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Kim D, Sundling KE, Virk R, Thrall MJ, Alperstein S, Bui MM, Chen-Yost H, Donnelly AD, Lin O, Liu X, Madrigal E, Michelow P, Schmitt FC, Vielh PR, Zakowski MF, Parwani AV, Jenkins E, Siddiqui MT, Pantanowitz L, Li Z. Digital cytology part 2: artificial intelligence in cytology: a concept paper with review and recommendations from the American Society of Cytopathology Digital Cytology Task Force. J Am Soc Cytopathol 2024; 13:97-110. [PMID: 38158317 DOI: 10.1016/j.jasc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
Digital cytology and artificial intelligence (AI) are gaining greater adoption in the cytology laboratory. However, peer-reviewed real-world data and literature are lacking in regard to the current clinical landscape. The American Society of Cytopathology in conjunction with the International Academy of Cytology and the Digital Pathology Association established a special task force comprising 20 members with expertise and/or interest in digital cytology. The aim of the group was to investigate the feasibility of incorporating digital cytology, specifically cytology whole slide scanning and AI applications, into the workflow of the laboratory. In turn, the impact on cytopathologists, cytologists (cytotechnologists), and cytology departments were also assessed. The task force reviewed existing literature on digital cytology, conducted a worldwide survey, and held a virtual roundtable discussion on digital cytology and AI with multiple industry corporate representatives. This white paper, presented in 2 parts, summarizes the current state of digital cytology and AI practice in global cytology practice. Part 1 of the white paper is presented as a separate paper which details a review and best practice recommendations for incorporating digital cytology into practice. Part 2 of the white paper presented here provides a comprehensive review of AI in cytology practice along with best practice recommendations and legal considerations. Additionally, the cytology global survey results highlighting current AI practices by various laboratories, as well as current attitudes, are reported.
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Affiliation(s)
- David Kim
- Department of Pathology & Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kaitlin E Sundling
- The Wisconsin State Laboratory of Hygiene and Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Renu Virk
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Susan Alperstein
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Marilyn M Bui
- The Department of Pathology, Moffitt Cancer Center & Research Institute, Tampa, Florida
| | | | - Amber D Donnelly
- Diagnostic Cytology Education, University of Nebraska Medical Center, College of Allied Health Professions, Omaha, Nebraska
| | - Oscar Lin
- Department of Pathology & Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Xiaoying Liu
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emilio Madrigal
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Pamela Michelow
- Division of Anatomical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; Department of Pathology, National Health Laboratory Services, Johannesburg, South Africa
| | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe R Vielh
- Department of Pathology, Medipath and American Hospital of Paris, Paris, France
| | | | - Anil V Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Zaibo Li
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Aljerian K, Alrashedi A, Alkulaibi R, Alsuwailem R, Alshahrani A, Alzahrani FM, Alqazlan N, Temsah MH. Assessing Knowledge, Acceptance, and Anticipated Impact of Telepathology in Saudi Arabia: Insights From Healthcare Workers and Patients. Cureus 2023; 15:e49218. [PMID: 38143684 PMCID: PMC10739504 DOI: 10.7759/cureus.49218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/26/2023] Open
Abstract
INTRODUCTION Telepathology, a rapidly evolving field in modern healthcare, has the potential to significantly impact the diagnosis and management of diseases. This study aimed to assess the prevalence of acceptance and knowledge, the likelihood of future use, and the perceived advantages and disadvantages of telepathology among healthcare workers (HCWs) and patients in Saudi Arabia. METHODS A cross-sectional study was conducted with 388 participants, including 179 HCWs and 209 adult patients across Saudi Arabia. Data were collected using a bilingual, self-administered, and anonymous computer-based questionnaire. The Statistical Package for Social Sciences (SPSS, IBM Corp., Armonk, NY) was employed for data analysis. RESULTS The participants had an average knowledge rate of 80.3% (n=312) concerning telepathology. A substantial 88.16% (n=342) were inclined towards its acceptance, and an optimistic 89.97% (n=349) foresaw its potential utility. Among the respondents, 70% (n=272) pinpointed "expedited results" as the principal merit of telepathology. However, 60% (n=233) flagged "the necessity for costly infrastructure" as its chief limitation. CONCLUSIONS The insights derived underscore a prominent knowledge and endorsement of telepathology among the Saudi population and HCWs. Despite certain drawbacks, participants believe that telepathology is feasible and offers numerous benefits that could greatly enhance the healthcare system in Saudi Arabia. Future research should focus on evaluating its practical implementation and efficacy within healthcare facilities.
