Cytology, Education & Training

New Reporting System for Urine Cytology

Effective November 5, 2017, Spectrum Health Regional Laboratory will be implementing the Paris System for reporting Urine Cytology.

The main purpose of urine cytology is to detect high-grade urothelial carcinoma (HGUC). With this principle in mind, The Paris System (TPS) Working Group, composed of cytopathologists, surgical pathologists, and urologists, has proposed and published a standardized reporting system that includes specific diagnostic categories and cytomorphologic criteria for the reliable diagnosis of HGUC.

The Paris System Working Group, organized at the 2013 International Congress of Cytology, conceived a standardized platform on which to base cytologic interpretation of urine samples. The widespread dissemination of this approach to cytologic examination and reporting of urologic samples and the scheme’s universal acceptance by pathologists and urologists is critical for its success. For urologists, understanding the diagnostic criteria, their clinical implications, and the limitations of TPS is essential if they are to utilize urine cytology and noninvasive ancillary tests in a thoughtful and practical manner.

Diagnostic categories for The Paris System for Reporting Urinary Cytology

  1. Nondiagnostic/unsatisfactory
  2. Negative for high-grade urothelial carcinoma (NHGUC)
  3. Atypical urothelial cells (AUC)
  4. Suspicious for high-grade urothelial carcinoma (SHGUC)
  5. High-grade urothelial carcinoma (HGUC)
  6. Low-grade urothelial neoplasm (LGUN)
  7. Other: primary and secondary malignancies and miscellaneous lesions

Relative risk of the diagnostic categories outlined in The Paris System, based on studies to date.

Category Risk of Malignancy, % Management
Unsatisfactory/nondiagnostic <5–10% repeat cytology, cystoscopy in 3 months if increased clinical suspicion
Negative for high-grade urothelial carcinoma 0–10% clinical follow-up as needed
Atypical urothelial cells 8–35% clinical follow-up as needed; potential use of ancillary testing
Suspicious for high-grade urothelial carcinoma 50–90% more aggressive follow-up, cystoscopy, biopsy
Low-grade urothelial neoplasm ~10% need cystoscopy and biopsy to further evaluate grade and stage
High-grade urothelial carcinoma >90% more aggressive follow-up, cystoscopy, biopsy, staging
Other malignancy >90% more aggressive follow-up, cystoscopy, biopsy, staging

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