Glass Ryan, Rosca Oana, Raab Stephen, Szabelska Jolanta, Chau Karen, Sheikh-Fayyaz Silvat, Cocker Rubina
Department of Pathology, Staten Island University Hospital, Staten Island, New York.
Department of Pathology, University of Mississippi, Jackson, Mississippi.
Diagn Cytopathol. 2019 Jul;47(7):675-681. doi: 10.1002/dc.24166. Epub 2019 Apr 24.
Implementing the Paris system for reporting urine cytology (TPS) can substantiate atypical diagnosis while improving standardization and risk stratification. This study evaluates its performance and reproducibility in challenging cases and examines whether focused education of morphological features can improve outcomes.
In our prior study, urine cytology cases diagnosed as "atypical" with surgical follow-up were used. Cases showing poor agreement in that study were collected for this one. Representative photographs of each case were taken and distributed via online questionnaires. Participants were asked to render an initial diagnosis and evaluate the presence of several morphological features. Educational material was distributed, followed by additional questionnaires.
Three participants evaluated 40 cases before and after educational materials. TPS diagnoses were significantly more specific (0.23 vs 0.59, P = 0.004) and more accurate (0.43 vs 0.66, P = 0.0125) than diagnoses made with our institutional system. Fewer overall cases were diagnosed as "atypical" with TPS. TPS education resulted in slightly, though not significantly, more specific diagnoses (0.25 vs 0.59, P = 0.083). Interobserver agreement decreased for nuclear-to-cytoplasmic (N/C) ratio, TPS diagnoses and initial diagnoses, and increased for all other features. TPS resulted in downgrading of cases with biopsy-proven low grade urothelial neoplasm (LGUN) from "atypical" to negative for high grade urothelial carcinoma (NHGUC) (P = 0.018).
Use of TPS in challenging urine cytology cases can improve specificity, risk stratification, and diagnostic accuracy while decreasing the number of "atypical" diagnoses. Though training can help cytopathologists better apply these criteria, it is unclear how to effectively improve evaluation of N/C ratio.
实施巴黎系统报告尿细胞学检查（TPS）可证实非典型诊断，同时提高标准化和风险分层。本研究评估其在具有挑战性病例中的性能和可重复性，并探讨对形态学特征进行针对性教育是否能改善结果。
在我们之前的研究中，使用了经手术随访诊断为“非典型”的尿细胞学病例。收集该研究中显示一致性较差的病例用于本研究。拍摄每个病例的代表性照片并通过在线问卷进行分发。要求参与者做出初步诊断并评估几种形态学特征的存在情况。分发教育材料，随后进行额外的问卷调查。
三名参与者在教育材料前后评估了40个病例。与我们机构系统做出的诊断相比，TPS诊断的特异性显著更高（0.23对0.59，P = 0.004）且准确性更高（0.43对0.66，P = 0.0125）。使用TPS诊断为“非典型”的总体病例更少。TPS教育导致诊断的特异性略有提高（0.25对0.59，P = 0.083），但差异不显著。观察者间对核质比（N/C）、TPS诊断和初步诊断的一致性降低，而对所有其他特征的一致性增加。TPS导致活检证实为低级别尿路上皮肿瘤（LGUN）的病例从“非典型”降级为高级别尿路上皮癌阴性（NHGUC）（P = 0.018）。
在具有挑战性的尿细胞学病例中使用TPS可提高特异性、风险分层和诊断准确性，同时减少“非典型”诊断的数量。尽管培训可帮助细胞病理学家更好地应用这些标准，但尚不清楚如何有效改善对N/C比的评估。