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Affiliation(s)
- Khaldoon Aljerian
- Department of Pathology, College of Medicine, King Saud University, Riyadh, SAU
| | | | | | | | | | | | | | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, Pediatric Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, SAU
- Evidence-Based Health Care & Knowledge Translation Research, King Saud University, Riyadh, SAU
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Tang HP, Cai D, Kong YQ, Ye H, Ma ZX, Lv HS, Tuo LR, Pan QJ, Liu ZH, Han X. Cervical cytology screening facilitated by an artificial intelligence microscope: A preliminary study. Cancer Cytopathol 2021; 129:693-700. [PMID: 33826796 DOI: 10.1002/cncy.22425] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/02/2021] [Accepted: 01/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cervical cytology screening is usually laborious with a heavy workload and poor diagnostic consistency. The authors have developed an artificial intelligence (AI) microscope that can provide onsite diagnostic assistance for cervical cytology screening in real time. METHODS A total of 2167 cervical cytology slides were selected from a cohort of 10,601 cases from Shenzhen Maternity and Child Healthcare Hospital, and the training data set consisted of 42,073 abnormal cervical epithelial cells. The recognition results of an AI technique were presented in a microscope eyepiece by an augmented reality technique. Potentially abnormal cells were highlighted with binary classification results in a 10× field of view (FOV) and with multiclassification results according to the Bethesda system in 20× and 40× FOVs. In addition, 486 slides were selected for the reader study to evaluate the performance of the AI microscope. RESULTS In the reader study, which compared manual reading with AI assistance, the sensitivities for the detection of low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions were significantly improved from 0.837 to 0.923 (P < .001) and from 0.830 to 0.917 (P < .01), respectively; the κ score for atypical squamous cells of undetermined significance (ASCUS) was improved from 0.581 to 0.637; the averaged pairwise κ of consistency for multiclassification was improved from 0.649 to 0.706; the averaged pairwise κ of consistency for binary classification was improved from 0.720 to 0.798; and the averaged pairwise κ of ASCUS was improved from 0.557 to 0.639. CONCLUSIONS The results of this study show that an AI microscope can provide real-time assistance for cervical cytology screening and improve the efficiency and accuracy of cervical cytology diagnosis.
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Affiliation(s)
- Hong-Ping Tang
- Department of Pathology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - De Cai
- AI Lab, Tencent, Shenzhen, China
| | - Yan-Qing Kong
- Department of Pathology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Hu Ye
- AI Lab, Tencent, Shenzhen, China
| | | | - Huai-Sheng Lv
- Department of Pathology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Lin-Rong Tuo
- Department of Pathology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Qin-Jing Pan
- Department of Pathology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China.,Department of Pathology, Cancer Institute and Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhi-Hua Liu
- Department of Gynecology, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Xiao Han
- AI Lab, Tencent, Shenzhen, China
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Rezende MT, Bianchi AGC, Carneiro CM. Cervical cancer: Automation of Pap test screening. Diagn Cytopathol 2021; 49:559-574. [PMID: 33548162 DOI: 10.1002/dc.24708] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cervical cancer progresses slowly, increasing the chance of early detection of pre-neoplastic lesions via Pap exam test and subsequently preventing deaths. However, the exam presents both false-negatives and false-positives results. Therefore, automatic methods (AMs) of reading the Pap test have been used to improve the quality control of the exam. We performed a literature review to evaluate the feasibility of implementing AMs in laboratories. METHODS This work reviewed scientific publications regarding automated cytology from the last 15 years. The terms used were "Papanicolaou test" and "Automated cytology screening" in Portuguese, English, and Spanish, in the three scientific databases (SCIELO, PUBMED, MEDLINE). RESULTS Of the resulting 787 articles, 34 were selected for a complete review, including three AMs: ThinPrep Imaging System, FocalPoint GS Imaging System and CytoProcessor. In total, 1 317 148 cytopathological slides were evaluated automatically, with 1 308 028 (99.3%) liquid-based cytology slides and 9120 (0.7%) conventional cytology smears. The AM diagnostic performances were statistically equal to or better than those of the manual method. AM use increased the detection of cellular abnormalities and reduced false-negatives. The average sample rejection rate was ≤3.5%. CONCLUSION AMs are relevant in quality control during the analytical phase of cervical cancer screening. This technology eliminates slide-handling steps and reduces the sample space, allowing professionals to focus on diagnostic interpretation while maintaining high-level care, which can reduce false-negatives. Further studies with conventional cytology are needed. The use of AM is still not so widespread in cytopathology laboratories.
