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Giacomazzo M, Cian F, Castagnaro M, Gelain ME, Bonsembiante F. Digital Cytology in Veterinary Education: A Comprehensive Survey of Its Application and Perception among Undergraduate and Postgraduate Students. Animals (Basel) 2024; 14:1561. [PMID: 38891608 PMCID: PMC11170988 DOI: 10.3390/ani14111561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
The COVID-19 pandemic accelerated technological changes in veterinary education, particularly in clinical pathology and anatomic pathology courses transitioning from traditional methods to digital pathology (DP). This study evaluates the personal effectiveness and satisfaction, as well as the advantages and disadvantages, of DP, in particular digital cytology (DC), as a teaching method among European veterinary students, both at the undergraduate and postgraduate level, who attended digital pathology courses during and before the pandemic. A further aim is to discuss the differences between the two student groups. A Google Form survey consisting of 11 multiple-choice questions was emailed to pathology teachers and distributed to their students. Results indicated that undergraduate students showed greater digital pathology training, favouring DC as the most effective learning modality. In contrast, postgraduate students reported less digital slide training, and their preference for learning cytology was split between DC alone and DC integrated with traditional microscopy. All students experienced whole slide imaging for learning cytology slides prevalently, and they stated that DC enhanced their learning experience. While DC demonstrates personal effectiveness and satisfaction as a teaching method, it is important to not replace pathology training with light microscopy completely, as almost a third of the students indicated.
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Affiliation(s)
- Marta Giacomazzo
- Department of Comparative Biomedicine and Food Science, University of Padova, 35122 Padova, Italy; (M.G.); (M.C.)
| | | | - Massimo Castagnaro
- Department of Comparative Biomedicine and Food Science, University of Padova, 35122 Padova, Italy; (M.G.); (M.C.)
| | - Maria Elena Gelain
- Department of Comparative Biomedicine and Food Science, University of Padova, 35122 Padova, Italy; (M.G.); (M.C.)
| | - Federico Bonsembiante
- Department of Animal Medicine, Production and Health, University of Padova, 35122 Padova, Italy;
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Goel A, Kapatia G, Parwaiz A, Gupta S. Commentary on "Comparison of glass and digital slides for cervical cytopathology screening and interpretation". Diagn Cytopathol 2023; 51:791-792. [PMID: 37828831 DOI: 10.1002/dc.25242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Archit Goel
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Gargi Kapatia
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Bathinda, India
| | - Amber Parwaiz
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Patna, India
| | - Shruti Gupta
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), Rae Bareli, India
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de Velozo G, Cordeiro J, Sousa J, Holanda AC, Pessoa G, Porfírio M, Távora F. Comparison of glass and digital slides for cervical cytopathology screening and interpretation. Diagn Cytopathol 2023; 51:735-743. [PMID: 37587842 DOI: 10.1002/dc.25209] [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: 05/22/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
Cervical cancer is the second most common form of cancer and a leading cause of premature death among women aged 15 to 44 worldwide. In Brazil, there is a high prevalence of infection by the human papillomavirus - HPV. Digital pathology optimizes time and space for reading cervicovaginal cytology slides. We evaluated the feasibility of using whole slide images (WSI) for the routine interpretation of cytology exams. A total of 99 cases of vaginal cytology were selected from a reference laboratory in Northeastern Brazil. Three cytotechnicians participated in the study. Cellular atypia was the one that most presented concordance values. Two observers almost perfectly agreed (k = 0.86 and k = 0.84, respectively) on the negative diagnoses. The performance of the evaluators for NILM (negative for intraepithelial lesion and malignancy) showed high reproducibility and sensitivity in the digital slides, mainly between evaluators A and C. In contrast, the microbiology group showed disagreement between the diagnoses by digital slides and the standard- gold. The concordance between the digital diagnoses and the gold standard for ASCUS was 89%. In the inflammatory category, Spearman's test showed similar results between raters A, B, and C (rs = 0.47, rs = 0.41, and rs = 0.47, respectively). This study reports the diagnostic validation using digital slides in view of the need to optimize the cytology visualization process. Our experience shows good diagnostic agreement between digital and optical microscopy in several analyzed categories, but mainly in relation to cellular atypia and inflammatory processes.
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Affiliation(s)
| | - Juliana Cordeiro
- Federal University of Ceará, Argos Patologia Laboratory, Fortaleza, Brazil
| | | | | | | | - Mônica Porfírio
- Federal University of Ceará, Argos Patologia Laboratory, Fortaleza, Brazil
| | - Fábio Távora
- Federal University of Ceará, Argos Patologia Laboratory, Fortaleza, Brazil
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Post R, Doxzon K, Goldberg A. Telecytology rapid onsite evaluation, with real-time communication between cytopathologist, cytotechnologist, and proceduralist, offers better adequacy rates for lymph node, but not thyroid, fine-needle aspirations. J Am Soc Cytopathol 2023; 12:407-414. [PMID: 37620222 DOI: 10.1016/j.jasc.2023.07.002] [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: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Rapid onsite evaluation (ROSE) decreases rates of inadequate fine-needle aspirations (FNAs). Telecytology allows pathologists to perform ROSE without being physically "on site", thereby saving cytopathologists' travel time and allowing them to perform ROSE for multiple institutions. Little research exists comparing telecytology to non-telecytology ROSE for FNA inadequacy rates. MATERIALS AND METHODS Using previously obtained quality metrics, we compared inadequacy rates for lymph node and thyroid FNAs with and without ROSE and with non-telecytology ROSE compared with telecytology ROSE. Use of ROSE was determined by the proceduralist. Type of ROSE was location-based, as only certain locations at our institution have telecytology capabilities. Chi-squared testing was used to compare proportions of populations and P value was set to 0.05. RESULTS A total of 1168 lymph node and 1177 thyroid FNAs were included in our adequacy analysis. We found any ROSE decreased our inadequacy rate for both lymph node (20.4% to 12.7%, P = 0.002) and thyroid (34.7% to 4.8%, P = 7.4 × 10-18) FNAs. We found telecytology further decreased our inadequacy rate for lymph node (13.8% to 5.9%, P = 0.016), but not thyroid (3.3% to 5.0%, P = 0.34), FNAs. CONCLUSIONS At our institution, when using telecytology, slides are read in real time with the cytotechnologist and the proceduralist looking at slides together near the patient bedside, while the cytopathologist is on the phone looking at slides on the computer screen via Dameware. When non-telecytology ROSE is performed, the cytotechnologist evaluates a slide, brings it to the cytopathologist's office and then the cytopathologist calls the proceduralist to discuss the slide. We believe telecytology offers an opportunity for more inclusive communication thereby improving adequacy rates for more complex cases, like lymph nodes, without affecting adequacy rates for cases where assessment of adequacy is less complex, like thyroid. This research supports use of telecytology especially for complex cases.
