ArticleCancer cytopathology2025
Does artificial intelligence redefine nuclear-to-cytoplasmic ratio threshold for diagnosing high-grade urothelial carcinoma?
Article in Cancer cytopathology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Artificial intelligence in nongynecologic cytology: A systematic review of current research and commercial tools.Cancer cytopathology · 2026Pooled it
- Does artificial intelligence redefine nuclear-to-cytoplasmic ratio threshold for diagnosing high-grade urothelial carcinoma?Cancer cytopathology · 2025Article
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Abstract
backgroundThe Paris System (TPS) introduced standardized nuclear-to-cytoplasmic (N/C) ratio thresholds for urine cytology to improve high-grade urothelial carcinoma (HGUC) detection, but these criteria remain subjective. This study used AIxURO, an artificial intelligence-based model, to measure N/C ratio and nuclear area to identify abnormal cells in whole slide images (WSIs).
methodsA total of 106 urine cytology slides from 46 lower urinary tract (LUT) and 60 upper urinary tract (UUT) cancer cases, diagnosed as atypical urothelial cell (15.1%), suspicious for high-grade urothelial carcinoma (SHGUC) (23.6%), and HGUC (61.3%), with biopsy-confirmed HGUC or carcinoma in situ (CIS), were digitized and analyzed by AIxURO. The model quantified suspicious and atypical cells, N/C ratios, and nuclear areas, with statistical differences assessed using Kruskal-Wallis tests.
resultsAIxURO identified fewer suspicious cells than atypical cells (20.5 vs. 242.0, p < .001). Suspicious cells had higher N/C ratios (0.66 vs. 0.58, p < .001) and larger nuclear areas (102.3 vs. 85.7 µm
conclusionsAIxURO provides objective quantification of N/C ratios and nuclear areas, refining TPS criteria for distinguishing suspicious from atypical cells. A lower N/C ratio cutoff (0.66) for SHGUC/HGUC may be more appropriate than the TPS threshold (>0.7). Findings support using consistent N/C ratio criteria across UUT and LUT cases.
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