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This study assessed diagnostic agreement in urinary cytopathology using The Paris System (TPS). High-grade urothelial carcinoma and negative findings showed the best agreement among observers.

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Area of Science:

  • Uropathology
  • Cytopathology
  • Medical Diagnostics

Background:

  • The 2015 publication of The Paris System for Urinary Cytopathology (TPS) standardized terminology.
  • Assessing interobserver agreement is crucial for diagnostic consistency.

Purpose of the Study:

  • To evaluate diagnostic agreement among participants using TPS criteria.
  • To compare participant agreement with the TPS author consensus.

Main Methods:

  • A web-based interobserver study was conducted.
  • 1313 participants evaluated 85 TPS atlas images.
  • Participant data included training, certification, and practice patterns.

Main Results:

  • Board-certified cytopathologists and specialist cytotechnologists showed higher agreement.
  • Diagnostic categories with highest agreement: Negative for High-Grade Urothelial Carcinoma (71%), Low-Grade Urothelial Neoplasm (62%), and High-Grade Urothelial Carcinoma (57%).
  • Indeterminate categories demonstrated low concordance.

Conclusions:

  • The Paris System categories Negative for High-Grade Urothelial Carcinoma, Low-Grade Urothelial Neoplasm, and High-Grade Urothelial Carcinoma showed the most observer agreement.
  • This study establishes a baseline for future interobserver reliability assessments in urinary cytopathology.