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Affiliation(s)
- Robert Post
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Kelly Doxzon
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Allison Goldberg
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Keshavamurthy KN, Dylov DV, Yazdanfar S, Patel D, Silk T, Silk M, Jacques F, Petre EN, Gonen M, Rekhtman N, Ostroverkhov V, Scher HI, Solomon SB, Durack JC. Evaluation of an Integrated Spectroscopy and Classification Platform for Point-of-Care Core Needle Biopsy Assessment: Performance Characteristics from Ex Vivo Renal Mass Biopsies. J Vasc Interv Radiol 2022; 33:1408-1415.e3. [PMID: 35940363 PMCID: PMC10204606 DOI: 10.1016/j.jvir.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate a transmission optical spectroscopy instrument for rapid ex vivo assessment of core needle cancer biopsies (CNBs) at the point of care. MATERIALS AND METHODS CNBs from surgically resected renal tumors and nontumor regions were scanned on their sampling trays with a custom spectroscopy instrument. After extracting principal spectral components, machine learning was used to train logistic regression, support vector machines, and random decision forest (RF) classifiers on 80% of randomized and stratified data. The algorithms were evaluated on the remaining 20% of the data set held out during training. Binary classification (tumor/nontumor) was performed based on a decision threshold. Multinomial classification was also performed to differentiate between the subtypes of renal cell carcinoma (RCC) and account for potential confounding effects from fat, blood, and necrotic tissue. Classifiers were compared based on sensitivity, specificity, and positive predictive value (PPV) relative to a histopathologic standard. RESULTS A total of 545 CNBs from 102 patients were analyzed, yielding 5,583 spectra after outlier exclusion. At the individual spectra level, the best performing algorithm was RF with sensitivities of 96% and 92% and specificities of 90% and 89%, for the binary and multiclass analyses, respectively. At the full CNB level, RF algorithm also showed the highest sensitivity and specificity (93% and 91%, respectively). For RCC subtypes, the highest sensitivity and PPV were attained for clear cell (93.5%) and chromophobe (98.2%) subtypes, respectively. CONCLUSIONS Ex vivo spectroscopy imaging paired with machine learning can accurately characterize renal mass CNB at the time of tissue acquisition.
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Affiliation(s)
| | - Dmitry V Dylov
- Skolkovo Institute of Science and Technology, Moscow, Russia
| | | | - Dharam Patel
- Novartis Pharmaceutical Corporation, East Hanover, New Jersey
| | - Tarik Silk
- New York University Langone Medical Center, New York, New York
| | - Mikhail Silk
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Natasha Rekhtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Howard I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeremy C Durack
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Sarode VR. The current practice of telecytology for rapid on-site evaluation (ROSE): Practical considerations and limitations. Semin Diagn Pathol 2022; 39:463-467. [PMID: 35718579 DOI: 10.1053/j.semdp.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Abstract
Advances in digital imaging technology and development of high-speed internet has brought a change in ROSE practice from the traditional in-person to remote evaluation. The rapid expansion of image-guided procedures to obtain tissues for diagnosis and ancillary testing has put a huge demand on cytopathologists' time to perform on-site adequacy assessment. The technology of transmitting digital slide images in real-time via the internet from procedure site that can be viewed remotely and provide preliminary diagnosis, has had a huge impact on the practice of ROSE. Telecytology (TC) has increased the efficiency of cytopathologists, by cutting down on travel time to procedure sites and eliminate the long wait time between procedures/needle passes. It also provides the cytopathologist with the flexibility of covering ROSE procedures occurring at several locations simultaneously. The options and design of TC systems are driven by clinical needs, availability of resources and case volume. A buy-in from stakeholders early in the process, infrastructure planning and information technology (IT) support are critical for the successful implementation of TC. Training of staff, validation study and compliance training should be performed according to established guidelines. There are different TC platforms commercially available in the market today, these include static image sharing, real-time video streaming, robotic microscopy and whole slide imaging (WSI). Additionally, low-cost TC system can be built and designed using equipment that are available off-the-shelf. The intent of this review is to highlight the current practices of TC, the pros and cons of each system are discussed.
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Affiliation(s)
- Venetia Rumnong Sarode
- Director of Cytopathology Clements University Hospital, UT Southwestern Medical Center, 6201 Harry Hines Blvd, Dallas, TX 75390-9073, USA.
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Alrafiah AR. Application and performance of artificial intelligence technology in cytopathology. Acta Histochem 2022; 124:151890. [PMID: 35366580 DOI: 10.1016/j.acthis.2022.151890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Abstract
Deep learning algorithms and artificial intelligence (AI) are making great progress in their capacity to evaluate and interpret image data recent advancements in computer vision and machine learning. The first use of AI in a pathology lab was in cytopathology, when a computer-assisted Pap test screening was created. Initially designed to diagnose rather than screen, there was a lot of disagreement concerning their wide use to clinical specimens. However, whole-slide imaging of both gynaecological and non-gynaecological histopathology have been the subject of recent AI work. An overview of the literature on AI in cytopathology is provided in this brief review. To be more precise, it intends to emphasize the relevance of applications of AI algorithms to gynaecological and non-gynaecologic cytology. Between January 2000 and December 2021, a search on artificial intelligence in cytopathology was conducted in several well-known databases, including PubMed, Web of Science, Scopus, Embase, and Google Scholar. Only full-text papers that could be accessed online were evaluated.
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Archondakis S, Roma M, Kaladelfou E. Implementation of pre-captured videos for remote diagnosis of cervical cytology specimens. Cytopathology 2020; 32:338-343. [PMID: 33368677 DOI: 10.1111/cyt.12948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/08/2020] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology. METHODS The study was performed on representative short videos captured from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; adenocarcinoma, 2) that were sent via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on the overall digital video quality. Contributors' and reviewers' diagnoses were collected, recorded, and statistically evaluated. RESULTS Statistical evaluation detected no significant difference in diagnostic accuracy between cytological diagnoses based on short videos versus conventional slides. The overall interobserver agreement ranged from substantial to almost perfect with κ values of 0.74-0.91. CONCLUSIONS Short videos produced by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into the daily workflow. Short pre-captured videos of cervical smears can be used for rapid and accurate diagnosis, diminishing turnaround times and improving small cytology departments' quality indices. They can also be used for archiving, teleconsultation, and second opinion purposes, improving the performance of already existing static telecytology stations.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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Perez D, Stemmer MN, Khurana KK. Utilization of Dynamic Telecytopathology for Rapid Onsite Evaluation of Touch Imprint Cytology of Needle Core Biopsy: Diagnostic Accuracy and Pitfalls. Telemed J E Health 2020; 27:525-531. [PMID: 32833582 DOI: 10.1089/tmj.2020.0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: In the era of personalized medicine, there has been an increase in demand on cytopathology service to perform rapid onsite evaluation of touch imprints (ROSETIs) of needle core biopsies (NCBs) to ensure sample adequacy and provide preliminary diagnosis. Limited publications have addressed use of telecytopathology for ROSETIs. We present our experience with telecytopathology-guided ROSETIs of NCBs. Materials and Methods: Cytotechnologist onsite transmitted real-time images of Diff-QUIK stained touch imprints of NCBs using an Olympus digital camera through Ethernet to a pathologist. The preliminary diagnosis from telecytopathology-guided ROSETIs was compared with that of the final NCB for diagnostic accuracy. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: Of 186 cases, 163 (87%) were concordant and 23 (13%) were discordant. Of the 23 discordant cases, 14 (58%) were diagnosed as benign with final NCB diagnoses as malignant and 9 (41%) were suspicious on ROSETIs with final NCB diagnoses as benign. The causes of discordance among cases categorized as benign on preliminary and malignant on final included interpretative error (9) and sampling (6). Six cases categorized as suspicious on preliminary and negative on final biopsy diagnosis correlated with concurrent fine-needle aspiration, raising the possibility of loss of diagnostic areas in processed tissue cores. Remaining three cases in this category represented misinterpretation of reactive cells. Sensitivity, specificity, PPV, and NPV were 87.9%, 95.7%, 97.1%, and 82.7%, respectively. Conclusions: Telecytopathology-guided ROSETI yields high accuracy for preliminary interpretation of NCBs and may be utilized as an effective substitute for conventional microscopy.
