The first edition of The Paris System for Reporting Urinary Cytology introduced a completely new paradigm for detecting bladder cancer by urine cytology. This system concentrated on defining morphological characteristics of the most clinically significant form of bladder cancer, High Grade Urothelial Carcinoma. This new approach has been widely accepted throughout the world, and has become part of the daily practice of cytology. Considering that the first edition of The Paris System (TPS) introduced a new model of urinary cytodiagnosis, verification and expansion of initial material and data were anticipated. Based on evolving knowledge and readership requests, the group of highly experienced authors have created a new edition of TPS. This second edition includes areas and issues not originally covered. A new chapter on urine cytology of the upper tract, a rarely addressed topic, has been introduced. Furthermore, the issue of cellular degeneration is discussed in the criteria of all diagnostic categories. Examples of standardized reports are included in each chapter. Most importantly, a separate chapter presents data defining the risk of malignancy (ROM) for each diagnostic category to inform clinical management. New high quality images augment those of the first edition to better illustrate diagnostic clues and potential pitfalls. In addition to chapters on diagnostic criteria, current concepts of pathogenesis of bladder cancer, specimen adequacy and preparation, and ancillary tests are covered in separate chapters. A bonus to the volume is a comprehensive history of urine as the earliest diagnostic sample of human disease, richly illustrated with artworks from major museums.
Written by internationally recognized authorities, this comprehensive and evidence-based guide to urine cytology is supported by the newest data confirming the original concept and significance of diagnostic criteria defining High Grade Urothelial Carcinoma. TPS is an essential tool for anyone who is practicing urinary cytology, including cytotechnologists, pathologists-in-training and practicing pathologists. This book should find a place in every cytology laboratory throughout the world.
The Concept has been endorsed by the American Society of Cytopathology, and the International Academy of Cytology.
Author(s): Eva M. Wojcik, Daniel F.I. Kurtycz, Dorothy L. Rosenthal
Edition: 2
Publisher: Springer
Year: 2022
Language: English
Pages: 339
City: Cham
Preface
Introduction
Abbreviations
Contents
Contributors
Editors
Authors
1: Pathogenesis of Urothelial Carcinoma
Summary of Changes in the Second Edition
Background
Molecular Pathways of Neoplastic Transformation of Urothelium
References
2: Adequacy of Urine Specimens (Adequacy)
Summary of Changes in the Second Edition
Background
The Adequacy Algorithm
Volume and Adequacy
Cellularity and Adequacy
The Less Than Optimal Adequacy Category
Recommendations
Future Directions
Sample Reports
Example 1
Example 2
Example 3
Example 4
Example 5
References
3: Negative for High-Grade Urothelial Carcinoma (NHGUC)
Summary of Changes in the Second Edition
Background
Definition of Negative for High-Grade Urothelial Carcinoma (NHGUC)
Criteria of Components of NHGUC
Benign Superficial (Umbrella) Urothelial Cells
Squamous Epithelial Cells, Both Superficial and Intermediate
Glandular Cells
Degenerative Changes
Urothelial Tissue Fragments
Benign Urothelial Tissue Fragments
Atypical Urothelial Tissue Fragments (AUTFs)
Low-Grade Urothelial Neoplasia (LGUN)
Urothelial Tissue Fragments (UTFs) in Voided Urine
Benign Urothelial Tissue Fragments (BUTFs) in Instrumented Urine
Urolithiasis (“Stone Atypia”)
Urothelial Changes Characteristic of Infectious Processes
Acute Bacterial Infections
Characteristic Viral Cytopathic Effects
Parasites
Urothelial Changes Associated with Treatment Effects
Radiation
Immunotherapy
Chemotherapy
Seminal Vesicle Cells
Bladder Diversion Specimens
The Rate of Negative Samples in a Usual Laboratory Population
Category Performance
Sample Reports
References
4: Atypical Urothelial Cells (AUC)
Summary of Changes in the Second Edition
Background
Definition
Clarification of Issues Unresolved by the First Edition of TPS Regarding Atypia
Urothelial Degeneration: Does Degeneration Mean Atypia?
