Search

Background: Urine cytology is generally considered the primary approach for screening for recurrence of bladder cancer. However, it is currently unclear how best to use cytological examinations for assessment and early detection of recurrence, beyond identifying a positive finding that requires more invasive methods to confirm recurrence and decide on therapeutic options. Because screening programs are frequent, and can be burdensome, finding quantitative means to reduce this burden for patients, cytopathologists, and urologists is an important endeavor and can improve both the efficiency and reliability of findings. Additionally, identifying ways to risk‐stratify patients is crucial for improving quality of life while reducing the risk of future recurrence or progression of the cancer. Methods: In this study, a computational machine learning tool, AutoParis‐X, was leveraged to extract imaging features from urine cytology examinations longitudinally to study the predictive potential of urine cytology for assessing recurrence risk. This study examined how the significance of imaging predictors changes over time before and after surgery to determine which predictors and time periods are most relevant for assessing recurrence risk. Results: Results indicate that imaging predictors extracted using AutoParis‐X can predict recurrence as well or better than traditional cytological/histological assessments alone and that the predictiveness of these features is variable across time, with key differences in overall specimen atypia identified immediately before tumor recurrence. Conclusions: Further research will clarify how computational methods can be effectively used in high‐volume screening programs to improve recurrence detection and complement traditional modes of assessment. This study used AutoParis‐X, a machine learning tool, to extract imaging features from urine cytology examinations to predict recurrence risk in patients with bladder cancer. The results demonstrate that quantitative features of urine specimen atypia can predict recurrence as well or better than traditional cytological/histological assessments alone and can potentially complement traditional methods of assessment in screening programs pending further development and validation of computational methods that leverage multiple longitudinal cytology examinations. [ABSTRACT FROM AUTHOR]

Urine cytology is used to screen for urothelial carcinoma in patients with hematuria or risk factors (eg, smoking, industrial dye exposure) and is an essential clinical triage and longitudinal monitoring tool for patients with known bladder cancer. However, urine cytology is semisubjective and thus susceptible to issues including specimen quality, interobserver variability, and "hedging" towards equivocal ("atypical") diagnoses. These factors limit the predictive value of urine cytology and increase reliance on invasive procedures (cystoscopy). The Paris System for Reporting Urine Cytology (TPS) was formulated to provide more quantitative/reproducible endpoints with well-defined criteria for urothelial atypia. TPS is often compared to other assessment techniques to justify its adoption. TPS results in decreased use of the atypical category and better reproducibility. Previous reports comparing diagnoses pre- and post-TPS have not considered temporal differences between diagnoses made under prior systems and TPS. By aggregating across time, studies may underestimate the magnitude of differences between assessment methods. We conducted a large-scale longitudinal reassessment of urine cytology using TPS criteria from specimens collected from 2008 to 2018, prior to the mid-2018 adoption of TPS at an academic medical center. Findings indicate that differences in atypical assignment were largest at the start of the period and these differences progressively decreased towards insignificance just prior to TPS implementation. This finding suggests that cytopathologists had begun to utilize the quantitative TPS criteria prior to official adoption, which may more broadly inform adoption strategies, communication, and understanding for evolving classification systems in cytology. • The Paris System (TPS) refined quantitative assessment criteria for urine cytology. • We performed a longitudinal reexamination comparing TPS and previous criteria. • Diagnostic differences disappeared prior to the official TPS implementation. • Findings suggest early adoption of TPS criteria. • Dissemination of evolving cytopathology guidelines can inform adoption practices. [ABSTRACT FROM AUTHOR]