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Affiliation(s)
- Diandra Perez
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Melissa N Stemmer
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kamal K Khurana
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York, USA
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Chiou PZ. Learning cytology in times of pandemic: an educational institutional experience with remote teaching. J Am Soc Cytopathol 2020; 9:579-585. [PMID: 32622857 PMCID: PMC7283062 DOI: 10.1016/j.jasc.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 01/24/2023]
Abstract
Introduction As the coronavirus pandemic swept across national and state borders, institutions of higher learning, including cytology, began closing campuses and moving instruction online. We have described a method of remotely teaching cytology in our institution, including using the telecytology concept used with rapid onsite evaluation and remote conferencing and educational tools to conduct eCytology learning. This is a cost-effective method to transition a traditional in-classroom program into online teaching for cytology. It can also be implemented quickly. Materials and methods In March 2020, our cytology program developed a method for teaching cytology remotely. The distance-learning teaching method included the use of remote conferencing (Zoom platform) and learning management platforms (Canvas) to present lectures and administer tests. Remote multihead sessions were conducted by adapting the telecytology rapid onsite evaluation concept, which attaches a mobile device to the microscope to transmit live video to remote learners. Results When asked about their experience with online learning, the students had responded positively. All the students indicated a willingness to attend classes remotely in the future, even when the traditional in-classroom learning option is available. Conclusions We have presented a method for educating students remotely using existing technology that is affordable and can be implemented quickly by nearly all cytology education programs. Our experience with teaching eCytology in times of pandemic can serve as a cost-effective way to transition a traditionally in-classroom program, into an online teaching in cytology. It can also be implemented quickly. Remote multi-head sessions, conducted by adapting the tele-cytology ROSE concept with an attached mobile device to the microscope, is an effective approach to distance learning in times of social distancing and is a promising tool for the future cytology education. The students, when asked about their experiences with online learning, responded positively.
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Affiliation(s)
- Paul Z Chiou
- Clinical Laboratory and Medical Imaging, Rutgers Biomedical and Health Sciences, Newark, New Jersey.
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Archondakis S, Roma M, Kaladelfou E. The Implementation of Static Telecytology for Teleconsultation Purposes During Preoperative Evaluation of Thyroid Fine-Needle Aspiration Specimens. Telemed J E Health 2020; 27:207-212. [PMID: 32379546 DOI: 10.1089/tmj.2020.0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: The objective of this study was to investigate the impact of applying static telecytology for teleconsultation purposes during preoperative evaluation of challenging thyroid fine-needle aspiration specimens. Materials and Methods: The study was performed on 141 cytologically challenging specimens of 125 patients referred to Alpha Prolipsis Cytopathology Department. All cases were finally confirmed histologically. During the study, 10 characteristic images from each case were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists, with documented experience in the field of thyroid cytology. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered based on digitized images and conventional slides. Telecytology is a prompt and valid method for acquisition of a second opinion diagnosis in challenging cases and can be integrated into daily workflow. The use of telecytology for teleconsultation purposes in the laboratory's daily workflow will further ensure the accuracy of preoperative cytological diagnoses and will contribute to cytopathologists continuous education and better understanding of the criteria applied in thyroid gland lesions cytomorphological diagnosis. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered based on digitized images among contributing cytopathologists. The overall interobserver agreement was very good with κ values of 0.73-0.88. Conclusions: The widespread availability of imaging technology and telecommunication enables instant access to global expert cytopathologists. Static telecytology can be used as an efficient method for acquisition of second opinion in challenging thyroid fine-needle aspiration specimens. It can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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12
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Archondakis S, Roma M, Kaladelfou E. The Use of Static Telecytology for Quality Assessment Purposes in the Evaluation of Cervical Smears Prepared by Means of Liquid-Based Cytology. Telemed J E Health 2020; 26:1522-1525. [PMID: 32167860 DOI: 10.1089/tmj.2019.0303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology. Materials and Methods: The study was performed on representative digital cytological images from a total of 808 cervical smears (benign, 270; atypical squamous cells of undetermined significance, 184; low-grade squamous intraepithelial lesion, 124; high-grade squamous intraepithelial lesion, 174; squamous cell carcinoma, 52; and adenocarcinoma, 4) that were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. Their reports were recorded and classified. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of digitized images and conventional slides. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97. Conclusions: Static telecytology can be used as an alternative method for the cytological diagnosis of cervical smears, particularly in quality assurance programs. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.
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Affiliation(s)
- Stavros Archondakis
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Maria Roma
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
| | - Evropi Kaladelfou
- Department of Cytopathology, Alpha Prolipsis Medical Laboratories, Athens, Greece
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Satturwar S, Monaco SE, Xing J, Pantanowitz L. The utility of cell blocks for international cytopathology teleconsultation by whole slide imaging. Cytopathology 2020; 31:419-425. [PMID: 31961454 DOI: 10.1111/cyt.12800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/31/2019] [Accepted: 01/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Telecytology for second opinion consultation has largely been limited by technical issues, such as the inability to focus well on cellular material. Nevertheless, international telecytology consultation was undertaken at our institution with partners in China and Italy. To overcome issues with scanning cytology slides, we adopted a cell-block (CB) preference for teleconsultation. METHODS Telecytology consultation cases received over a 7.5-year period were retrospectively reviewed. Cytology glass slides were scanned without Z-stacking using different whole slide scanners. For one referring site, only haematoxylin-eosin-stained CBs were scanned, as well as immunostains requested by consultants. For another host centre, aspirate smears were also scanned in some cases. RESULTS A total of 51 non-gynaecological cases (44 CB only) were evaluated from 48 patients. The specimens included pleural fluids (19), pancreas (14), lymph nodes (6), peritoneal fluids (2) and miscellaneous samples (10). The cytological diagnoses spectrum included 16 (31.37%) cases positive for malignancy, 7 (13.72%) positive for neoplasm, 6 (11.76%) suspicious for malignancy, 10 (19.60%) atypical, 10 (19.60%) negative for malignancy and 2 (3.92%) non-diagnostic. In 42 (82.35%) cases, immunocytochemistry was requested. Turn-around-time ranged from 1.5 to 306 hours. CONCLUSIONS Our experience shows that international telecytology for consultation purposes involving non-gynaecological cases is feasible. A second opinion interpretation was rendered in the majority (64.7%) of cases. Utilising CB only for cytology consultations by whole slide imaging solved focus issues that typically plague evaluation of cytology aspirate smears.
