尿液细胞学-巴黎系统
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The Quest for Standardization of Urine Cytology Reporting – The Evolution of the Paris System The ASC Companion Meeting at the 2014 USCAP Rosenthal D, Wojcik E. The ASC Companion Meeting at the 2014 USCAP: the quest for standardization of urine cytology reporting—the evolution of the Paris System. J Am Soc Cytopathol. 2014;3:II–III.
Maybe it was the beautiful weather, perhaps it was the “standing room only” audience, but by any metric, the ASC Companion Meeting was an undisputed success. Moderated by Eva Wojcik, who answered the “Why Paris?” question. Simply put, the quest started in Paris! Last spring, the panelists of the two urine cytology sessions of the 18th Congress of the International Academy of Cytopathology decided to meet and tackle the as yet unsolved issue of standardization of reporting urine cytology. During the first face-to-face meeting, the newly formed “Paris Working Group” outlined an initial classification frame. In the following months the Group obtained the sponsorship of the ASC and IAC, and significantly broadened its membership, particularly to include international members. Currently, to illustrate the true international effort, the Working Group is composed of members from practically all continents. The foundations of the work began in Paris in May 2013 followed by a second meeting of the group at the ASC Annual Meeting in November 2013. Following this, in order to develop consensus and stimulate discussion, a list of discussion-provoking statements was posted on the Paris Website accessible through the ASC (http://www.cytopathology.org/ and IAC (http://www.cytology-iac.org/
websites. That led us to the March 2014 USCAP ASC Companion Meeting. The evening began with an historic review “From Bethesda to Paris - establishing standardized reporting systems”.Ritu Nayar, current ASC President, was the perfect narrator as she has had extensive experience with the Bethesda Systems for Reporting Cervical Cytology and Thyroid Cytology. She described the advantages of a standardized reporting system, and applauded the joint sponsorship of the Paris System by both the ASC and the IAC. Not incidentally, two of the IAC officers were in the audience, Philippe Viehl, President, and Fernando Schmitt, Secretary-treasurer. In addition to the IAC officers, many IAC members of the Paris System Working Group had traveled from afar, including Japan, Europe and South Africa, just to attend this session. Eva Wojcik then described “Urine cytology - What really matters? Pathogenesis of urothelial carcinoma”. The two general pathways, leading to the formation of low grade and high grade urothelial tumors, form the rationale for the Paris System, emphasizing the detection of high grade cancers, and minimizing the low grade lesions. Eva brought the audience up-to-date with the latest molecular evidence for these two pathogenetic pathways. Marcus Quek, Urologic Surgeon from Loyola University Medical Center, shared his view, “What is significant for me? The Urologist's perspective”. As a clinician managing patients based upon cytologic interpretations, he echoed the importance of recognizing high grade lesions. Dr. Quek also supported the rationale for a standardized terminology. Defining adequacy criteria is always a difficult task. Guliz Barkan outlined her group’s studies to provide scientific bases via “Finally: Adequacy criteria for instrumented urines with proposed diagnostic categories and frequencies”. She emphasized that her working group would be critical in defining criteria, and not simply select random numbers as has so often been the case in prior adequacy guidelines. Guliz also discussed published literature emphasizing current lack of standardization that led to a staggering range of reported atypia rates ranging from
1.9% to over 23%. She emphasized that standardizing and defining this indeterminate diagnostic category is a major focus of the evolving system. In addition, she outlined the proposed diagnostic categories and presented the initial data and feedback from the Paris Website open comment period. In search of the morphologic criteria to identify high grade urothelial carcinoma, Dotty Rosenthal queried 