The Paris System for Reporting Urinary Cytology 2022
The Paris System for Reporting Urinary Cytology (TPSRUC, The Paris System [TPS] 1.0-2016 OLDER VERSION | The Paris System for Reporting Urinary Cytology (TPSRUC, The Paris System [TPS] 2.0-2022 NEWER VERSION | Risk of Malignancy (ROM) vs Risk of high-grade Malignancy (ROHM) | Clinical Management | |
ROM (%) (TPS 1.0) | ROHM (%) (TPS 2.0) | |||
I)non-diagnostic | I)non-diagnostic | <5-10 | 0-16 | Identify cause, repeat sample depending on the risk of malignancy |
II)Negative for high grade urothelial carcinoma (NHGUC) | II)Negative for high grade urothelial carcinoma (NHGUC) | 0-10 | 8-24 | Continue the routine surveillance at intervals as per the risk of recurrence |
III)Atypical urothelial cells (AUC) | III)Atypical urothelial cells (AUC) | 8-35 | 24-53 | Individualized workup based on the risk |
IV) Suspicious for high-grade urothelial carcinoma (SHGUC) | IV) Suspicious for high-grade urothelial carcinoma (SHGUC) | 50-90 | 59-94 | Active investigation to identify the source of the suspicious or positive cells - for both lower and upper tracts in form of CPE and cross sectional imaging for upper tract either as CT or MRI |
VI)Low-grade urothelial neoplasm (LGUN) | Categorized under Negative for high grade UC | |||
V)High grade urothelial carcinoma (HGUC) | V)High grade urothelial carcinoma (HGUC) | >90 | 76-100 | Active investigation to identify the source of the suspicious or positive cells |
Novel Molecular Classification of Muscle Invasive Bladder Cancer
Subtypes | Luminal papillary (LumP) | Luminal non-specified (LumNS) | Luminal unstable (LumU) | Stroma-rich | Basal/squamous (Ba/Sq) | Neuroendocrine-like (NE-Like) |
Differentiation Type | Luminal | Luminal | Luminal | Luminal and Basal | Basal and Squamous | Neuroendocrine |
Expression of Genes | PPARγ GATA3 FOXA1 UPK1A UPK2 KRT20 ESR2 | PPARγ GATA3 FOXA1 UPK1A UPK2 KRT20 ESR2 | PPARγ GATA3 FOXA1 UPK1A UPK2 KRT20 ESR2 | Markers of smooth muscle, endothelium, fibroblasts, myofibroblasts | KRT5 KRT6A KRT14 CD44 TGM1 DSC3 PI3 | Synaptophysin CGA NSE/CD56 |
Alternation of Genomic | -FGFR3 Alternation (Over expression Amplification or FGFR3-TAC3 Fusions) -KDM6A Mutations -CDKN2A Deletions | -ELF3 Mutations -Amplification or Fusion of PPARγ | -PPARγ Mutation -Over-expression of E2F3 and SOX4, -Mutation affecting nucleotide-excision repair pathway, ERCC2 TP53 Mutation | TP53 or RB1 | Inactivation/Mutation/Deletion of TP53 or RB1 | |
Infiltration | Not seen | -Stromal Cells i.e. Fibroblasts, -Immune cells i.e. Lymphocytes B and T | Not seen | Stromal and Immune cells (T and B- Cells) | Immune Cells- Cytotoxic Lymphocytes and NK cells | Not Seen |
Prognosis | The Best | Poor | Intermediate | Intermediate | Poor | The Worst |
Compiled by Dr Siddharth Verma, VMMC & SJH, New Delhi
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