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Affiliation(s)
- Swati Satturwar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Lin DM, Tracht J, Rosenblum F, Kouba E, Bahl D, Patel A, Eltoum IE. Rapid On-Site Evaluation With Telecytology Significantly Reduced Unsatisfactory Rates of Thyroid Fine-Needle Aspiration. Am J Clin Pathol 2020; 153:342-345. [PMID: 31628844 DOI: 10.1093/ajcp/aqz164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We evaluated telecytology rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration. To the best of our knowledge, this study is the first case-control clinical trial of thyroid telecytology. METHODS We introduced on-site ROSE in our institution's thyroid clinic for 6 months, followed by telecytology for 12 months. Our institution's ultrasound clinic, where ROSE is not provided, was used as a control group for each period. RESULTS Both groups had similar initial unsatisfactory rates (thyroid clinic: 8.8%; ultrasound clinic: 8.0%) before the study began. The thyroid clinic's unsatisfactory rate was significantly reduced to 1.6% after on-site ROSE (P = .001) and to 3.8% after telecytology ROSE (P = .010), with no significant difference between on-site and telecytology ROSE periods (P > .05). The ultrasound clinic's unsatisfactory rate was unchanged for both periods. Concordance between telecytology ROSE and final adequacy was 97% (κ = 0.699). CONCLUSIONS Telecytology ROSE reduces unsatisfactory rates for ultrasound-guided fine-needle aspiration without compromising patient care.
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Affiliation(s)
- Diana M Lin
- Department of Pathology, University of Alabama at Birmingham
| | - Jessica Tracht
- Department of Pathology, University of Alabama at Birmingham
| | - Frida Rosenblum
- Department of Pathology, University of Alabama at Birmingham
| | - Erik Kouba
- Department of Pathology, University of Alabama at Birmingham
| | - Deepti Bahl
- Department of Endocrinology, University of Alabama at Birmingham
| | - Anish Patel
- Department of Endocrinology, University of Alabama at Birmingham
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Monaco SE, Han M, Dietz R, Xing J, Cuda J, Pantanowitz L. Assessing competency for remote telecytology rapid on‐site evaluation using pre‐recorded dynamic video streaming. Cytopathology 2020; 31:411-418. [DOI: 10.1111/cyt.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Sara E. Monaco
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Min Han
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Robin Dietz
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Juan Xing
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Jacqueline Cuda
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Liron Pantanowitz
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
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16
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Naous R, Kobayashi K, Khurana KK. Dynamic Telecytopathology-Guided Rapid On-Site Assessment of Percutaneous Image-Guided Fine-Needle Aspiration of Hepatic Lesions: An Institutional Review of 178 Cases. Telemed J E Health 2019; 26:961-966. [PMID: 31657674 DOI: 10.1089/tmj.2019.0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Rapid on-site evaluation (ROSE) of image-guided fine-needle aspiration (IGFNA) of hepatic lesions is necessary to ensure adequate sample collection and render preliminary diagnosis. We review our experience with utilization of telecytopathology for ROSE of IGFNA of liver lesions. Materials and Methods: Cytotechnologists at a remote site transmitted real-time images of Diff-Quik-stained cytology smears of hepatic lesions obtained using an Olympus DP70 digital camera via Ethernet to a pathologist. All live communications were conducted using the Vocera voice communication system. Preliminary telecytopathology ROSE diagnosis was compared with the final diagnosis for accuracy. Results: ROSE using telecytopathology of IGFNAs of hepatic lesion was performed on a total of 178 cases. Preliminary diagnosis of unsatisfactory, benign, suspicious for malignancy, and positive for malignancy was 2%, 28%, 15%, and 55%, respectively, for telecytopathology. The overall concordance between the preliminary and final cytology diagnoses was 94.4%. Nine of the cases were upgraded to suspicious/malignant final diagnosis contributing to an upgrade rate of 5%. One case with preliminary evaluation of positive for malignancy was downgraded to benign cytology on final diagnosis resulting in a downgrade rate of 0.1%. Conclusion: Utilization of telecytopathology is highly effective and accurate for ROSE of IGFNAs of hepatic lesions and may serve as a substitute for conventional microscopy.
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Affiliation(s)
- Rana Naous
- Department of Pathology and SUNY Upstate Medical University, Syracuse, New York, USA
| | - Katsuhiro Kobayashi
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kamal K Khurana
- Department of Pathology and SUNY Upstate Medical University, Syracuse, New York, USA
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17
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Brooker AJ, Krimer PM, Meichner K, Garner BC. Impact of photographer experience and number of images on telecytology accuracy. Vet Clin Pathol 2019; 48:419-424. [PMID: 31515821 DOI: 10.1111/vcp.12768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies evaluating the potential impact of photographer experience or the number of images evaluated using the "store-and-forward" method of telecytology are not reported. OBJECTIVES This study aimed to determine the diagnostic sensitivity (Se) and specificity (Sp) of static telecytology when images were taken by experienced and inexperienced cytologists and when the number of images taken varied. Clinical agreement between the diagnoses was compared. METHODS Fifty archived cytology cases were randomly chosen. A board-certified clinical pathologist and a recent veterinary graduate took five images of each case. A third pathologist made a preliminary diagnosis after reviewing two images, and a final diagnosis after reviewing all images. The gold standard for comparison was the glass slide cytologic diagnosis. RESULTS Se and Sp were higher for the experienced cytologist and the evaluation of more images, but differences were not statistically significant. Clinical agreement between the image and glass slide diagnoses was significantly higher when images were taken by an experienced rather than inexperienced cytologist after the evaluation of two (P = .007) and five images (P = .008). The telecytology diagnoses agreed with the gold standard diagnoses more frequently after evaluation of five images rather than two when images were captured by both the experienced (P < .001) and inexperienced cytologist (P < .001). CONCLUSIONS There is more clinical agreement when the photographer has more cytology experience and when more images are provided for interpretation.
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Affiliation(s)
- Alyssa J Brooker
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Paula M Krimer
- Athens Veterinary Diagnostic Laboratory, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Kristina Meichner
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - Bridget C Garner
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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18
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Selvaggi SM. On the job training: an educational program in ROSE of fine needle aspirates and telecytology for cytotechnologists. J Am Soc Cytopathol 2018; 7:306-310. [PMID: 31043300 DOI: 10.1016/j.jasc.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION As the demand for rapid on-site evaluation (ROSE) of fine needle aspirates (FNAs) has continued to increase, the provision of service requires a creative approach to maximize efficiency without compromising patient care. We describe the educational process used to train cytotechnologists in ROSE of FNAs using telecytology. MATERIALS AND METHODS In 2005, the cytopathology division of the University of Wisconsin pathology department developed an on the job training program for cytotechnologists in ROSE of FNAs using telecytology. Training includes education in assistance on FNA procedures, proficiency and competency in specimen adequacy assessments, and proper usage of the telecytology work station. Trainees are monitored by a trainer through all the steps of the process, including the checklists and examination. RESULTS Eight cytotechnologists successfully completed the program, with test scores ranging from 90% to 95%, and were deemed competent by all measures to provide ROSE of FNAs via telecytology. CONCLUSIONS Cytotechnologists play a pivotal role in the provision of an FNA service. Schools of cytotechnology should educate students (future cytotechnologists) in ROSE of FNAs and video streaming via telecytology to prepare them for clinical work, enhance their scope of practice, and improve their job satisfaction.
