Background: The diagnosis of upper urinary tract urothelial carcinoma (UTUC) in cytological specimens is challenging, particularly the designation of atypical urothelial cells (AUC). The application of the Paris System for Reporting Urinary Cytology (TPS) has improved the performance of lower tract urothelial carcinoma specimens but has shown variable results in upper tract specimens, which are frequently instrumented. Methods: This retrospective study analysed upper tract selective cytology samples from January to December 2023. Samples were classified under TPS 2.0 categories. Histological specimens were used where available as the gold standard to calculate statistical metrics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Out of 122 samples, 12.2% were considered non-diagnostic or insufficient, with 13.1% designated as Non-high-grade urothelial carcinoma (N-HGUC), 53.3% as atypical urothelial cells (AUC) and 21.3% as positive/suspicious for HGUC. Histopathological correlation was available for 48.7% of cases. The risk of malignancy was: NHGUC (0%), AUC (47%) and HGUC (77.7%). The highest PPV was for HGUC (78%), with a diagnostic accuracy of 81.3% and specificity of 88%. In contrast, AUC had a PPV of 47% in instrumented and non-instrumented samples, rising to 58% in combination with the HGUC category. Conclusion: TPS 2.0 is an effective tool with excellent diagnostic accuracy for HGUC and in excluding malignancies in the N-HGUC category, but in our hands, the high rates of the AUC category, together with the low PPV, remain a major challenge and an obstacle to the correct stratification of patients with UTUC.
背景：上尿路尿路上皮癌（UTUC）在细胞学标本中的诊断具有挑战性，尤其是非典型尿路上皮细胞（AUC）的判定。巴黎尿路细胞学报告系统（TPS）的应用改善了低级别尿路上皮癌标本的诊断效能，但在经常进行器械操作的上尿路标本中，其应用效果存在差异。方法：本回顾性研究分析了2023年1月至12月的上尿路选择性细胞学样本。样本根据TPS 2.0标准进行分类。在可获得的情况下，以组织学标本作为金标准，计算包括敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）在内的统计指标。结果：在122份样本中，12.2%被认为无法诊断或样本不足，13.1%被判定为非高级别尿路上皮癌（N-HGUC），53.3%为非典型尿路上皮细胞（AUC），21.3%为HGUC阳性/可疑。48.7%的病例可获得组织病理学对照。恶性风险分别为：NHGUC（0%）、AUC（47%）和HGUC（77.7%）。HGUC类别的PPV最高（78%），诊断准确率为81.3%，特异性为88%。相比之下，AUC类别在器械操作和非器械操作样本中的PPV为47%，与HGUC类别合并计算时升至58%。结论：TPS 2.0是一个有效的工具，对于HGUC的诊断和排除N-HGUC类别的恶性肿瘤具有出色的诊断准确性。但在我们的实践中，AUC类别的高比例及其低PPV，仍然是正确分层UTUC患者的主要挑战和障碍。
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