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Lin O, Alperstein S, Barkan GA, Cuda JM, Kezlarian B, Jhala D, Jin X, Mehrotra S, Monaco SE, Rao J, Saieg M, Thrall M, Pantanowitz L. American Society of Cytopathology Telecytology validation recommendations for rapid on-site evaluation (ROSE). J Am Soc Cytopathol 2024; 13:111-121. [PMID: 38310002 DOI: 10.1016/j.jasc.2023.12.001] [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: 10/13/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 02/05/2024]
Abstract
Telecytology has multiple applications, including rapid onsite evaluation (ROSE) of fine-needle aspiration (FNA) specimens. It can enhance cytopathology practice by increasing productivity, reducing costs, and providing subspecialty expertise in areas with limited access to a cytopathologist. However, there are currently no specific validation guidelines to ensure safe practice and compliance with regulations. This initiative, promoted by the American Society of Cytopathology (ASC), intends to propose recommendations for telecytology implementation. These recommendations propose that the validation process should include testing of all hardware and software, both separately and as a whole; training of all individuals who will participate in telecytology with regular competency evaluations; a structured approach using retrospective slides with defined diagnoses for validation and prospective cases for verification and quality assurance. Telecytology processes must be integrated into the laboratory's quality management system and benchmarks for discrepancy rates between preliminary and final diagnoses should be established and monitored. Special attention should be paid to minimize discrepancies that downgrade malignant cases to benign (false positive on telecytology). Currently, billing and reimbursement codes for telecytology are not yet available. Once, they are, recommendation of the appropriate usage of these codes would be a part of the recommendations. These proposed guidelines are intended to be a resource for laboratories that are considering implementing telecytology. These recommendations can help to ensure the safe and effective use of telecytology and maximize its benefits for patients.
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Affiliation(s)
- Oscar Lin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Susan Alperstein
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, New York, New York
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Jacqueline M Cuda
- Department of Pathology and Laboratory Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Brie Kezlarian
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Darshana Jhala
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Pittsburgh, Pennsylvania
| | - Xiaobing Jin
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Sara E Monaco
- Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania
| | - Jianyu Rao
- Department of Pathology and Laboratory, UCLA Health, Los Angeles, California
| | - Mauro Saieg
- Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil
| | - Michael Thrall
- Department of Pathology, Houston Methodist Hospital, Houston, Texas
| | - Liron Pantanowitz
- Department of Pathology and Laboratory Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Garavand A, Aslani N, Behmanesh A, Khara R, Ehsanzadeh SJ, Khodaveisi T. Features of teleoncology in lung cancer: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 114:107831. [PMID: 37295044 DOI: 10.1016/j.pec.2023.107831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/17/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES There are several challenges in providing healthcare services for lung cancer patients. Using teleoncology is an effective solution to meet such challenges. Given this, we in this study aimed to identify the features of teleoncology in lung cancer. METHODS We conducted this scoping review in 2023. We first searched scientific databases including PubMed, Scopus, ISI Web of Sciences, and Science Direct by combining related keywords for the past 12 years (2012-2023). RESULTS After reviewing 860 articles, we selected 39 studies for the purpose of this study. The interventions of teleoncology for lung cancer patients have four main categories, namely: monitoring of symptoms, monitoring the process of treatment and rehabilitation of patients, self-management and patient empowerment, and providing consultation for patients. CONCLUSION The appropriate implementation of teleoncology systems improves the patient's condition and reduces lung cancer complications by improving the availability of different health services. PRACTICE IMPLICATIONS More attention should be paid to the evaluation of telemedicine systems from the perspective of patients and health service providers. Also, the latest platforms, including mobile phone-based software, should be used to implement such systems.