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Affiliation(s)
- Mariana T Rezende
- Postgraduate Program in Biotechnology, Biological Sciences Research Center (NUPEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Cytology Laboratory, Clinical Analysis Department, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Andrea G C Bianchi
- Computing Department, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
| | - Cláudia M Carneiro
- Postgraduate Program in Biotechnology, Biological Sciences Research Center (NUPEB), Federal University of Ouro Preto, Ouro Preto, MG, Brazil.,Cytology Laboratory, Clinical Analysis Department, Federal University of Ouro Preto, Ouro Preto, MG, Brazil
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Pimple SA, Mishra GA, Deodhar KK. Evidence based appropriate triage strategies for implementing high risk HPV as primary technology in cervical cancer screening. ACTA ACUST UNITED AC 2020; 72:96-105. [PMID: 32403908 DOI: 10.23736/s0026-4784.20.04511-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary cervical cancer screening by HPV testing for high risk human papillomavirus (hrHPV) is expected to replace cytology-based programs in many parts of the world. Its high sensitivity and negative predictive value permit longer screening intervals up to beyond five years. However, low positive predictive value can lead to unnecessary referrals and overtreatment since most hrHPV infections are transient and will not develop disease. Therefore risk stratification is needed to effectively triage and identify women among the hrHPV positives, who are at an increased risk of cervical (pre)cancer who need further diagnostic evaluation to decide on further management. Several triage strategies like HPV16/18 genotyping, p16/Ki67 dual staining and DNA methylation markers (CADM1, MAL and miR-124-2) have been evaluated to determine suitable triage options. Triage with p16/Ki-67 dual-stain provided better long-term risk stratification than cytology with significant reduction in cumulative 5 years CIN3+ risk in p16/Ki-67 negative women. DNA methylation assays have shown higher specificity than cytology and higher sensitivity than HPV16/18 genotyping with added advantages of reproducibility and application on self-collected samples. Based on current evidence, Pap cytology with or without additional HPV16/18 genotyping remains the most recommended triage strategies for primary HPV screening. Other strategies will need more longitudinal studies to provide evidence of risk reduction in test negative results. WHO recommends Visual Inspection with Acetic Acid (VIA) for triaging HPV-positive women in LMIC settings. An optimal triage strategy that can be integrated with primary HPV screening should be able to segregate and reassure the large majority of women who are at very low risk of cervical cancer.
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Affiliation(s)
- Sharmila A Pimple
- Department of Preventive Oncology, Center for Cancer Epidemiology (CCE), Tata Memorial Center, Mumbai, India - .,Homi Bhabha National Institute (HBNI), Mumbai, India -
| | - Gauravi A Mishra
- Department of Preventive Oncology, Center for Cancer Epidemiology (CCE), Tata Memorial Center, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kedar K Deodhar
- Department of Pathology, Tata Memorial Hospital, Mumbai, India.,Homi Bhabha National Institute (HBNI), Mumbai, India
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Nuttall DS, Hillier S, Clayton HR, Savage AJ, Martin CM, O’Leary JJ. A retrospective validation of the FocalPoint GS slide profiler NFR technology by analysis of interval disease outcomes compared with manual cytology. Cancer Cytopathol 2019; 127:240-246. [DOI: 10.1002/cncy.22109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 12/12/2022]
Affiliation(s)
- David S. Nuttall
- Manchester Cytology Centre Manchester Royal Infirmary Manchester United Kingdom
| | | | | | - Amanda J. Savage
- Cytopathology Department Glan Clwyd Hospital Denbighshire United Kingdom
| | - Cara M. Martin
- School of Medicine Trinity College Dublin Dublin Ireland
| | - John J. O’Leary
- School of Medicine Trinity College Dublin Dublin Ireland
- CERVIVA Research Consortium Dublin Ireland
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Thrall MJ. Automated screening of Papanicolaou tests: A review of the literature. Diagn Cytopathol 2018; 47:20-27. [DOI: 10.1002/dc.23931] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/20/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Michael J. Thrall
- Department of Pathology and Genomic Medicine; Houston Methodist Hospital, 6565 Fannin M227; Houston Texas 77030
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8
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Wong OG, Ho MW, Tsun OK, Ng AK, Tsui EY, Chow JN, Ip PP, Cheung AN. An automated quantitative DNA image cytometry system detects abnormal cells in cervical cytology with high sensitivity. Cytopathology 2018; 29:267-274. [PMID: 29578257 DOI: 10.1111/cyt.12540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 12/27/2022]
Affiliation(s)
