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Farahani SJ, Li J, Minder B, Vielh P, Glisic M, Muka T. Impact of implementing the first edition of the Paris system for reporting: A systematic review and meta-analysis. Cytopathology 2024. [PMID: 38934101 DOI: 10.1111/cyt.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
Urine cytology is a noninvasive, widely used diagnostic tool for screening and surveillance of genitourinary tract neoplasms. However, the absence of unified terminology and clear objective morphological criteria limits the clinical benefit of urine cytology. The Paris System for Reporting Urine Cytology (TPS) was developed with the goal of standardizing reporting and improving urine cytology performance in detecting high-grade malignancy (HGM). We aimed to evaluate potential effects of TPS on improving urine cytology diagnostic performance and clinical utility by conducting a systematic review and meta-analysis. We searched six electronic databases to identify cross-sectional and cohort studies written in English assessing the accuracy of urine cytology in detecting genitourinary tract malignancies of patients under surveillance or with clinical suspicion of malignancy from January 2004 to December 2022. We extracted relevant data from eligible studies to calculate relative distribution of cytology diagnostic categories; ratio of atypical to HGM cytology diagnosis; and risk of HGM (ROHGM) and HGM likelihood ratio (HGM-LR) associated with cytology diagnostic categories. We used a generalized linear mixed model with logit transformation to combine proportions and multilevel mixed-effect logistic regression to pool diagnostic accuracy measurements. We performed meta-regression to evaluate any significant difference between TPS and non-TPS cohorts. We included 64 studies for 99,796 combined total cytology samples, across 31 TPS and 49 non-TPS cohorts. Pooled relative distribution [95% confidence interval (CI)] of negative for high-grade urothelial carcinoma (NHGUC)/negative for malignancy (NM); atypical urothelial cells (AUC); suspicious for high-grade urothelial carcinoma (SHGUC)/suspicious for malignancy (SM); low-grade urothelial neoplasm (LGUN); and HGM categories among satisfactory cytology cases were 83.8% (80.3%-86.9%), 8.0% (6.0%-10.6%), 2.2% (1.4%-3.3%), 0.01% (0.0%-0.1%), and 4.2% (3.2%-5.5%) in TPS versus 80.8% (76.8-2.7%), 11.3% (8.6%-14.7%), 1.8% (1.2%-2.7%), 0.01% (0.0%-0.1%), and 3.3% (2.5%-4.3%) in non-TPS cohorts. Adopting TPS classification resulted in a significant increase in the frequency of NHGUC and a reduction in AUC cytology diagnoses, respectively. The AUC/HGM ratio in TPS cohort was 2.0, which showed a statistically significant difference from the atypical/HGM ratio of 4.1 in non-TPS cohort (p-value: 0.01). Moreover, the summary rate (95% CI) of LGUN called AUC on cytology significantly decreased to 20.8% (14.9%-28.3%) in the TPS compared with 34.1% (26.4%-42.8%) in non-TPS cohorts. The pooled ROHGM (95% CI) was 20.4% (6.2%-50.0%) in nondiagnostic (NDX), 15.5% (9.6%-24.2%) in NHGUC, 40.2% (30.9%-50.2%) in AUC, 80.8% (72.9%-86.8%) in SHGUC, 15.1% (5.7%-34.3%) in LGUN, and 91.4% (87.3%-94.3%) in HGM categories in TPS studies. NHGUC, AUC, SHGUC, and HGM categories were associated with HGM-LR (95% CI) of 0.2 (0.1-0.3), 0.9 (0.6-1.3), 6.9 (2.4-19.9), and 16.8 (8.3-33.8). Our results suggest that TPS 1.0 has reduced the relative frequency of AUC diagnosis, AUC/HGM ratio, and the frequency of LGUNs diagnosed as AUC on cytology. Adopting this classification has improved the clinical utility of SHGUC and HGM cytology diagnoses in ruling in high-grade lesions. However, an NHGUC diagnosis does not reliably rule out the presence of a high-grade lesion.