Atypical Squamous Cells (ASC) and Categorization
Nuclear Cytoplasmic (N/C) Ratio as a Criterion
TPS Criteria Including Those for AUC Are Maintained for Upper Tract Samples
TPS Criteria Including Those for AUC Are Currently Maintained for All Preparation Types
Updates from The Paris System Survey (2020)
Criteria
Explanatory Notes
Conclusion
Sample Reports
Example 1
Example 2
References
5: Suspicious for High-Grade Urothelial Carcinoma (SHGUC)
Summary of Changes in the Second Edition
Background
Definition
Criteria
Explanatory Notes
Prevalence of SHGUC
Risk of Malignancy
Management
References
6: High-Grade Urothelial Carcinoma (HGUC)
Summary of Changes in the Second Edition
Background
Introduction
Required Cytomorphologic Criteria of Malignancy for HGUC
Additional Cytomorphologic Features
Variances Noted in the Cytomorphology of HGUC
Important Histologic Variants of HGUC in Urine Cytology
Sample Reports
Example 1
Example 2
Example 3
References
7: Cytopathology of the Upper Urinary Tract
Background
Definition of Upper Tract Urothelial Carcinoma (UTUC)
Etiology of Upper Tract Urothelial Carcinoma
UTUC Prevalence
Molecular Biology of Upper Tract Urothelial Carcinoma
Molecular Biology of UTUC Vs. UCB
Molecular Biology of Upper Tract HGUC Vs. Upper Tract LGUC
Criteria for Upper Tract Urothelial Carcinomas
General Criteria for HGUC
Upper Tract HGUC in Instrumented Specimens
Upper Tract HGUC in Voided Urine Specimens
Upper Tract Low-Grade Urothelial Neoplasms (LGUN)
Performance of Urinary Cytology for Upper Tract Urothelial Carcinoma
Historical Performance of Urinary Cytology for UTUC
Modern Performance of Urinary Cytology for Upper Tract Urothelial Carcinoma
Modern Performance of Urinary Cytology for UTHGUC
Modern Performance of Urinary Cytology for Upper Tract LGUN
Clinical Management of Upper Tract Urothelial Carcinoma
Special Considerations for Collection, Preparation, and Adequacy
Specimen Collection
The Role of Cell Blocks
Adequacy
Ancillary Testing in Upper Tract Urothelial Carcinoma
Examples of Reports
Upper Tract HGUC in Instrumented Specimens (with Cell Block)
Upper Tract NHGUC in Voided Urine Specimens (with Cell Block) (Upper Tract lesion by radiology)
References
8: Non-Urothelial Malignancies and Other Miscellaneous Lesions
Summary of Changes in the Second Edition
Introduction
Non-urothelial Malignancies
Background
Primary Epithelial Malignancies
Primary Squamous Cell Carcinoma
Background
Definition
Cytologic Criteria
Explanatory Notes
Atypical Squamous Cells
Background
Definition
Explanatory Notes
Primary Adenocarcinoma
Background
Definition
Criteria
Explanatory Notes
Neuroendocrine Tumors
Background
Definition of SmCC
Criteria
Explanatory Notes
Secondary Epithelial Malignancies
Background
Colorectal AdCa
Prostate AdCa
Gynecologic Malignancies
Breast AdCa
Gastric AdCa
Lung Carcinoma
Renal Cell Carcinoma
Non-epithelial Malignancies
Background
Sarcoma
Definition
Criteria
Explanatory Notes
Malignant Melanoma
Background
Definition
Criteria (Fig. 8.36)
Explanatory Notes
Hematopoietic Malignancies
Background
Lymphoma
Plasmacytoma
Other Miscellaneous Lesions
Paraganglioma
Nephrogenic Adenoma
Sample Reports
Example 1
Example 2
Example 3
Example 4
Example 5
Example 6
Example 7
Example 8
Example 9
Example 10
Example 11
References
9: Ancillary Studies in Urinary Cytology
Summary of Changes in the Second Edition.
Background
Pre-Analytical Procedures, Technique, and Evaluation of UroVysion® FISH
Specimen Preparation
Analysis of FISH Signals
Imaging and Automation of UroVysion® FISH Analysis
Advantages of an Automated Imaging System
Details of Automated Imaging Systems
Target FISH
Reporting of Results
Performance of UroVysion® FISH Testing
UroVysion® FISH in Atypical Urinary Cytology
Change of TPS Category after U-FISH Analysis
Cost-Effectiveness of UroVysion® FISH
Pitfalls in UroVysion® FISH Analysis
FDA-Approved Liquid-Based Tests
BTA Test
The NMP22 Test
Other Liquid-Based Biomarkers
Ancillary Tests Based on Next-Generation Sequencing Technology
Conclusions
Sample Reports
The Influence of UroVysion FISH on the Interpretation of Cytological Findings in Urinary Samples
Example 1 (AUC, FISH Negative)
Example 2 (SHGUC after BCG, FISH Positive)
Example 3 (AUC in Bladder Washing from Negative Surveillance Cystoscopy, FISH Positive)
Example 4 (AUC in Voided Urine, FISH Positive)
Example 5 (AUC in Bladder Washing, Tetraploid FISH Pattern)
Appendix
UroVysion® Assay
Automated Imaging Systems for UroVysion® FISH Analysis
References
10: Cytopreparatory Techniques
Summary of Changes in the Second Edition
Background
Specimen Collection
Assessment
Processing
Preparation Methods
Liquid Based Preparation
Cytocentrifugation
Direct Smear Preparation
Liquid Based Preparation
Millipore Filtration (EMD Millipore, Billerica, MA)
Cell Block Preparations
Centrifugation Sediment Cell Block
Shandon Cytoblock™ Cell Block
Cellient® Cell Block
Discussion
Conclusions and Recommendations
Appendix A: Centrifugation Process Standard Operating Procedure
Title
Purpose
Responsibilities
Equipment
Procedure
Training
Revision History
Appendix B: ThinPrep™ Process Standard Operating Procedure
Title
Purpose
Scope
Responsibilities
Procedure
Training
Revision History
Appendix C: SurePath™ Preparation Using BD Totalys™ MultiProcessor for Non-gynecologic Processing
Title
Appendix D: Cytocentrifuge Cell Block Process Standard Operating Procedure
Title
Purpose
Responsibilities
General Guidelines/Policy
Training
Revision History
References
11: Risk of High-Grade Malignancy (ROHM)
Background
Current Evidence for ROHM
ROHM in Low-Grade Neoplasms
Overall Performance of TPS
Conclusion
References
12: Clinical Management
Summary of Changes in the Second Edition
Background
Management of Negative for High-Grade Urothelial Carcinoma (NHGUC)
Management of Atypical Urothelial Cells (AUC)
Management of Suspicious (SHGUC) and Positive for High-Grade Urothelial Carcinoma (HGUC)
Management of Low-Grade Urothelial Neoplasms (LGUN)
Management of Non-urothelial Tumors
Management of the Unsatisfactory Specimen
Conclusions
References
13: The History of Urinary Cytology: The Long and Winding Road to Paris 2.0
Ancient History
The Beginnings of the Study of Cells in the Urine (Urine Cytology)
The Modern Era
References
Afterword – Honoring the Past, Anticipating the Future
Future Clinical and Research Needs
Index