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Affiliation(s)
- Suzanne M Selvaggi
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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19
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Schmolze DB, Fischer AH. An Automatable Method for Determining Adequacy of Thyroid Fine-Needle Aspiration Samples. Arch Pathol Lab Med 2018; 143:1084-1088. [PMID: 30354272 DOI: 10.5858/arpa.2018-0072-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Thyroid nodules are a common clinical problem. Cytologic evaluation via fine-needle aspiration is often employed in the diagnostic workup, and rapid on-site assessment of adequacy can help ensure an adequate sample is obtained. However, rapid on-site assessment of adequacy only examines part of the sample, a part that may not then be available for ancillary testing. Moreover, the procedure is time-consuming and poorly reimbursed. OBJECTIVE.— To develop an automatable fluorescence-based image analysis system for assessing the adequacy of thyroid fine-needle aspirations that uses the entire aspirated sample. DESIGN.— There were 12 previously diagnosed cases that served as a training set, and 11 cases were used for validation of an image analysis algorithm. The samples were fluorescently stained and imaged using a fluorescent microscope. The images were assessed for adequacy by an image analysis algorithm. Following image analysis, a ThinPrep slide was prepared and blindly scored by a cytopathologist. The standard and computer-derived results were then compared. RESULTS.— The algorithm was optimized using the 12 cases in the training set and then applied to the 11 test cases. A total of 8 of 8 adequate samples in the test group were correctly scored as adequate, and 2 of 3 cases that were inadequate were correctly scored as inadequate by the algorithm. One case was erroneously designated as not adequate by the algorithm. CONCLUSIONS.— Our results demonstrate the feasibility of automating thyroid adequacy assessment using a fluorescent labeling technique followed by computer image analysis.
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Affiliation(s)
- Daniel B Schmolze
- From the Department of Pathology, City of Hope National Medical Center, Duarte, California (Dr Schmolze); and the Department of Pathology, University of Massachusetts Medical School, Worcester (Dr Fischer)
| | - Andrew H Fischer
- From the Department of Pathology, City of Hope National Medical Center, Duarte, California (Dr Schmolze); and the Department of Pathology, University of Massachusetts Medical School, Worcester (Dr Fischer)
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20
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Caron JE, Ying Y, Ye Q, Cheng L, Rao JY. International telecytology: Current applications and future potential. Diagn Cytopathol 2018; 47:28-34. [PMID: 29727061 DOI: 10.1002/dc.23960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/10/2022]
Abstract
International telecytology can improve patient care by increasing access to regional and international expertise in cytopathology. The majority of international telecytology studies published to date have been based on static telepathology platforms. Overall concordance rates for these studies ranged from 71% to 93%. This is comparable to the concordance rates published for other studies comparing diagnoses made by digital still images to reference glass slides, which vary from 80% to 95%. Static telepathology systems are relatively cheap and easy to use, and have the potential to increase access to international experts in developing countries with limited resources. In contrast, resource-rich academic and private medical centers can use whole slide digital imaging (WSI) for telecytology consultation, though few studies have been published addressing this topic. International telepathology consultation services with digital whole slide image capabilities have been established at several academic medical centers including the University of Pittsburgh Medical Center (UPMC) and the University of California at Los Angeles (UCLA), through the UCLA Center for Telepathology and Digital Pathology. In a small series of 20 telecytology cases submitted to UCLA from 2014 to 2017 (10 gynecologic and 10 fine needle aspiration cases), a meaningful diagnosis was rendered for 100% of cases, with 100% concordance between the submitting institution, versus consultation diagnosis provided by UCLA. These limited results are promising, and in the future both WSI and static telecytology consultation may have a place serving clinical needs in different practice settings.
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Affiliation(s)
- Justin E Caron
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90025
| | - Yong Ying
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90025
| | - Qin Ye
- Department of Pathology, Second Affiliate Hospital of Zhejiang University, Hangzhou, Zhejiang Province, 310009, P. R. China
| | - Lirong Cheng
- Department of Pathology, Second Affiliate Hospital of Zhejiang University, Hangzhou, Zhejiang Province, 310009, P. R. China
| | - Jian Yu Rao
- Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90025
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21
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Farrell JM, Riben MW, Staerkel GA, Huang ML, Dawlett M, Caraway NP. Efficacy of telecytopathology for preliminary assessment of fine-needle aspirations performed at a remote facility. J Am Soc Cytopathol 2018; 7:22-30. [PMID: 31043247 DOI: 10.1016/j.jasc.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The need for real time anatomic pathology services has grown as healthcare systems, traditionally found at large medical centers, expand into smaller communities. The placement of a pathologist is not cost-, time-, or resource-efficient. Telecytopathology can provide rapid offsite evaluation of cytology tissues. This study evaluated the accuracy rate of rendered preliminary assessments for telecytopathology of ultrasound (US)-guided fine-needle aspirations (FNAs) for an offsite facility by comparing preliminary assessment results with the final diagnosis. MATERIALS AND METHODS The pathology database was searched for telecytopathology US-guided FNAs with rapid offsite evaluation performed at a regional care center from August 2014 to June 2016. A total of 674 consecutive US-guided FNAs from 444 patients were obtained. FNA sites included lymph node (345 cases), breast (178 cases), thyroid gland (71 cases), and others (80 cases). RESULTS Preliminary assessments of the 674 FNAs were adequate/benign in 275 (41%) cases, adequate/malignant in 182 (27%) cases, adequate/further review needed in 162 (24%) cases, indeterminate/borderline cellularity in 37 (5%) cases, and nondiagnostic in 18 (3%) cases. Final FNA diagnoses rendered included 391 (58%) negative for malignancy, 205 (30%) malignant, 34 (5%) atypical/suspicious for malignancy, 26 (4%) indeterminate cellularity-favor benign, and 18 (3%) nondiagnostic specimens. Concurrent core biopsy was performed in 42 cases and 83 cases were triaged for ancillary studies. The majority (99%) of US-guided FNAs demonstrated concordant preliminary assessments with the final diagnoses. A major discrepancy occurred in 1 case; 5 cases had minor discrepancies. CONCLUSIONS Remote facility telecytopathology can be utilized as an accurate modality in guiding appropriate tissue acquisition and final diagnosis.
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Affiliation(s)
- Jessica M Farrell
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael W Riben
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregg A Staerkel
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monica L Huang
- Department of Diagnostic Radiology-Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marilyn Dawlett
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy P Caraway
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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22
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Sirintrapun SJ, Rudomina D, Mazzella A, Feratovic R, Alago W, Siegelbaum R, Lin O. Robotic Telecytology for Remote Cytologic Evaluation without an On-site Cytotechnologist or Cytopathologist: An Active Quality Assessment and Experience of Over 400 Cases. J Pathol Inform 2017; 8:35. [PMID: 28966835 PMCID: PMC5609392 DOI: 10.4103/jpi.jpi_25_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first satellite center to offer interventional radiology procedures at Memorial Sloan Kettering Cancer Center opened in October 2014. Two of the procedures offered, fine needle aspirations and core biopsies, required a rapid on-site cytologic evaluation of smears and biopsy touch imprints for cellular content and adequacy. The volume and frequency of such evaluations did not justify hiring on-site cytotechnologists, and therefore, a dynamic robotic telecytology (TC) solution was created. In this article, we provide data on our experience with this active implementation. Sakura VisionTek was selected as our robotic TC solution. METHODS A retrospective analysis of all TC evaluations from this satellite site was performed. Information was collected on demographics, lesion location, imaging modality; a comparison of TC-assisted adequacy with final adequacy was also conducted. RESULTS An analysis of 439 cases was performed over a period of 23 months with perfect correlation in 92.7% (407/439) of the cases. An adequacy upgrade (inadequate specimen becomes adequate) in 6.6% (29/439) of the cases. An adequacy downgrade (adequate specimen becomes inadequate), is near zero at 0.7% (3/439) of the cases. CONCLUSIONS Dynamic robotic TC is effective for immediate evaluations performed without on-site cytotechnology staff. The overall intent of this article is to present data and concordance rates as outcome metrics. Thus far, such outcome metrics have exceeded our expectations. Our TC implementation shows high, perfect concordance. Adequacy upgrades are minor but more relevant and impressive is a near zero adequacy downgrade. Our full implementation has been so successful that plans are in place for configurations at future satellite sites.
