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 RESEARCH ARTICLE
CytoJournal 2017,  14:17

Interobserver reproducibility of the Paris system for reporting urinary cytology


1 Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri, USA
2 Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
3 Department of Pathology and Laboratory Medicine and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA

Correspondence Address:
Lester J Layfield
Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, Missouri
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cytojournal.cytojournal_12_17

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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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