The Paris System For Reporting Urinary Cytology: A Meta-Analysis

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Abstract

The Paris System (TPS) for Reporting Urinary Cytology is a standardized, evidence-based reporting system, comprising seven diagnostic categories: nondiagnostic, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells (AUC), suspicious for high-grade urothelial carcinoma (SHGUC), HGUC, low-grade urothelial neoplasm (LGUN), and other malignancies. This study aimed to calculate the pooled risk of high-grade malignancy (ROHM) of each category and demonstrate the diagnostic accuracy of urine cytology reported with TPS. Four databases (PubMed, Embase, Scopus, Web of Science) were searched. Specific inclusion and exclusion criteria were applied, while data were extracted and analyzed both qualitatively and quantitatively. The pooled ROHM was 17.70% for the nondiagnostic category (95% CI, 0.0650; 0.3997), 13.04% for the NHGUC (95% CI, 0.0932; 0.1796), 38.65% for the AUC (95% CI, 0.3042; 0.4759), 12.45% for the LGUN (95% CI, 0.0431; 0.3101), 76.89 for the SHGUC (95% CI, 0.7063; 0.8216), and 91.79% for the HGUC and other malignancies (95% CI, 0.8722; 0.9482). A summary ROC curve was created and the Area Under the Curve (AUC) was 0.849, while the pooled sensitivity was 0.669 (95% CI, 0.589; 0.741) and false-positive rate was 0.101 (95% CI, 0.063; 0.158). In addition, the pooled DOR of the included studies was 21.258 (95% CI, 14.336; 31.522). TPS assigns each sample into a diagnostic category linked with a specific ROHM, guiding clinical management.

Keywords: bladder cancer; cytopathology; diagnostic accuracy; pathology; risk of high-grade malignancy (ROHM); sensitivity and specificity; tumor; urine; urothelial carcinoma; urothelial neoplasia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1

Flowchart of this meta-analysis.

Figure 1

Flowchart of this meta-analysis.

Figure 2

SROC curve of the included…

Figure 2

SROC curve of the included studies.

Figure 3

Diagnostic Odds Ratio (DOR) of…

Figure 3

Diagnostic Odds Ratio (DOR) of the eligible studies.

Figure 4

Diagnostic Odds Ratio (DOR) of…

Figure 4

Diagnostic Odds Ratio (DOR) of the eligible studies using conventional cytology.

Figure 5

Diagnostic Odds Ratio (DOR) of…

Figure 5

Diagnostic Odds Ratio (DOR) of the eligible studies using liquid-based cytology.

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