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Affiliation(s)
| | - Dorota Rudomina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allix Mazzella
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rusmir Feratovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Alago
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Siegelbaum
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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23
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Fassina A, Cappellesso R, Tötsch M, Barroca H, Marchiò C, Dina R, Ovcin E, Bussolati G. Next-generation learning and training: The Cy-TEST experience. Cancer Cytopathol 2017; 125:669-673. [PMID: 28759174 DOI: 10.1002/cncy.21895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Ambrogio Fassina
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Rocco Cappellesso
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Martin Tötsch
- Institute of Cytology, Graz University Hospital, Medical University of Graz, Graz, Austria
| | - Helena Barroca
- Saint John Hospital, Porto, Portugal.,Department of Pathology and Medical Oncology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Caterina Marchiò
- Surgical Pathology and Cytopathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Roberto Dina
- Department of Pathology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Emanuela Ovcin
- Consortium for Research and Continuing Education, Turin, Italy
| | - Gianni Bussolati
- Surgical Pathology and Cytopathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
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Abstract
The advancements in the fields of technology and networking have revolutionized the world including the fields of medicine and dentistry. Telemedicine and its various branches provide a broad platform to medical professionals for consultations and investigations and can also act as a valuable educational aid. This review highlights the components, methods employed, clinical applications, advantages, disadvantages of telepathology and telecytology.
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Affiliation(s)
- Roquaiya Nishat
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Sujatha Ramachandra
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Shyam Sundar Behura
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Harish Kumar
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
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25
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. ATA clinical guidelines for telepathology. Telemed J E Health 2016; 20:1049-56. [PMID: 25384254 DOI: 10.1089/tmj.2014.9976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liron Pantanowitz
- 1 Department of Pathology, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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Saco A, Ramírez J, Rakislova N, Mira A, Ordi J. Validation of Whole-Slide Imaging for Histolopathogical Diagnosis: Current State. Pathobiology 2016; 83:89-98. [PMID: 27099935 DOI: 10.1159/000442823] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rapid advances in informatics and technological improvements have led to the development of high-throughput whole-slide imaging (WSI) scanners able to produce high-quality digital images, which allow achieving a correct diagnosis of the biopsies using virtual viewers. This technology is currently prepared to be introduced in the departments of pathology for routine diagnosis. The aim of this review is to analyze the current evidence regarding the use of WSI in primary or routine diagnosis in the different subspecialties of pathology. An increasing number of studies have shown almost perfect inter- and intraobserver agreement between the diagnoses obtained with WSI and the classical diagnoses based on conventional light microscopy. The only exception seems to be cytology, which still requires some technological development. Although validation studies are needed in some areas of pathology, growing evidence indicates that WSI is a reliable tool for routine diagnosis. Pathologists have a positive perception of the ergonomics of the workstations, the low magnification of WSI and the possibility of making annotations and measurements. WSI can be used from any device and anywhere, thereby providing great opportunities for teleconsultation. New technologies such as the recognition of histopathology patterns using image analysis may facilitate diagnosis and improve the reproducibility among pathologists in the future.
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27
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Durdu M, Harman M. Diagnostic value of telecytology in tertiary teledermatological consultation: a retrospective analysis of 75 cases. Int J Dermatol 2016; 55:e392-8. [PMID: 26873118 DOI: 10.1111/ijd.13219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 10/08/2015] [Accepted: 10/18/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The addition of dermatoscopic images to clinical images is reported to increase the diagnostic value of teledermatology. No study has investigated the contribution of telecytology to teledermatology. We aimed to assess the diagnostic accuracy of telecytology in tertiary teledermatological evaluation. METHODS The study included 75 patients for whom no diagnosis could be established at face-to-face clinical examinations and cytological evaluations, who therefore consulted with a dermatologist experienced in cytology through the store-and-forward method. Telecytological diagnosis was then compared with the final diagnosis, and diagnostic accuracy was calculated. RESULTS In the past 2 years, 75 patients (38 [50.7%] female, 37 [49.3%] male) were evaluated by telecytology. According to definitive diagnoses, 31 patients (41.3%) had erosive-vesiculobullous, 25 (33.3%) had tumoral, and 19 (15.8%) had granulomatous disease. Diagnostic accuracy of telecytology was 90.7%. LIMITATIONS Our study was a retrospective study, and cytological images were evaluated by one dermatologist only; therefore, no reliability analysis could be performed. CONCLUSION This study revealed that the cytological images should be used in tertiary teledermatological evaluation. Further studies should therefore be carried out to investigate the diagnostic value of different telecytological methods.
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Affiliation(s)
- Murat Durdu
- Department of Dermatology, Başkent University Faculty of Medicine, Adana Hospital, Adana, Turkey
| | - Mehmet Harman
- Department of Dermatology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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28
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Agarwal S, Zhao L, Zhang R, Hassell L. FaceTime validation study: Low-cost streaming video for cytology adequacy assessment. Cancer Cytopathol 2015; 124:213-20. [DOI: 10.1002/cncy.21636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/04/2015] [Accepted: 09/25/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Shweta Agarwal
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Lichao Zhao
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Roy Zhang
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
| | - Lewis Hassell
- Department of Pathology; University of Oklahoma Health Sciences Center; Oklahoma City Oklahoma
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29
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Bongaerts O, van Diest PJ, Pieters M, Nap M. Working toward consensus among professionals in the identification of classical cervical cytomorphological characteristics in whole slide images. J Pathol Inform 2015; 6:52. [PMID: 26605117 PMCID: PMC4629309 DOI: 10.4103/2153-3539.166013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/06/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction: Cervical cancer is one of the most common causes of death in women worldwide.[1] The introduction of cervical cytology in screening programs is an effective way for early detection and treatment of cervical precancerous lesions. Conventional screening of cervical cytology slides is still considered the current “gold standard” for the assessment of proficiency in becoming a cytotechnician, but diagnosis using digital whole slide images (WSI) may offer many advantages. Materials and Methods: In this study, we have used a selection of WSI from thin-layer specimens of the most common cervical infections and (pre) neoplastic lesions, and hypothesized that weekly WSI based case-meetings would help to obtain optimal acceptance of the new digital workflow in daily pathology practice. A questionnaire, before and after the test period was used to study the effect of our approach. Results: The participants clearly had to go through a learning curve to get accustomed to viewing WSI. In the beginning, there was a little self-confidence in recognizing classical cervical cytomorphological features in the WSI, and there were complaints about the speed of viewing and insufficient Z-resolution for cell groups. Adjusting the Z-stack settings resulted in better three-dimensional information due to better focusing options. Weekly meetings appeared to be instrumental in the implementation process, as participants had to select and present WSI from thematic cases themselves, and thereby, got used to viewing WSI. Some WSI were replaced by better ones until a final set of 45 representatives WSI remained. Eventually, the consensus was reached among all participants that cytomorphological features in WSI from thin-layers cervical specimens could comparably be appreciated in WSI as by conventional microscopy. The selection of 45 WSI was now used to create a digital WSI based reference atlas to support further studies. Conclusion: We have obtained consensus between professionals that WSI from cervical cytology can be used to identify cytomorphological features, necessary for diagnosis. In addition, we observed that active participation of professionals had a positive effect on the overall acceptance of WSI and was important in the change management.
