 12’si (%27) YDÜK-kuşkulu, 10’u (%23) YDÜK olarak sınıflandırıldı. Mesane biyopsi örnekleri 2016 WHO/ISUP klasifikasyon sistemine göre sınıflandırılmasında 9 (%20,5) olgu benign, 10 (%22,7) olgu noninvaziv düşük dereceli ürotelyal karsinom (noninv-DDÜK), 2 olgu (%4,5) düşük malignite potansiyelli papiller ürotelyal neoplazi (DMPPÜN), 8 olgu (%18,2) noninvaziv yüksek dereceli ürotelyal karsinom (noninv-YDÜK), 15 olgu (%34.1) invaziv ürotelyal karsinom (İÜK) olarak değerlendirildi. Tüm olgularda ÜSRPS’nin yüksek dereceli ürotelyal karsinomları yakalama açısından duyarlılığı, özgüllüğü, pozitif prediktif değeri, negatif prediktif değeri ve doğruluğu hesaplandığında sırasıyla; %86,9, %90, %91, %82 ve %86,4 olarak saptandı.

Sonuç: ÜSRPS üriner sitoloji raporlamasında YDÜK saptama açısından duyarlılığı ve özgüllüğü yüksek bir raporlama sistemidir. Patoloji laboratuvarlarında yaygın olarak kullanımı ile ürotelyal karsinomu olan hastaların tanı ve takibine önemli katkı sağlayacaktır.

Anahtar Kelimeler

• Üriner sitoloji
• Ürotelyal Karsinom
• Paris Sistemi

Kaynakça

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