Skip to main content

Suspicious for High-Grade Urothelial Carcinoma (SHGUC)

  • 282 Accesses


The diagnosis of suspicious for high-grade urothelial carcinoma (SHGUC) is meant to reflect the presence of a small number of urothelial cells with increased nuclear-to-cytoplasmic ratio and severe nuclear atypia that falls short for a diagnosis of HGUC, but beyond atypia that is associated with the category of atypical urothelial cells (AUC). This chapter describes the detailed quantitative and qualitative cytomorphologic criteria needed for a diagnosis of SHGUC. It also discusses the prevalence of this diagnosis in the literature and the associated risk of high-grade malignancy (ROHM).


  • High-grade urothelial carcinoma (HGUC)
  • Suspicious for HGUC (SHGUC)
  • Atypia
  • Severe atypia.

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-88686-8_5
  • Chapter length: 12 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
USD   54.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-88686-8
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   69.99
Price excludes VAT (USA)
Fig. 5.1
Fig. 5.2
Fig. 5.3
Fig. 5.4
Fig. 5.5
Fig. 5.6
Fig. 5.7
Fig. 5.8
Fig. 5.9
Fig. 5.10
Fig. 5.11
Fig. 5.12
Fig. 5.13
Fig. 5.14
Fig. 5.15


  1. Stanzione N, Ahmed T, Fung PC, Cai D, Lu DY, Sumida LC, Moatamed NA. The continual impact of the Paris system on urine cytology, a 3-year experience. Cytopathology. 2020;31(1):35–40. PMID: 31596979.

    CrossRef  Google Scholar 

  2. de Paula R, Oliveira A, Nunes W, Bovolim G, Domingos T, De Brot L, Bezerra S, Cunha I, Morini M, Saieg M. Two-year study on the application of the Paris system for urinary cytology in a cancer centre. Cytopathology. 2020;31(1):41–6. PMID:

    CrossRef  Google Scholar 

  3. Wang Y, Auger M, Kanber Y, Caglar D, Brimo F. Implementing the Paris system for reporting urinary cytology results in a decrease in the rate of the “atypical” category and an increase in its prediction of subsequent high-grade urothelial carcinoma. Cancer Cytopathol. 2018; PMID: 29278461.

    Google Scholar 

  4. Rohilla M, Singh P, Rajwanshi A, Gupta N, Srinivasan R, Dey P, Kakkar N. Cytohistological correlation of urine cytology in a tertiary centre with application of the Paris system. Cytopathology. 2018;29(5):436–43. PMID: 29920811.

    CrossRef  Google Scholar 

  5. Hassan M, Solanki S, Kassouf W, Kanber Y, Caglar D, Auger M, Brimo F. Impact of implementing the Paris system for reporting urine cytology in the performance of urine cytology. Am J Clin Pathol. 2016;146(3):384–90. PMID: 27543983.

    CrossRef  Google Scholar 

  6. Xing J, Monaco S, Pantanowitz L. The ability of the Paris system to stratify the risk of high-grade urothelial carcinoma. J Am Soc Cytopathol [Internet]. Elsevier Inc; 2018;7(5):S43. Aveailable from:

  7. Nguyen L, Nilforoushan N, Krane JF, Bose S, Bakkar R. Should "suspicious for high-grade urothelial carcinoma" and "positive for high-grade urothelial carcinoma" remain separate categories?. Cancer Cytopathol. 2020. PMID: 33036060.

    Google Scholar 

  8. Zare S, Mirsadraei L, Reisian N, Liao X, Roma A, Shabaik A, Hasteh F. A single institutional experience with the Paris system for reporting urinary cytology: correlation of cytology and histology in 194 cases. Am J Clin Pathol. 2018;150(2):162–7. PMID: 29878037.

    CrossRef  Google Scholar 

  9. Granados R, Duarte JA, Corrales T, Camarmo E, Bajo P. Applying the Paris system for reporting urine cytology increases the rate of atypical urothelial cells in benign cases: a need for patient management recommendations. Acta Cytol. 2017;61(1):71–6. PMID: 27838683.

    CAS  CrossRef  Google Scholar 

  10. Brimo F, Xu B, Kassouf W, Ahmadi-Kaliji B, Charbonneau M, Nahal A, Kanber Y, Caglar D, Auger M. Urine cytology: does the number of atypical urothelial cells matter? A qualitative and quantitative study of 112 cases. J Am Soc Cytopathol. 2015;4(4):232–8. PMID: 31051759.

    CrossRef  Google Scholar 

  11. McCroskey Z, Bahar B, Hu Z, Wojcik E, Barkan G. Subclassifying atypia in urine cytology: what are the helpful features? J Am Soc Cytopathol. 2015;4(4):183–9. PMID: 31051752.

    CrossRef  Google Scholar 

  12. Daniel F. I. Kurtycz, Fadi Brimo, Dorothy L. Rosenthal, Momin T. Siddiqui, Z. Laura Tabatabai, Christopher J. VandenBussche, Eva M. Wojcik, Güliz A. Barkan, Perceptions of Paris: An international survey in preparation for The Paris System for Reporting Urinary Cytology 2.0 (TPS 2.0), accepted, American Society of Cytopathology’s 66rd Annual Scientific Meeting, Las Vegas, Nevada, November 11–14, 2021.

    Google Scholar 

  13. Meilleroux J, Daniel G, Aziza J, d’Aure DM, Quintyn-Ranty ML, Basset CML, Evrard SM, Courtade-Saidi MM. One year of experience using the Paris system for reporting urinary cytology. Cancer Cytopathol. 2018;126(6):430–6. PMID: 29663682.

    CrossRef  Google Scholar 

  14. Bakkar R, Mirocha J, Fan X, Frishberg DP, Peralta-Venturina M, de Zhai J, Bose S. Impact of the Paris system for reporting urine cytopathology on predictive values of the equivocal diagnostic categories and interobserver agreement. Cytojournal. 2019;16:21.

    CrossRef  Google Scholar 

  15. Pastorello RG, Barkan GA, Saieg M. Experience on the use of The Paris System for Reporting Urinary Cytopathology: review of the published literature. J Am Soc Cytopathol. 2020:S2213–2945(20)30323–9.

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Fadi Brimo .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Brimo, F. et al. (2022). Suspicious for High-Grade Urothelial Carcinoma (SHGUC). In: Wojcik, E.M., Kurtycz, D.F., Rosenthal, D.L. (eds) The Paris System for Reporting Urinary Cytology. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88685-1

  • Online ISBN: 978-3-030-88686-8

  • eBook Packages: MedicineMedicine (R0)