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Affiliation(s)
- Odille Bongaerts
- Department of Pathology, Atrium Medical Center, Parkstad, Heerlen, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center, Heidelberglaan, Utrecht, The Netherlands
| | - Math Pieters
- Fertility Unit, Division Mother and Child, University Medical Center, Heidelberglaan, Utrecht, The Netherlands
| | - Marius Nap
- Department of Pathology, Atrium Medical Center, Parkstad, Heerlen, The Netherlands
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Odronic SI, Roberson J, Booth CN. Current practice patterns in nongynecologic and fine-needle aspiration cytology. J Am Soc Cytopathol 2015; 4:239-245. [PMID: 31051760 DOI: 10.1016/j.jasc.2015.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/16/2015] [Accepted: 02/18/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The American Society of Cytopathology Clinical Practice Committee in collaboration with the American Society of Cytotechnology surveyed cytology practitioners to better understand current practices related to nongynecologic (NGYN) cytology. While work practices in gynecologic (GYN) cytology are highly regulated with limited variation among specimens and processing techniques, practice patterns for NGYN cytology are less standardized among laboratories. MATERIALS AND METHODS An NGYN cytology survey was created that consisted of 40 questions focusing on 6 main topic areas: (1) practice settings and demographic data; (2) NGYN non-fine-needle aspiration cytology; (3) fine-needle aspiration (FNA) cytology; (4) rapid on-site evaluation practices; (5) workload recording practices; and (6) expanding roles of the cytotechnologist (CT). The survey was sent to all American Society of Cytopathology and American Society of Cytotechnology members and remained available for 40 days. RESULTS There were 368 survey participants (14% response rate) with nearly equal participation among CTs, cytology general managers and/or supervisors, and pathologists representing a variety of practice types. Most laboratories (87%) are providing a rapid on-site evaluation service for FNA specimens. The role of CTs is expanding with the majority of respondents stating that CTs assist with both clinician-performed and pathologist-performed FNA acquisition (77% and 50%, respectively), telecytology (16%), and screening of ancillary studies, including special stains (64%), immunohistochemistry (23%), and fluorescence in situ hybridization (16%). CONCLUSIONS Knowledge of NGYN cytology practice patterns among laboratories may contribute information to better define the future of cytotechnology, support reimbursement initiatives, and enhance quality and efficiencies in the cytology laboratory.
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Affiliation(s)
- Shelley I Odronic
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio
| | - Janie Roberson
- Department of Pathology, University of Alabama, Birmingham, Alabama
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio.
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Khurana KK, Xu W, Wang D, Swarnkar A. Rapid on-site evaluation with dynamic telecytopathology for ultrasound-guided fine-needle aspiration of head and neck nonthyroid lesions. J Pathol Inform 2015; 6:19. [PMID: 26110087 PMCID: PMC4466783 DOI: 10.4103/2153-3539.157781] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/17/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) at the time of ultrasound-guided fine-needle aspiration (USGFNA) of head and neck lesion is essential for obtaining adequate samples and providing the preliminary diagnosis. We summarize our experience with ROSE of USGFNA on head and neck nonthyroid lesions using telecytopathology. MATERIALS AND METHODS Real-time images of Diff-Quik stained cytology smears were obtained at ultrasound suite with an Olympus DP-70 digital camera attached to an Olympus CX41 microscope, and transmitted via ethernet by a cytotechnologist to a cytopathologist in cytopathology laboratory who rendered a preliminary diagnosis. Live communication was conducted with Vocera voice communication system. The ultrasound suite was located on different floor from the cytopathology laboratory. Accuracy of ROSE via telecytopathology was compared with an equal number of cases that received ROSE, prior to introduction of telecytopathology, via conventional microscopy. RESULTS Rapid on-site evaluation was performed on a total of 116 USGFNA of head and neck nonthyroid lesions. The telecytopathology system and conventional microscopy was used to evaluate equal number of cases (58 each). Preliminary diagnoses of benign, atypical/suspicious for malignancy, and positive for malignancy were 72.4%, 17.2% and 10.3% for telecytopathology, and 69.0%, 10.3% and 20.7% for conventional microscopy. None of the cases were deemed unsatisfactory. The overall concordance between the preliminary and final diagnoses was 94.8% for telecytopathology and 98.3% for conventional microscopy and was not statistically significant (P = 0.309). The causes of discordant preliminary and final diagnoses were mainly attributed to availability of cell block and Papanicolaou-stained slides for review or flow cytometry results for lymphoma cases at the time of final sign out. CONCLUSIONS Telecytopathology is comparable with conventional microscopy in ROSE of USGFNA of head and neck nonthyroid lesions.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, Syracuse, New York, USA
| | - Weisheng Xu
- Department of Pathology, State University of New York, Syracuse, New York, USA
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, State University of New York, Syracuse, New York, USA
| | - Amar Swarnkar
- Department of Radiology, State University of New York, Syracuse, New York, USA
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. American Telemedicine Association clinical guidelines for telepathology. J Pathol Inform 2014. [PMID: 25379345 DOI: 10.4103/2153–3539.143329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kim Dickinson
- Integrated Oncology, LabCorp and Digital Pathology Association, Irvine, CA, USA
| | - Andrew J Evans
- Department of Pathology, University Health Network Toronto General Hospital, Toronto, Canada
| | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Walter H Henricks
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jochen K Lennerz
- Department of Pathology, University Ulm, Albert-Einstein-Allee, Ulm, Germany
| | | | - Anil V Parwani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Riben
- Department of Pathology, Anatomic Pathology Informatics, MD Anderson, Houston, TX, USA
| | - Col Daniel Smith
- Department of Pathology, Keesler Medical Center, Biloxi, MS, USA
| | - J Mark Tuthill
- Department of Pathology, Pathology Informatics, Henry Ford Health System, Detroit, MI, USA
| | | | - David C Wilbur
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, Lowe A, Parwani AV, Riben M, Smith CD, Tuthill JM, Weinstein RS, Wilbur DC, Krupinski EA, Bernard J. American Telemedicine Association clinical guidelines for telepathology. J Pathol Inform 2014; 5:39. [PMID: 25379345 PMCID: PMC4221880 DOI: 10.4103/2153-3539.143329] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/16/2022] Open
Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kim Dickinson
- Integrated Oncology, LabCorp and Digital Pathology Association, Irvine, CA, USA
| | - Andrew J Evans
- Department of Pathology, University Health Network Toronto General Hospital, Toronto, Canada
| | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Walter H Henricks
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jochen K Lennerz
- Department of Pathology, University Ulm, Albert-Einstein-Allee, Ulm, Germany
| | | | - Anil V Parwani
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael Riben
- Department of Pathology, Anatomic Pathology Informatics, MD Anderson, Houston, TX, USA
| | - Col Daniel Smith
- Department of Pathology, Keesler Medical Center, Biloxi, MS, USA
| | - J Mark Tuthill
- Department of Pathology, Pathology Informatics, Henry Ford Health System, Detroit, MI, USA
| | | | - David C Wilbur
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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McCarthy EE, McMahon RQ, Das K, Stewart J. Internal validation testing for new technologies: Bringing telecytopathology into the mainstream. Diagn Cytopathol 2014; 43:3-7. [DOI: 10.1002/dc.23167] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/21/2014] [Accepted: 05/02/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Erin E. McCarthy
