Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan.
Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan.
Cytopathology. 2023 Jul;34(4):295-301. doi: 10.1111/cyt.13229. Epub 2023 Mar 23.
The Paris System for Reporting Urinary Cytology considered the nuclear-to-cytoplasmic (N:C) ratio as the most important cytomorphological feature for detecting high-grade urothelial carcinoma (HGUC) cells. Few quantitative studies have been conducted on other features although quantitative studies on the N:C ratio have been reported. Therefore, this study quantitatively analysed important cytomorphological features in distinguishing benign reactive cells from HGUC cells.
We analysed 2866 cells from the urine of 52 patients. A digital image analyser was used to quantitatively measure the nuclear area, cell area, N:C ratio, and nuclear roundness for HGUC cells and benign reactive cells. Additionally, the diagnostic value of quantitative cytomorphological criteria in HGUC cells was evaluated by the receiver operating characteristic curve.
The area under the curve for the prediction of HGUC cells for all cells and the top five cells was in the following order: nuclear area (0.920 and 0.992, respectively), N:C ratio (0.849 and 0.977), cell area (0.781 and 0.920), and nuclear roundness (0.624 and 0.605). The best cutoff value of the N:C ratio to differentiate HGUC cells from benign reactive cells was 0.438, and using the N:C ratio of 0.702, the positive predictive value obtained was 100%.
Our study indicated that nuclear area is a more important cytomorphological criterion than the N:C ratio for HGUC cell detection. Moreover, extracted data of the top five cells were more valuable than the data of all cells, which can be helpful in the routine practice and future criteria definition in urine cytology.
巴黎泌尿系统细胞学报告系统认为核质比（N:C）是检测高级别尿路上皮癌（HGUC）细胞的最重要细胞学特征。尽管已经有关于 N:C 比的定量研究，但很少有关于其他特征的定量研究。因此，本研究定量分析了鉴别良性反应性细胞与 HGUC 细胞的重要细胞学特征。
我们分析了 52 名患者尿液中的 2866 个细胞。使用数字图像分析器定量测量 HGUC 细胞和良性反应性细胞的核面积、细胞面积、N:C 比和核圆形度。此外，通过受试者工作特征曲线评估定量细胞学标准在 HGUC 细胞中的诊断价值。
所有细胞和前 5 个细胞预测 HGUC 细胞的曲线下面积分别为：核面积（分别为 0.920 和 0.992）、N:C 比（分别为 0.849 和 0.977）、细胞面积（分别为 0.781 和 0.920）和核圆形度（分别为 0.624 和 0.605）。区分 HGUC 细胞与良性反应性细胞的最佳 N:C 比值截断值为 0.438，使用 N:C 比值为 0.702 时，阳性预测值为 100%。
本研究表明，核面积是检测 HGUC 细胞比 N:C 比更重要的细胞学标准。此外，前五名细胞提取的数据比所有细胞的数据更有价值，这有助于常规实践和未来尿细胞学标准的定义。