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Affiliation(s)
- Sahar J Farahani
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Caner, New York, New York, USA
| | - Joshua Li
- Department of Pathology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Beatrice Minder
- Public Health & Primary Care Library, University Library of Bern, University of Bern, Bern, Switzerland
| | - Philippe Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland
- Epistudia, Bern, Switzerland
| | - Taulant Muka
- Epistudia, Bern, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
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Levy JJ, Chan N, Marotti JD, Rodrigues NJ, Ismail AAO, Kerr DA, Gutmann EJ, Glass RE, Dodge CP, Suriawinata AA, Christensen B, Liu X, Vaickus LJ. Examining longitudinal markers of bladder cancer recurrence through a semiautonomous machine learning system for quantifying specimen atypia from urine cytology. Cancer Cytopathol 2023; 131:561-573. [PMID: 37358142 PMCID: PMC10527805 DOI: 10.1002/cncy.22725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Urine cytology is generally considered the primary approach for screening for recurrence of bladder cancer. However, it is currently unclear how best to use cytological examinations for assessment and early detection of recurrence, beyond identifying a positive finding that requires more invasive methods to confirm recurrence and decide on therapeutic options. Because screening programs are frequent, and can be burdensome, finding quantitative means to reduce this burden for patients, cytopathologists, and urologists is an important endeavor and can improve both the efficiency and reliability of findings. Additionally, identifying ways to risk-stratify patients is crucial for improving quality of life while reducing the risk of future recurrence or progression of the cancer. METHODS In this study, a computational machine learning tool, AutoParis-X, was leveraged to extract imaging features from urine cytology examinations longitudinally to study the predictive potential of urine cytology for assessing recurrence risk. This study examined how the significance of imaging predictors changes over time before and after surgery to determine which predictors and time periods are most relevant for assessing recurrence risk. RESULTS Results indicate that imaging predictors extracted using AutoParis-X can predict recurrence as well or better than traditional cytological/histological assessments alone and that the predictiveness of these features is variable across time, with key differences in overall specimen atypia identified immediately before tumor recurrence. CONCLUSIONS Further research will clarify how computational methods can be effectively used in high-volume screening programs to improve recurrence detection and complement traditional modes of assessment.
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Affiliation(s)
- Joshua J. Levy
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Natt Chan
- Program in Quantitative Biomedical Sciences, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Jonathan D. Marotti
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Nathalie J. Rodrigues
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
| | - A. Aziz O. Ismail
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- White River Junction VA Medical Center, White River Junction, VT, 05009
| | - Darcy A. Kerr
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Edward J. Gutmann
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | | | | | - Arief A. Suriawinata
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Brock Christensen
- Department of Epidemiology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Molecular and Systems Biology, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
- Department of Community and Family Medicine, Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Xiaoying Liu
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
| | - Louis J. Vaickus
- Emerging Diagnostic and Investigative Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766
- Dartmouth College Geisel School of Medicine, Hanover, NH, 03756
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Glass R, Cocker R, Rosen L, Coutsouvelis C, Chau K, Slim F, Brenkert R, Sheikh-Fayyaz S, Farmer P, Das K. The impact of subdividing the “atypical” category for urinary cytology on patient management. Diagn Cytopathol 2016; 44:477-82. [DOI: 10.1002/dc.23468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/10/2015] [Accepted: 02/22/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Ryan Glass
- Department of Pathology; Staten Island University Hospital; New York New York
| | - Rubina Cocker
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Lisa Rosen
- North Shore-LIJ Health System; Feinstein Institute for Medical Research; New York New York
| | | | - Karen Chau
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Farah Slim
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Ryan Brenkert
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Silvat Sheikh-Fayyaz
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Peter Farmer
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
| | - Kasturi Das
- Department of Pathology; Hofstra North Shore LIJ School of Medicine; New York New York
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Glass RE, Coutsouvelis C, Sheikh-Fayyaz S, Chau K, Rosen L, Brenkert R, Slim F, Epelbaum F, Das K, Cocker RS. Two-tiered subdivision of atypia on urine cytology can improve patient follow-up and optimize the utility of UroVysion. Cancer Cytopathol 2015; 124:188-95. [DOI: 10.1002/cncy.21630] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Ryan E. Glass
- Department of Pathology; North Shore-LIJ Staten Island University Hospital; Staten Island, New York
| | | | - Silvat Sheikh-Fayyaz
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Karen Chau
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Lisa Rosen
- Department of Biostatistics; Feinstein Institute for Medical Research, North Shore-LIJ Health System; Manhasset, New York
| | - Ryan Brenkert
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Farah Slim
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Fanya Epelbaum
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Kasturi Das
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
| | - Rubina S. Cocker
- Department of Cytopathology; North Shore-LIJ Health System; Lake Success, New York
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