Reproducibility of the Johns Hopkins Hospital template for urologic cytology samples

• Published in: Journal of the American Society of Cytopathology JASC 2014-05, Vol.3 (3), p.156-164
• Main Authors: Olson, Matthew T., MD, Novak, Anna, CT(ASCP), Boonyaarunnate, Thiraphon, MD, Trotter, Jessi, CT(ASCP), Sachs, Sharon, CT(ASCP) (IAC), Kelly, Deidra, CT(ASCP), Ford, Sterling, CT(ASCP), Cornish, Toby C., MD, Toll, Adam, MD, Tatsas, Armanda D., MD, Maleki, Zahra, MD, Erozan, Yener S., MD, Rosenthal, Dorothy L., MD
• Format: Article
• Language: English
• Subjects: Interobserver reproducibility; Pathology; The Johns Hopkins System for Reporting Urinary Cytopathology; The Paris System for Reporting Urinary Cytopathology; Urinary cytology; Urothelial carcinoma
• ISSN: 2213-2945; 2213-2945
• DOI: 10.1016/j.jasc.2014.02.003

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.