Üriner Sitoloji Raporlamasında Paris Sistemi Ne Kadar Etkin?

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

How effective the Paris system in urinary cytology reporting?

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.

Keywords:

Urinary Cytology, Urothelial, Carcinoma,

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1. Rosenthal DL, Wojcik EM, Kurtycz DFI. The Paris System for Reporting Urinary Cytology. First ed. Switzerland: Springers International Publishing; 2016.
2. Xylinas E, Kluth LA, Rieken M, et al. Urine markers for detection and surveillance of bladder cancer. Urol Oncol. 2014;32(3):222-9.
3. Yafi FA, Brimo F, Steinberg J, et al. Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer. Urol Oncol. 2015;33(2):66 e25-31.
4. Gupta M, VandenBussche CJ, Bivalacqua TJ. Urinary cytology and the Paris system for reporting urinary cytology: Implications for urological management. Cytopathology. 2018;29(4):368-70.
5. Jones J. Non-muscle invasive cansers (Ta,T1, CIS). In: Scott MA KL, Novick A C, Partin A W, Peters CA, Ramchandani P, eds. Campbell-Walsh Urology. 11th edn ed. Philadelphia: Elsevier; 2016. p. 2205-22.
6. Gregoire M, Fradet Y, Meyer F, et al. Diagnostic accuracy of urinary cytology, and deoxyribonucleic acid flow cytometry and cytology on bladder washings during followup for bladder tumors. J Urol. 1997;157(5):1660-4.
7. Layfield LJ, Elsheikh TM, Fili A, et al. Review of the state of the art and recommendations of the Papanicolaou Society of Cytopathology for urinary cytology procedures and reporting : the Papanicolaou Society of Cytopathology Practice Guidelines Task Force. Diagn Cytopathol. 2004;30(1):24-30.
8. Bostwick DG, Hossain D. Does subdivision of the "atypical" urine cytology increase predictive accuracy for urothelial carcinoma? Diagn Cytopathol. 2014;42(12):1034-44.
9. Bhatia A, Dey P, Kakkar N, Srinivasan R, Nijhawan R. Malignant atypical cell in urine cytology: a diagnostic dilemma. Cytojournal. 2006;3:28.
10. Muus Ubago J, Mehta V, Wojcik EM, Barkan GA. Evaluation of atypical urine cytology progression to malignancy. Cancer Cytopathol. 2013;121(7):387-91.
11. Lee PJ, Owens CL, Lithgow MY, Jiang Z, Fischer AH. Causes of false-negative for high-grade urothelial carcinoma in urine cytology. Diagn Cytopathol. 2016;44(12):994-9.
12. Cowan ML, Rosenthal DL, VandenBussche CJ. Improved risk stratification for patients with high-grade urothelial carcinoma following application of the Paris System for Reporting Urinary Cytology. Cancer Cytopathol. 2017;125(6):427-34.
13. Hassan M, Solanki S, Kassouf W, et al. Impact of Implementing the Paris System for Reporting Urine Cytology in the Performance of Urine Cytology: A Correlative Study of 124 Cases. Am J Clin Pathol. 2016;146(3):384-90.
14. Wang Y, Auger M, Kanber Y, Caglar D, Brimo F. Implementing The Paris System for Reporting Urinary Cytology results in a decrease in the rate of the "atypical" category and an increase in its prediction of subsequent high-grade urothelial carcinoma. Cancer Cytopathol. 2018;126(3):207-14.
15. Tanaka N, Kikuchi E, Kanao K, et al. The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study. Urol Oncol. 2014;32(1):48 e19-26.
16. Barkan GA, Wojcik EM, Nayar R, et al. The Paris System for Reporting Urinary Cytology: The Quest to Develop a Standardized Terminology. Acta Cytol. 2016;60(3):185-97.
17. McCroskey Z, Pambuccian SE, Kleitherms S, et al. Accuracy and interobserver variability of the cytologic diagnosis of low-grade urothelial carcinoma in instrumented urinary tract cytology specimens. Am J Clin Pathol. 2015;144(6):902-8.