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Abstract：
The diagnosis of atypia has always been under question both by the pathologist and the clinician. It was one of the main aims of the Paris system (TPS) to reduce the number of cases under the AUC (Atypical urothelial cells) category. With the strict criteria laid down by the Paris system, the rate of diagnosis of this category has reduced markedly. This study was done to test the impact of implementing TPS categories and criteria in comparison to our previously used system. TPS is one of the important deciding factors for the management of the patient. The management of patients with AUC diagnosis often varies depending on the treating physician (urologist/nonurologist). For further categorization of the diagnosis of AUC, markers like p53 and Ki67 can be used. One hundred urinary cytology specimens received for the period of 6 months were included in the study. The presentation of the categorical variables was done in the form of numbers and percentages (%). Interrater kappa agreement was used to find out the strength of the agreement between the Paris system and the traditional system. Using histopathological diagnosis as the gold standard, sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic accuracy were calculated. Immunohistochemistry was performed on the cell block for Ki67 and p53, and their values were correlated with histopathological examination, using Spearman\'s rank correlation. The interrater kappa agreement analyzed between the traditional reporting system and the Paris system was 0.522. Around 32% (6/19) of cases that were reported as AUC by the traditional system were recategorized under negative for high-grade urothelial carcinoma (NHGUC) by the Paris system. Thus, obliviating the need for further management and decreasing the unnecessary cost of the health care system with a decrease in patient anxiety. Histopathology was available in 28 cases and diagnostic accuracy of urine cytology classified by TPS was 89.2% with a sensitivity of 94.4%, specificity of 80%, positive likelihood ratio of 89.4, and negative likelihood ratio of 88.6. The correlation coefficient of p53 with grading of carcinoma was found to be strong at 0.864. The correlation coefficient of Ki67 with grading of carcinoma was also as strong as 0.885. TPS along with immunohistochemistry improves the performance of urine cytology by reclassifying the AUC category into other groups and increases the sensitivity for detecting HGUC.
摘要：
病理学家和临床医生一直在质疑非典型性的诊断。巴黎系统（TPS）的主要目标之一是减少AUC（非典型尿路上皮细胞）类别下的病例数。在巴黎系统制定的严格标准下，该类别的诊断率明显下降。这项研究是为了测试与我们以前使用的系统相比，实施TPS类别和标准的影响。TPS是患者管理的重要决定因素之一。AUC诊断患者的管理通常取决于治疗医师（泌尿科医师/非泌尿科医师）。对于AUC诊断的进一步分类，可以使用p53和Ki67等标记。该研究包括在6个月期间接受的一百个尿细胞学标本。分类变量的表示以数字和百分比(%)的形式进行。使用Interraterkappa协议来找出巴黎系统与传统系统之间协议的强度。以组织病理学诊断为金标准,灵敏度,特异性，正似然比(PLR)，负似然比(NLR)，并计算诊断准确性。对Ki67和p53的细胞块进行免疫组织化学，它们的值与组织病理学检查相关，使用斯皮尔曼的等级相关性。传统报告系统和巴黎系统之间分析的评分者kappa协议为0.522。巴黎系统将传统系统报告为AUC的约32％（6/19）的病例重新分类为高级别尿路上皮癌（NHGUC）阴性。因此，克服了进一步管理的需要，并降低了医疗保健系统的不必要成本，同时减少了患者的焦虑。28例有组织病理学检查，按TPS分类的尿细胞学诊断准确率为89.2％，灵敏度为94.4％。特异性为80%，正似然比为89.4，负似然比为88.6。发现p53与癌症分级的相关系数为0.864。Ki67与癌症分级的相关系数也高达0.885。TPS与免疫组织化学一起通过将AUC类别重新分类到其他组来改善尿细胞学的性能，并增加检测HGUC的灵敏度。
