Wang Yeh-Han, Hang Jen-Fan, Wen Chien-Hui, Liao Kuan-Cho, Lee Wen-Ying, Lai Chiung-Ru
Department of Anatomic Pathology, Taipei Institute of Pathology, Taipei 10374, Taiwan.
Institute of Public Health, National Yang-Ming University, 11221 Taipei, Taiwan.
Cancers (Basel). 2020 Jan 22;12(2):272. doi: 10.3390/cancers12020272.
In the Paris System (TPS), standardized cytomorphological criteria and diagnostic categories were proposed for reporting urine cytology. To evaluate the diagnostic agreement and interobserver concordance for assessing TPS criteria, the Taiwan Society of Clinical Cytology organized an online survey with 10 atypical urine cytology cases. A total of 137 participants completed the survey. The mean agreement of diagnosis was 51.2%, ranging from 34.3% to 83.2% for each case. For 60% (6/10) of cases, the agreement was <50%. The interobserver concordance of diagnosis and cytological criteria assessment showed poor agreement. The nuclear-to-cytoplasmic (N/C) ratio had the highest kappa value of 0.386, indicating a significantly higher interobserver concordance and reproducibility than the other three TPS criteria. The correct rate of assessing the N/C ratio increased as the N/C ratio increased (correlation coefficient: 0.891, < 0.01). Three cases with an N/C ratio near 0.5 were overestimated. Poor interobserver concordance of diagnosis and TPS criteria was revealed. Compared with other cytological features, the N/C ratio assessment was quantitative and more reproducible, but a tendency to overestimate cells was noted when the N/C ratio was approximately 0.5. Continuing education programs should emphasize the accurate assessment of N/C ratio to improve the application of TPS.
在巴黎系统（TPS）中，提出了用于报告尿液细胞学检查的标准化细胞形态学标准和诊断类别。为了评估评估TPS标准时的诊断一致性和观察者间的一致性，台湾临床细胞学学会组织了一项针对10例非典型尿液细胞学病例的在线调查。共有137名参与者完成了调查。诊断的平均一致性为51.2%，每个病例的一致性范围为34.3%至83.2%。对于60%（6/10）的病例，一致性<50%。诊断和细胞学标准评估的观察者间一致性显示出较差的一致性。核质比（N/C）的kappa值最高，为0.386，表明观察者间的一致性和可重复性显著高于其他三个TPS标准。随着N/C比值的增加，评估N/C比值的正确率也增加（相关系数：0.891，<0.01）。有3例N/C比值接近0.5的病例被高估。结果显示诊断和TPS标准的观察者间一致性较差。与其他细胞学特征相比，N/C比值评估是定量的且更具可重复性，但当N/C比值约为0.5时，存在高估细胞的趋势。继续教育项目应强调对N/C比值的准确评估，以改善TPS的应用。