- O. G. Wong
- Department of Pathology; The University of Hong Kong; Shenzhen China
| | - M. W. Ho
- Department of Pathology; The University of Hong Kong; Shenzhen China
| | - O. K. Tsun
- Department of Pathology; The University of Hong Kong; Shenzhen China
| | - A. K. Ng
- Department of Pathology; The University of Hong Kong; Shenzhen China
- Hong Kong and The University of Hong Kong-Shenzhen Hospital; Shenzhen China
| | - E. Y. Tsui
- Department of Pathology; The University of Hong Kong; Shenzhen China
| | - J. N. Chow
- Department of Pathology; The University of Hong Kong; Shenzhen China
| | - P. P. Ip
- Department of Pathology; The University of Hong Kong; Shenzhen China
| | - A. N. Cheung
- Department of Pathology; The University of Hong Kong; Shenzhen China
- Hong Kong and The University of Hong Kong-Shenzhen Hospital; Shenzhen China
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Saieg MA, Motta TH, Fodra ME, Scapulatempo C, Longatto-Filho A, Stiepcich MMA. Automated screening of conventional gynecological cytology smears: feasible and reliable. Acta Cytol 2014; 58:378-82. [PMID: 25195537 DOI: 10.1159/000365944] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/02/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We tested the ability of automated screening in processing conventional gynecological cytology smears and its efficacy in assessing sample adequacy and stratifying cases for risk of malignancy. STUDY DESIGN Cases were retrospectively selected, including unsatisfactory samples and slides with various sorts of artifacts. Automated screening was performed using the FocalPoint GS Imaging System (Becton Dickinson, Franklin Lakes, N.J., USA), with classification into five quintiles. For agreement purposes, cases were grouped into high risk for malignancy (quintiles 1 and 2) and low risk for malignancy (quintiles 3, 4 and 5). RESULTS A total of 120 cases (median age 37.5 years, range 18-85) were included in the study. Eighty-three cases (69.2%) could be successfully classified into quintiles. When divided by risk, 31 cases were placed in the high-risk and 52 in the low-risk group. The overall sensitivity and specificity of the automated analysis was 100 and 70.3%, respectively. CONCLUSIONS Automated analysis could analyze the majority of conventional smears, including one case previously screened as unsatisfactory. All malignant and high-grade lesions were correctly classified into the high-risk group. Broad use of this automation system could potentially decrease screening time and augment the efficacy in detecting precursor neoplastic changes in cervical cytology smears.
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10
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Stein MD, Fregnani JHTG, Scapulatempo C, Mafra A, Campacci N, Longatto-Filho A. Performance and reproducibility of gynecologic cytology interpretation using the FocalPoint system: results of the RODEO Study Team. Am J Clin Pathol 2013; 140:567-71. [PMID: 24045555 DOI: 10.1309/ajcpwl36jxmresfh] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To assess whether automated screening in the cytologic examination of Papanicolaou smear slides results in smaller margins of error than manual screening. METHODS We compared cytotechnologists' performance and reproducibility of manual and automated screening of 10,165 consecutive cervical cytology slides examined at Barretos Cancer Hospital using the FocalPoint system. RESULTS In total, 83% of atypical squamous cells of undetermined significance and greater were classified as quintiles 1 and 2; no high-grade squamous intraepithelial lesions and greater were observed in quintile 5. No statistically significant differences were found between manual and automated screening, using cervical biopsy specimens as the gold standard. CONCLUSIONS FocalPoint safely screened high-grade lesions, which can be valuable for high-workload routines.
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Affiliation(s)
| | - José Humberto T. G. Fregnani
- Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
| | | | - Allini Mafra
- Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
| | | | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil
- Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal, and ICVS/3Bs—PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Colgan T. Reply to a validation study of the Focalpoint GS imaging system for gynecologic cytology screening. Cancer Cytopathol 2013; 121:738. [PMID: 23843272 DOI: 10.1002/cncy.21335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Terrence Colgan
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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12
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Renshaw A, Elsheikh TM. A validation study of the Focalpoint GS imaging system for gynecologic cytology screening. Cancer Cytopathol 2013; 121:737-8. [PMID: 23843282 DOI: 10.1002/cncy.21336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Renshaw
- Department of Pathology, Baptist Hospital, Miami, Florida
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