Bridging Perspectives: Integrating urologist and cytopathologist insights of urine cytology

In this comprehensive review, we explore the integration of both cytopathologic and urologic perspectives around interpretation of urine cytology under the Paris System for Reporting Urinary Cytology (TPS) and clinical management. Urine cytology is a pivotal diagnostic tool for urologists, especially in the detection and management of high-grade urothelial carcinoma (HGUC). The review highlights how TPS has standardized urine cytology interpretations through consistent diagnostic criteria and reduced atypical diagnoses. This standardization aids in communication between pathologists and clinicians. There is an educational need to foster more effective collaboration between urologists and cytopathologists. Clinicians are not formally educated about TPS, and guidelines do not exist for how TPS diagnostic categories should impact patient treatment/management. Therefore, as TPS continues to evolve, it is important for pathologists to understand how urologists perceive TPS and use its diagnostic categories. This review addresses the clinical management of various diagnostic categories under TPS, illustrating how urologists integrate urine cytology results with endoscopic and radiologic data to monitor recurrence, progression, and metastasis of bladder cancer. It also covers the adjunctive use of urinary biomarkers and advanced cystoscopic techniques to enhance diagnostic accuracy. By bridging cytopathologic insights with urologic clinical applications, this review provides a holistic understanding of the diagnostic and management strategies for bladder cancer, underscoring the indispensable role of urine cytology in urologic practice.