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Background: Adopting a computational approach for the assessment of urine cytology specimens has the potential to improve the efficiency, accuracy, and reliability of bladder cancer screening, which has heretofore relied on semisubjective manual assessment methods. As rigorous, quantitative criteria and guidelines have been introduced for improving screening practices (e.g., The Paris System for Reporting Urinary Cytology), algorithms to emulate semiautonomous diagnostic decision‐making have lagged behind, in part because of the complex and nuanced nature of urine cytology reporting. Methods: In this study, the authors report on the development and large‐scale validation of a deep‐learning tool, AutoParis‐X, which can facilitate rapid, semiautonomous examination of urine cytology specimens. Results: The results of this large‐scale, retrospective validation study indicate that AutoParis‐X can accurately determine urothelial cell atypia and aggregate a wide variety of cell‐related and cluster‐related information across a slide to yield an atypia burden score, which correlates closely with overall specimen atypia and is predictive of Paris system diagnostic categories. Importantly, this approach accounts for challenges associated with the assessment of overlapping cell cluster borders, which improve the ability to predict specimen atypia and accurately estimate the nuclear‐to‐cytoplasm ratio for cells in these clusters. Conclusions: The authors developed a publicly available, open‐source, interactive web application that features a simple, easy‐to‐use display for examining urine cytology whole‐slide images and determining the level of atypia in specific cells, flagging the most abnormal cells for pathologist review. The accuracy of AutoParis‐X (and other semiautomated digital pathology systems) indicates that these technologies are approaching clinical readiness and necessitates full evaluation of these algorithms in head‐to‐head clinical trials. The authors developed a publicly available, open‐source, interactive web application featuring a simple, easy‐to‐use display for examining urine cytology whole‐slide images and determining the atypia level of specific cells, flagging the most abnormal cells for pathologist review. This proposed computational approach for the assessment of urine cytology specimens exhibited potential to improve the efficiency, accuracy, and reliability of bladder cancer screening. [ABSTRACT FROM AUTHOR]

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]

Background: Urine cytology is commonly used as a screening test for high‐grade urothelial carcinoma for patients with risk factors or hematuria and is an essential step in longitudinal monitoring of patients with previous bladder cancer history. However, the semisubjective nature of current reporting systems for urine cytology (e.g., The Paris System) can hamper reproducibility. For instance, the incorporation of urothelial cell clusters into the classification schema is still an item of debate and perplexity among expert cytopathologists because several previous works have disputed their diagnostic relevance. Methods: In this work, an automated preprocessing tool for urothelial cell cluster assessment was developed that divides urothelial cell clusters into meaningful components for downstream assessment (ie, population‐based studies, workflow automation). Results: In this work, an automated preprocessing tool for urothelial cell cluster assessment was developed that divides urothelial cell clusters into meaningful components for downstream assessment (ie, population‐based studies, workflow automation). Results indicate that cell cluster atypia (i.e., defined by whether the cell cluster harbored multiple atypical cells, thresholded by a minimum number of cells), cell border overlap and smoothness, and total number of clusters are important markers of specimen atypia when considering assessment of urothelial cell clusters. Conclusions: Markers established through techniques to separate cell clusters may have wider applicability for the design and implementation of machine learning approaches for urine cytology assessment. Computer algorithms that can quantify signatures of cytological atypia across urine slides, for the assessment of urothelial carcinoma, are challenged by overlapping cell borders within urothelial cell clusters. The authors developed an AI tool which can accurately separate overlapping cell borders and report associations between cluster‐level cytological and architectural features and urothelial carcinoma, which can spur further associative findings and algorithms which require precise estimation of cell cluster predictors. [ABSTRACT FROM AUTHOR]