The Paris System for Reporting Urinary Cytology PDF
Preview The Paris System for Reporting Urinary Cytology
The Paris System for Reporting Urinary Cytology Eva M. Wojcik Daniel F.I. Kurtycz Dorothy L. Rosenthal Editors Second Edition 123 The Paris System for Reporting Urinary Cytology Eva M. Wojcik • Daniel F.I. Kurtycz Dorothy L. Rosenthal Editors The Paris System for Reporting Urinary Cytology Second Edition Editors Eva M. Wojcik Daniel F.I. Kurtycz Department of Pathology Department of Pathology and Laboratory Loyola University Medical Center Medicine, University of Wisconsin School Maywood, IL, USA of Medicine and Public Health, Wisconsin State Laboratory of Hygiene Dorothy L. Rosenthal Madison, WI, USA Department of Pathology/Cytopathology The Johns Hopkins University Baltimore, MD, USA ISBN 978-3-030-88685-1 ISBN 978-3-030-88686-8 (eBook) https://doi.org/10.1007/978-3-030-88686-8 © Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland This book is dedicated to the memory of Stefan Pambuccian, MD (1957–2020), one of the original members of The Paris Group. From the beginning, Stefan was an integral part of this project. His expertise and commitment were always the guiding principles for all of us to emulate. Dr. Pambuccian was one of the greatest pathologists our profession has ever produced. He was a teacher and researcher of the highest order. His work was fundamental for The Paris System (TPS) and his thoughtful, meticulous approach laid the ground for the success of TPS. Stefan was truly a gentle man. Despite his monumental expertise, his humility and dedication to work were exemplary. Stefan left behind an army of his grateful mentees who have been carrying on his legacy. Preface Almost a decade ago, members of two panels started preparing for the International Congress of Cytology that took place in Paris in 2013. We all had the feeling that maybe ours would be the last symposia on urine cytology. At that time, the rate of atypia was raging and credibility with our clinical colleagues was dwindling. Urine cytology was on the brink of losing clinical relevance, joining the fate of prostate FNA and breast FNA, at least in the United States. Moreover, for many years, urine cytology was one of the most frustrating types of cytology specimens, hated by most cytology practitioners. Whatever we were doing, there was a very high prob- ability that we were doing it wrong, at least in the eyes of our clinical colleagues. They would have seen papillary lesions during cystoscopy, but cytology reports were negative. On the other hand, they could not see any cystoscopic lesions and cytology reports were positive. Of course, we knew why this happened. Low-grade carcinomas do not exhibit enough morphologic changes to be distinguished from normal and reactive urothelium, while flat, high-grade lesions (CIS, carcinoma in situ), although cytologically detectable, are very difficult to visualize on cystoscopy. Definitely, it was time for action to save urines! Once we met in Paris, it was apparent that we were committed and ready to fix the problem. That is how the original “Paris group” formed. During our first impromptu meeting, we decided to start working on a standardized reporting system that would be based on consensus and evidence. Of significance, during the very first meeting we agreed that the new reporting system should concentrate on the detection of a clinically significant disease, high-grade malignancy. That was a true paradigm shift in urine cytology! The rest is history! However, it did not happen overnight. It took a large group of committed cytopathologists, surgical pathologists, and urologists who worked very hard together to create, in record time, a new reporting system that was pub- lished in 2016. We always knew that we had a good product, the system that we truly believed in; however, the success of The Paris System (TPS) exceeded every- one’s wildest imagination. Over the past 5 years, The Paris System has been trans- lated into Japanese, Russian, and Chinese, and has been accepted throughout the world as a standard of care. Our credibility in the eyes of clinicians has significantly improved and, most importantly, now we are able to provide better patient care, accurately screening for new or recurrent life-threatening high-grade bladder