Ranjana Shashidhar Ranade1, Netra Prakash Kori2, Vidisha Sharatchandra Athanikar3
BACKGROUND
Urine cytology when combined with cystoscopy remains a gold standard in
screening and surveillance of urothelial carcinoma. Paris system for reporting urine
cytology (PSRUC) gives seven well defined diagnostic criteria. We aimed to analyse
utility of urine cytology in patients with urogenital symptoms, compare existing
institutional system (EIS) with PSRUC and assess the performance of both
reporting systems in predicting subsequent high-grade urothelial carcinoma on
histopathology.
METHODS
A five year retrospective study included a total of 146 urine samples from 74
patients. Each case was assigned a category according to both EIS and PSRUC
system. After cyto-histological correlation, sensitivity, specificity and diagnostic
accuracy of urine cytology in detecting malignancy using PSRUC and EIS were
determined. Performance of urine cytology in predicting subsequent high grade
urothelial carcinoma (HGUC) was assessed for both reporting systems.
RESULTS
PSRUC resulted in reduction in number of cases assigned to atypical category (10.5
% vs. 3.4 %) and increase in low grade carcinomas assigned to NGUC category
(66 % vs. 100 %). Positive predictive value (PPV) for predicting subsequent high
grade urothelial carcinoma for HGUC and SHGUC category remained the same
(100 %). Sensitivity (66.67 % vs. 55.5 %), specificity (100 % vs. 85.71 %) and
diagnostic accuracy (81 % vs. 68.75 %) was improved with application of PSRUC
when compared to EIS. Two cases of genitourinary tuberculosis were diagnosed.
CONCLUSIONS
PSRUC improves predictive accuracy of subsequent high-grade urothelial
carcinoma on histopathology and it ensures uniformity in reporting. Judicious use
of urine cytology might aid in early diagnosis of infectious conditions like
tuberculosis.
