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

Area of Science:

• Urology
• Cytopathology
• Oncology

Background:

• The Paris System for Reporting Urinary Cytology (TPS) offers a standardized framework for urine cytology.
• Accurate risk stratification is crucial for managing urothelial carcinoma.
• Evaluating the diagnostic performance of TPS is essential for clinical application.

Purpose of the Study:

• To determine the pooled risk of high-grade malignancy (ROHM) for each TPS diagnostic category.
• To assess the overall diagnostic accuracy of urine cytology when reported using TPS.
• To provide evidence supporting the clinical utility of TPS in guiding patient management.

Main Methods:

• A systematic literature search was conducted across PubMed, Embase, Scopus, and Web of Science.
• Inclusion and exclusion criteria were applied to select relevant studies.
• Data extraction and quantitative analysis, including meta-analysis of diagnostic accuracy metrics, were performed.

Main Results:

• Pooled ROHM varied significantly across categories, ranging from 13.04% for negative for high-grade urothelial carcinoma (NHGUC) to 91.79% for HGUC and other malignancies.
• The summary Receiver Operating Characteristic (ROC) curve showed an Area Under the Curve (AUC) of 0.849.
• Pooled sensitivity was 0.669, with a false-positive rate of 0.101, and a diagnostic odds ratio (DOR) of 21.258.

Conclusions:

• The Paris System effectively categorizes urine cytology specimens, linking each category to a specific risk of high-grade malignancy.
• TPS demonstrates good diagnostic accuracy for detecting high-grade urothelial carcinoma.
• The findings support the use of TPS in clinical practice for informed decision-making in urologic oncology.