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Open AccessArticle

Diagnostic Agreement for High-Grade Urothelial Cell Carcinoma in Atypical Urine Cytology: A Nationwide Survey Reveals a Tendency for Overestimation in Specimens with an N/C Ratio Approaching 0.5

1
Department of Anatomic Pathology, Taipei Institute of Pathology, Taipei 10374, Taiwan
2
Institute of Public Health, National Yang-Ming University, Taipei 11221, Taiwan
3
College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
5
School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
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Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
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Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
8
Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
9
Department of Cytopathology, Chi Mei Medical Center, Tainan 71004, Taiwan
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(2), 272; https://doi.org/10.3390/cancers12020272 (registering DOI)
Received: 2 December 2019 / Revised: 16 January 2020 / Accepted: 19 January 2020 / Published: 22 January 2020
(This article belongs to the Special Issue Cytologic Features of Tumor)
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. View Full-Text
Keywords: atypical urine cytology; the Paris system (TPS); interobserver concordance; urothelial carcinoma; nuclear-to-cytoplasmic (N/C) ratio atypical urine cytology; the Paris system (TPS); interobserver concordance; urothelial carcinoma; nuclear-to-cytoplasmic (N/C) ratio
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Wang, Y.-H.; Hang, J.-F.; Wen, C.-H.; Liao, K.-C.; Lee, W.-Y.; Lai, C.-R. Diagnostic Agreement for High-Grade Urothelial Cell Carcinoma in Atypical Urine Cytology: A Nationwide Survey Reveals a Tendency for Overestimation in Specimens with an N/C Ratio Approaching 0.5. Cancers 2020, 12, 272.

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