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Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

BACKGROUND: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system...

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Autores principales: Long, Theresa, Layfield, Lester J., Esebua, Magda, Frazier, Shellaine R., Giorgadze, D. Tamar, Schmidt, Robert L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545779/
https://www.ncbi.nlm.nih.gov/pubmed/28828030
http://dx.doi.org/10.4103/cytojournal.cytojournal_12_17
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author Long, Theresa
Layfield, Lester J.
Esebua, Magda
Frazier, Shellaine R.
Giorgadze, D. Tamar
Schmidt, Robert L.
author_facet Long, Theresa
Layfield, Lester J.
Esebua, Magda
Frazier, Shellaine R.
Giorgadze, D. Tamar
Schmidt, Robert L.
author_sort Long, Theresa
collection PubMed
description BACKGROUND: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). METHODS: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. RESULTS: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. CONCLUSIONS: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.
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spelling pubmed-55457792017-08-21 Interobserver reproducibility of The Paris System for Reporting Urinary Cytology Long, Theresa Layfield, Lester J. Esebua, Magda Frazier, Shellaine R. Giorgadze, D. Tamar Schmidt, Robert L. Cytojournal Research Article BACKGROUND: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). METHODS: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. RESULTS: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. CONCLUSIONS: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application. Medknow Publications & Media Pvt Ltd 2017-07-24 /pmc/articles/PMC5545779/ /pubmed/28828030 http://dx.doi.org/10.4103/cytojournal.cytojournal_12_17 Text en Copyright: © 2017 Long, et al.; Licensee Cytopathology Foundation Inc. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Research Article
Long, Theresa
Layfield, Lester J.
Esebua, Magda
Frazier, Shellaine R.
Giorgadze, D. Tamar
Schmidt, Robert L.
Interobserver reproducibility of The Paris System for Reporting Urinary Cytology
title Interobserver reproducibility of The Paris System for Reporting Urinary Cytology
title_full Interobserver reproducibility of The Paris System for Reporting Urinary Cytology
title_fullStr Interobserver reproducibility of The Paris System for Reporting Urinary Cytology
title_full_unstemmed Interobserver reproducibility of The Paris System for Reporting Urinary Cytology
title_short Interobserver reproducibility of The Paris System for Reporting Urinary Cytology
title_sort interobserver reproducibility of the paris system for reporting urinary cytology
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545779/
https://www.ncbi.nlm.nih.gov/pubmed/28828030
http://dx.doi.org/10.4103/cytojournal.cytojournal_12_17
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