Abstract
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, p < 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.
Highlights
In the Paris System (TPS) for reporting urine cytology, standardized diagnostic criteria and terminology are proposed
Urine cytology is a key diagnostic tool either in screening or follow-up for urothelial malignancy, the consistency and accuracy of cytomorphological assessments are crucial for patient management
TPS criteria, the N/C ratio assessment revealed the highest kappa value (0.386), which was close to the cutoff of 0.4, indicating a fair to good agreement; this value was significantly higher than the kappa values for the other three TPS criteria
Summary
In the Paris System (TPS) for reporting urine cytology, standardized diagnostic criteria and terminology are proposed. Urine cytology is a key diagnostic tool either in screening or follow-up for urothelial malignancy, the consistency and accuracy of cytomorphological assessments are crucial for patient management. Kurtycz et al have noted that the agreement of diagnosis using TPS is not satisfying, especially for indeterminate cases, and the interobserver concordance of diagnosis is low [9,10]. They did not further clarify the interobserver concordance of the assessment of cytological features. To further evaluate the interobserver concordance for assessing atypical urothelial cells and how the cytologists incorporate TPS criteria in real-world practice, the Education and Research Committee of the TSCC designed an online survey.
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