cancer. vii viii Preface From the beginning, we realized that the first edition would only be a start. We needed real data to confirm that the criteria of The Paris System are appropriate. Most importantly, we needed prospective studies, based on TPS, to establish rates of malignancy for each diagnostic category to guide our clinical colleagues. This second edition fulfills these gaps. After the publication of TPS, a tsunami of papers from all over the world confirmed the reliability of our established criteria. Most significantly, the main goal of The Paris System was accomplished: lowering the rates of the indeterminate categories, particularly diagnoses of “atypia.” Moreover, after TPS had been published, we quickly realized that there were issues not sufficiently covered in the first edition, particularly degeneration, subtypes of high-grade urothelial carcinomas, and squamous dysplasias. TPS 2.0 extensively discusses these topics. Although the overall concept of the first edition remains the same, the second one is significantly expanded and much more richly illustrated. With this continuously evolving project, we are confident that urine cytology is here to stay. We hope you will agree! Maywood, IL, USA Eva M. Wojcik MD Madison, WI, USA Daniel F.I. Kurtycz MD Baltimore, MD, USA Dorothy L. Rosenthal MD Introduction When The Paris System for Reporting Urinary Cytology (TPS) was introduced in 2016, the new paradigm needed guidelines. Over the past 5 years, experience has provided evidence that the proposed criteria are effective. As aids for microscopists when dealing with a cytology slide, the authors of TPS 2.0 present the following in this section: 1. Decision Tree emphasizing changes in N/C ratios as morphologic find- ings worsen. The Paris System Approach to Diagnosis in Urinary Cytology Is there increased No N/C ratio ( 0.5)? Yes (i.e., not intermediate and basal urothelial cells) Are any one of the following features present in the atypical cells? Is there a reason for the 1. Hyperchromasia 2. Coarse Chromatin “atypia”? 3. Irregular chromatinic rim Polyomavirus? Granuloma? At least 2 features IIeal conduit? present and High ( ~ ≥ 0 .7) N/C ratio Urolithiasis? At least 1 feature How many cells with these Reactive changes? present features? “Few” ~ 5-10 cells “Many” ~ 10 cells NEGATIVE FOR HGUC ATYPICAL SUSPICIOUS FOR HGUC HGUC Graphic algorithm of the Paris System for Reporting Urinary Cytology decision tree. The system emphasis is on the detection of High-Grade Urothelial Carcinoma (HGUC). This snapshot conceptual flowchart illustrates the major points in the decision tree including evaluation of the N/C ratio, nuclear features, and cell quantity. Ref: We’ll Always Have Paris: The Paris System for Reporting Urinary Cytology 2022, Eva M. Wojcik, Daniel F.I. Kurtycz, Dorothy L. Rosenthal. J Am Soc Cytopathol. online preprint, DOI: https://doi.org/1.01016/ jasc.2021.12.03 ix x Introduction 2. Graphic illustration of visual differences in N/C ratios. N:C 0.3 0.4 0.5 0.6 0.7 0.8 ML Zhang, Cancer Cytopathol 2016;124:669-77 Introduction xi 3. Essential data for each diagnostic category. Diagnostic category Diagnostic criteria Example Frequency ROHM Unsatisfactory Voided urine–volume (>30ml) 0 - 5% 0 - 16% Instrumented urine-cellularity Negative for High Benign urothelial, glandular, squamous cells, benign tissue 70 - 90% 8 - 24% Grade Urothelial fragments, changes due to instrumentation, lithiasis, Carcinoma (NHGUC) polyoma virus,therapy. Low Grade Urothelial Neoplasm (LGUN) Atypical Urothelial Required –increased N/C ratio (>0.5) and one of: 5 - 15% 24 - 53% Cells (AUC) Hyperchromasia, Irregular clumpy chromatin or Irregular nuclear contours Suspicious for High Required –Few cells (<5-10) with high N/C ratio (> 0.7) and 0.5 - 3% 59 - 94% Grade Urothelial hyperchromasia, and/or Irregular clumpy chromatin, Carcinoma (SHGUC) Irregular nuclear contours Positive for High Required –Many cells (>10) with high N/C ratio (> 0.7) and 0.1 - 3% 76 - 100% Grade Urothelial hyperchromasia, Irregular clumpy chromatin, Irregular Carcinoma (HGUC) nuclear contours ROHM –Risk of High Grade Malignancy The authors of TPS will continue to monitor the utility of these criteria and will rely upon our end users to publish their experience with TPS.
The list of books you might like