- Wisconsin State Laboratory of Hygiene; University of Wisconsin-Madison; Madison Wisconsin
| | - Rachel Q. McMahon
- Cytopathology Section; University of Wisconsin Hospital and Clinics; Madison Wisconsin
| | - Kasturi Das
- North Shore-LIJ Hospital Systems; Lake Success; New York New York
| | - Jimmie Stewart
- Department of Pathology and Laboratory Medicine; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
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McMahon RQ, McCarthy EE, Hetzel SJ, Das K, Stewart J. Focus on technology: How important is resolution in telecytopathology? Cancer Cytopathol 2014; 122:546-52. [PMID: 24678000 DOI: 10.1002/cncy.21404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The authors conducted an analysis of 2 telepathology systems with different resolutions to determine how resolution affects the pathologists' ability to provide preliminary diagnoses for fine-needle aspirations (FNA). METHODS FNA cases evaluated by telepathology between February 1, 2011 and January 18, 2012 were reviewed. Concordance indices between preliminary and final diagnoses were calculated for cases assessed with two proprietary systems (the Remote Meeting Technologies iMedHD system and the Olympus NetCam system) using 3 diagnostic classifications (negative, atypical, and suspicious/positive). A Wilcoxon rank-sum test was used to compare the number of passes necessary to determine adequacy. RESULTS In total, 298 NetCam cases and 26 iMedHD cases were evaluated. The concordance index, which was calculated using the 3 classifications, was 0.943 (95% confidence interval, 0.922-0.963) for NetCam compared with 0.951 (95% confidence interval, 0.898-1.000) for iMedHD. The mean value for the number of passes required to determine adequacy was 2.2 for NetCam and 2.1 for iMedHD (P = .838). CONCLUSIONS The results from statistical analyses demonstrated no difference in the concordance indices between preliminary and final diagnoses or in the number of passes necessary to render adequacy between the 2 telepathology systems. However, because it had higher resolution along with other features, the iMedHD system achieved greater user satisfaction.
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Affiliation(s)
- Rachel Q McMahon
- Department of Cytopathology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Khurana KK, Kovalovsky A, Wang D, Lenox R. Feasibility of dynamic telecytopathology for rapid on-site evaluation of endobronchial ultrasound-guided transbronchial fine needle aspiration. Telemed J E Health 2014; 19:265-71. [PMID: 23540276 DOI: 10.1089/tmj.2012.0168] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Rapid on-site evaluation (ROSE) at the time of endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBFNA) is useful in obtaining adequate samples and providing preliminary diagnosis. We present our experience with ROSE of EBUS-TBFNA using telecytopathology. MATERIALS AND METHODS Real-time images of Diff-Quik (Mercedes Medical, Sarasota, FL)-stained cytology smears were obtained with an Olympus (Olympus America, Center Valley, PA) digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a cytopathologist in a cytopathology laboratory who rendered a preliminary diagnosis while communicating with an on-site cytotechnologist via the Vocera (San Jose, CA) voice communication system. The endoscopy suite was located a block away from the cytopathology laboratory. Accuracy of ROSE via telecytopathology was compared with an equal number of cases that received ROSE, prior to introduction of telecytopathology, via conventional microscopy. RESULTS ROSE was performed on a total of 200 EBUS-TBFNAs. The telecytopathology system and conventional microscopy were used to evaluate equal numbers of cases (100 each). Preliminary diagnoses of negative/benign, atypical/suspicious, and positive for malignancy were 58%, 14%, and 24% for telecytopathology and 57%, 10%, and 31% for conventional microscopy. Four percent of telecytopathology cases and 2% of conventional microscopy cases were deemed unsatisfactory at the time of ROSE. The overall concordance between the preliminary and final diagnoses was 96% for telecytopathology and 93% for conventional microscopy. The causes of discordant preliminary and final diagnoses could be mainly attributed to difficulty in distinguishing small cell carcinoma versus reactive lymph node due to crush artifact, atypia related to reactive bronchial epithelial cells, and availability of cell block material and Papanicolaou-stained slides for review at the time of final cytologic sign out. CONCLUSIONS Telecytopathology is comparable with conventional microscopy in ROSE of EBUS-TBFNA. It can serve as a valid substitute for conventional microscopy for on-site assessment of EBUS-TBFNA.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, Syracuse, NY 13210, USA.
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Khalbuss WE, Cuda J, Cucoranu IC. Screening and dotting virtual slides: A new challenge for cytotechnologists. Cytojournal 2013; 10:22. [PMID: 24379891 PMCID: PMC3870328 DOI: 10.4103/1742-6413.120790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/23/2013] [Indexed: 11/04/2022] Open
Abstract
Digital images are increasingly being used in cytopathology. Whole-slide imaging (WSI) is a digital imaging modality that uses computerized technology to scan and convert entire cytology glass slides into digital images that can be viewed on a digital display using the image viewer software. Digital image acquisition of cytology glass slides has improved significantly over the years due to the use of liquid-based preparations and advances in WSI scanning technology such as automatic multipoint pre-scan focus technology or z-stack scanning technology. Screening cytotechnologists are responsible for every cell that is present on an imaged slide. One of the challenges users have to overcome is to establish a technique to review systematically the entire imaged slide and to dot selected abnormal or significant findings. The scope of this article is to review the current user interface technology available for virtual slide navigation when screening digital slides in cytology. WSI scanner vendors provide tools, built into the image viewer software that allow for a more systematic navigation of the virtual slides, such as auto-panning, keyboard-controlled slide navigation and track map. Annotation tools can improve communication between the screener and the final reviewer or can be used for education. The tracking functionality allows recording of the WSI navigation process and provides a mechanism for confirmation of slide coverage by the screening cytotechnologist as well as a useful tool for quality assurance. As the WSI technology matures, additional features and tools to support navigation of a cytology virtual slide are anticipated.
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Affiliation(s)
- Walid E Khalbuss
- Address: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jackie Cuda
- Address: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ioan C Cucoranu
- Address: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Affiliation(s)
- Timothy Craig Allen
- From the Department of Pathology, University of Texas Health Science Center at Tyler. Dr Allen is now located at the University of Texas Medical Branch at Galveston, Texas
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Khurana KK, Kovalovsky A, Masrani D. Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center. J Pathol Inform 2012; 3:36. [PMID: 23243554 PMCID: PMC3519010 DOI: 10.4103/2153-3539.101803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 07/25/2012] [Indexed: 11/08/2022] Open
Abstract
Background: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA) specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA) of axillary lymph nodes in a remote breast care center. Materials and Methods: Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. Results: A total of 39 female patients (mean age: 50.5 years) seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. Conclusions: This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate compared with the final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, 750 East Adams Street, Syracuse, New York
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