Urine cytology is a rapid, simple, and the chief technique for detecting urinary tract cancer [1]. Urine cytology has variable sensitivity and specificity. Xing et al.'s study reported variable suboptimal sensitivity, especially low-grade neoplasm, and was highly specific for diagnosing urothelial cancer in urine cytology [1]. To overcome this limitation of urine cytology, different reporting systems were introduced from time to time [[2], [3], [4]]. The Paris System 1.0 (TPS 1.0) was introduced in 2016 for uniform and standardized reporting of urine cytology [4]. After six years in the practice of TPS 1.0, few pitfalls were encountered which included more false negative cases of urinary bladder (UB) cancers and high risk of malignancy for category negative for high-grade urothelial cancer (NHGUC) [5].Apart from it, TPS1 has been reported to have low sensitivity (37.5 to 46.0 %) and low positive predictive value (70.6 to 96 %) for diagnosing high-grade urothelial carcinoma (HGUC) [6]. The reported risk of malignancy (ROM) varied from different categories of TPS1.0, which was not conclusive [6,7]. To overcome these limitations of TPS1.0, TPS 2.0 was introduced in 2022 as an update of TPS [8,9]. TPS 2.0 categorizes urine cytology smears into 6 categories and includes non-diagnostic (ND), NHGUC, atypical urothelial cells (AUC), suspicious for high-grade urothelial cancer (SHGUC), HGUC and other malignancy (OM). In TPS 2.0, low-grade urothelial neoplasm (LGUN) category cases have been clubbed in the NHGUC category [8,9]. TPS 2.0 added three new chapters entitled Upper Urinary Tract Cytology, risk of high-grade Malignancies (ROHM) and history of urine cytology [9]. The main aim of TPS 2.0 is to increase the sensitivity and specificity of urine cytology to detect the risk of malignancy (ROM), especially high-grade urothelial cancer (ROHM).

Thus, considering the above context, we planned to assess the diagnostic accuracy and ROHM of the urinary tract using TPS 2.0 compared to TPS 1.0 and the conventional reporting system (CR) for urine cytology.