{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T01:16:06Z","timestamp":1783041366831,"version":"3.54.6"},"reference-count":75,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Since the release of The Paris System for Reporting Urinary Cytology (TPS), the assessment of urine cytology specimens has primarily focused on the detection of high-grade urothelial carcinoma (HGUC) and carcinoma in situ (CIS). Fortunately, the malignant cells in these lesions tend to be loosely cohesive, resulting in the natural exfoliation of individual malignant cells into the urine. However, HGUC\/CIS lesions occasionally exfoliate larger fragments which can be difficult to assess due to cellular overlap and fragment three-dimensionality. Furthermore, reactive benign urothelial fragments and fragments from low-grade urothelial neoplasms (LGUN) may also be seen in urine specimens and contain atypical cytomorphologic features. As a result, the significance of urothelial tissue fragments (UTFs) is often unclear. Herein, we discuss the literature on UTFs before and after the implementation of TPS, as well as strategies to help overcome this diagnostic challenge.<\/jats:p>","DOI":"10.3390\/diagnostics12040931","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T12:11:14Z","timestamp":1649419874000},"page":"931","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Diagnostic Dilemma of Urothelial Tissue Fragments in Urinary Tract Cytology Specimens"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-2474","authenticated-orcid":false,"given":"Derek B.","family":"Allison","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Lexington, KY 40536, USA"},{"name":"Department of Urology, University of Kentucky College of Medicine, Lexington, KY 40536, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8029-4787","authenticated-orcid":false,"given":"M. Lisa","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6055-4465","authenticated-orcid":false,"given":"Poonam","family":"Vohra","sequence":"additional","affiliation":[{"name":"Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8822-5655","authenticated-orcid":false,"given":"Christopher J.","family":"VandenBussche","sequence":"additional","affiliation":[{"name":"Departments of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1159\/000446270","article-title":"The Paris system for reporting urinary cytology: The quest to develop a standardized terminology","volume":"60","author":"Barkan","year":"2016","journal-title":"Acta Cytol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1111\/cyt.12345","article-title":"A review of the Paris system for reporting urinary cytology","volume":"27","author":"VandenBussche","year":"2016","journal-title":"Cytopathology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jasc.2021.12.003","article-title":"We\u2019ll always have Paris the Paris system for reporting urinary cytology 2022","volume":"11","author":"Wojcik","year":"2022","journal-title":"J. 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