TY - JOUR
T1 - Reproducibility of the Johns Hopkins Hospital template for urologic cytology samples
AU - Olson, Matthew T.
AU - Novak, Anna
AU - Boonyaarunnate, Thiraphon
AU - Trotter, Jessi
AU - Sachs, Sharon
AU - Kelly, Deidra
AU - Ford, Sterling
AU - Cornish, Toby C.
AU - Toll, Adam
AU - Tatsas, Armanda D.
AU - Maleki, Zahra
AU - Erozan, Yener S.
AU - Rosenthal, Dorothy L.
PY - 2014/5
Y1 - 2014/5
N2 - Introduction: Cytologic screening for urothelial carcinoma is fraught with low sensitivity, a high indeterminate rate, and until recently, poor standardization of terminology. The Johns Hopkins Hospital John K. Frost Cytopathology Laboratory has recently developed and published a template for reporting urine cytopathology; herein, we evaluate its interobserver reproducibility. Materials and methods: Two sets of 100 cases each were deidentified; each set was reviewed by 5 of 10 observers in a randomized order at the direction of computerized data collection software that tracked observation time as well as observer classification of the atypia-no atypia, atypia (AUC-US), or atypia suggestive of high-grade urothelial carcinoma (AUC-H). Specific morphologic features were also recorded. Cases were grouped into low-, intermediate-, and high-agreement based on the number of observers who made the assessment. The findings were correlated against clinical outcomes. Results: High agreement among observers about the presence or absence of high-grade features was possible in approximately two-thirds of indeterminate urine cases. Time and order did not factor significantly into observer propensity for identifying atypical features or favoring either AUC-US or AUC-H, and cases with high agreement about the presence of high-grade features were more likely to have a malignant follow-up. Furthermore, AUC-H diagnoses based on 2 or more high-grade features had a significantly higher malignancy risk than AUC-US diagnoses did. Conclusions: AUC-H is a valid diagnostic category with specific, reproducibly identified features that portend a higher risk of malignancy than the findings of AUC-US.
AB - Introduction: Cytologic screening for urothelial carcinoma is fraught with low sensitivity, a high indeterminate rate, and until recently, poor standardization of terminology. The Johns Hopkins Hospital John K. Frost Cytopathology Laboratory has recently developed and published a template for reporting urine cytopathology; herein, we evaluate its interobserver reproducibility. Materials and methods: Two sets of 100 cases each were deidentified; each set was reviewed by 5 of 10 observers in a randomized order at the direction of computerized data collection software that tracked observation time as well as observer classification of the atypia-no atypia, atypia (AUC-US), or atypia suggestive of high-grade urothelial carcinoma (AUC-H). Specific morphologic features were also recorded. Cases were grouped into low-, intermediate-, and high-agreement based on the number of observers who made the assessment. The findings were correlated against clinical outcomes. Results: High agreement among observers about the presence or absence of high-grade features was possible in approximately two-thirds of indeterminate urine cases. Time and order did not factor significantly into observer propensity for identifying atypical features or favoring either AUC-US or AUC-H, and cases with high agreement about the presence of high-grade features were more likely to have a malignant follow-up. Furthermore, AUC-H diagnoses based on 2 or more high-grade features had a significantly higher malignancy risk than AUC-US diagnoses did. Conclusions: AUC-H is a valid diagnostic category with specific, reproducibly identified features that portend a higher risk of malignancy than the findings of AUC-US.
KW - Interobserver reproducibility
KW - The Paris system for reporting urinary cytopathology
KW - The johns hopkins system for reporting urinary cytopathology
KW - Urinary cytology
KW - Urothelial carcinoma
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U2 - 10.1016/j.jasc.2014.02.003
DO - 10.1016/j.jasc.2014.02.003
M3 - Article
AN - SCOPUS:84899790571
SN - 2213-2945
VL - 3
SP - 156
EP - 164
JO - Journal of the American Society of Cytopathology
JF - Journal of the American Society of Cytopathology
IS - 3
ER -