{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:52:36Z","timestamp":1790207556538,"version":"4.1.0"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T00:00:00Z","timestamp":1746230400000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Paris System (TPS) introduced standardized nuclear\u2010to\u2010cytoplasmic (N\/C) ratio thresholds for urine cytology to improve high\u2010grade urothelial carcinoma (HGUC) detection, but these criteria remain subjective. This study used AIxURO, an artificial intelligence\u2010based model, to measure N\/C ratio and nuclear area to identify abnormal cells in whole slide images (WSIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 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\u2010grade urothelial carcinoma (SHGUC) (23.6%), and HGUC (61.3%), with biopsy\u2010confirmed 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\u2013Wallis tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      AIxURO identified fewer suspicious cells than atypical cells (20.5 vs. 242.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Suspicious cells had higher N\/C ratios (0.66 vs. 0.58,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and larger nuclear areas (102.3 vs. 85.7 \u00b5m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Although N\/C ratios did not differ significantly between UUT and LUT cases, nuclear areas varied among abnormal cells (CIS: 101.5 \u00b5m\n                      <jats:sup>2<\/jats:sup>\n                      ; HGUC: 83.5 \u00b5m\n                      <jats:sup>2<\/jats:sup>\n                      ). In HGUC cytology cases, the CIS category had larger nuclear areas than HGUC for both suspicious (116.3 vs. 100.4 \u00b5m\n                      <jats:sup>2<\/jats:sup>\n                      ) and atypical cells (101.5 vs. 82.2 \u00b5m\n                      <jats:sup>2<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AIxURO 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 (&gt;0.7). Findings support using consistent N\/C ratio criteria across UUT and LUT cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncy.70017","type":"journal-article","created":{"date-parts":[[2025,5,3]],"date-time":"2025-05-03T13:26:19Z","timestamp":1746278779000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Does artificial intelligence redefine nuclear\u2010to\u2010cytoplasmic ratio threshold for diagnosing high\u2010grade urothelial carcinoma?"],"prefix":"10.1002","volume":"133","author":[{"given":"Wei\u2010Lei","family":"Yang","sequence":"first","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3191-9514","authenticated-orcid":false,"given":"Barbara A.","family":"Crothers","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tien\u2010Jen","family":"Liu","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Wen","family":"Hsu","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng\u2010Hung","family":"Yeh","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Siou","family":"Liu","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guowei","family":"Shao","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming\u2010Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"AIxMed, Inc  Santa Clara California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tang\u2010Yi","family":"Tsao","sequence":"additional","affiliation":[{"name":"Department of Pathology Tung's Taichung MetroHarbor Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min\u2010Che","family":"Tung","sequence":"additional","affiliation":[{"name":"Division of Urology Department of Surgery Tung\u2019s Taichung MetroHarbor Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei\u2010Yi","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Pathology Show Chwan Memorial Hospital  Changhua Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-2784","authenticated-orcid":false,"given":"Jen\u2010Fan","family":"Hang","sequence":"additional","affiliation":[{"name":"Division of Cytopathology Department of Pathology and Laboratory Medicine Taipei Veterans General Hospital  Taipei Taiwan"},{"name":"School of Medicine and Institute of Clinical Medicine National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-22864-8"},{"key":"e_1_2_8_3_1","volume-title":"The Paris System for Reporting Urine Cytology","author":"Rosenthal DL","year":"2022"},{"issue":"1","key":"e_1_2_8_4_1","first-page":"52","article-title":"Urine cytology in bladder tumors","volume":"76","author":"Zein TA","year":"1991","journal-title":"Int 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