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Affiliation(s)
- Ali Garavand
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nasim Aslani
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Behmanesh
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Seyed Jafar Ehsanzadeh
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taleb Khodaveisi
- Department of Health Information Technology, School of Allied Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
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Penault-Llorca F, Kerr KM, Garrido P, Thunnissen E, Dequeker E, Normanno N, Patton SJ, Fairley J, Kapp J, de Ridder D, Ryška A, Moch H. Expert opinion on NSCLC small specimen biomarker testing - Part 1: Tissue collection and management. Virchows Arch 2022; 481:335-350. [PMID: 35857102 PMCID: PMC9485167 DOI: 10.1007/s00428-022-03343-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/11/2022]
Abstract
Biomarker testing is crucial for treatment selection in advanced non-small cell lung cancer (NSCLC). However, the quantity of available tissue often presents a key constraint for patients with advanced disease, where minimally invasive tissue biopsy typically returns small samples. In Part 1 of this two-part series, we summarise evidence-based recommendations relating to small sample processing for patients with NSCLC. Generally, tissue biopsy techniques that deliver the greatest quantity and quality of tissue with the least risk to the patient should be selected. Rapid on-site evaluation can help to ensure sufficient sample quality and quantity. Sample processing should be managed according to biomarker testing requirements, because tissue fixation methodology influences downstream nucleic acid, protein and morphological analyses. Accordingly, 10% neutral buffered formalin is recommended as an appropriate fixative, and the duration of fixation is recommended not to exceed 24–48 h. Tissue sparing techniques, including the ‘one biopsy per block’ approach and small sample cutting protocols, can help preserve tissue. Cytological material (formalin-fixed paraffin-embedded [FFPE] cytology blocks and non-FFPE samples such as smears and touch preparations) can be an excellent source of nucleic acid, providing either primary or supplementary patient material to complete morphological and molecular diagnoses. Considerations on biomarker testing, reporting and quality assessment are discussed in Part 2.
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Affiliation(s)
| | - Keith M Kerr
- Department of Pathology, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, UK
| | - Pilar Garrido
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, University of Alcalá, Madrid, Spain
| | - Erik Thunnissen
- Amsterdam University Medical Center, VU Medical Center, Amsterdam, the Netherlands
| | - Elisabeth Dequeker
- Department of Public Health, Biomedical Quality Assurance Research Unit, Campus Gasthuisberg, University Leuven, Leuven, Belgium
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori "Fondazione Giovanni Pascale" IRCCS, Naples, Italy
| | | | | | | | | | - Aleš Ryška
- Department of Pathology, Charles University Medical Faculty Hospital, Hradec Králové, Czech Republic
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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The 2021 WHO Classification of Lung Tumors: Impact of advances since 2015. J Thorac Oncol 2021; 17:362-387. [PMID: 34808341 DOI: 10.1016/j.jtho.2021.11.003] [Citation(s) in RCA: 402] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022]
Abstract
The 2021 World Health Organisation (WHO) Classification of Thoracic Tumours was published earlier this year, with classification of lung tumors being one of the chapters. The principles remain those of using morphology first, supported by immunohistochemistry and then molecular techniques. In 2015, there was particular emphasis on using immunohistochemistry to make classification more accurate. In 2021, there is greater emphasis throughout the book on advances in molecular pathology across all tumor types. Major features within this edition are 1) broader emphasis on genetic testing than in the 2015 WHO Classification, 2) a chapter entirely dedicated to the classification of small diagnostic samples, 3) continued recommendation to document percentages of histological patterns in invasive non-mucinous adenocarcinomas, with utilization of these features to apply a formal grading system, as well as using only invasive size for T-factor size determination in part lepidic non-mucinous lung adenocarcinomas as recommended by the 8th Edition TNM Classification, 4) recognition of spread through airspaces (STAS) as a histological feature with prognostic significance, 5) moving lymphoepithelial carcinoma to squamous cell carcinomas, 6) update on evolving concepts in lung neuroendocrine neoplasm classification, 7) recognition of bronchiolar adenoma/ciliated muconodular papillary tumor (BA/CMPT) as a new entity within the adenoma subgroup, 8) recognition of thoracic SMARCA4-deficient undifferentiated tumor, and 9) inclusion of essential and desirable diagnostic criteria for each tumor.
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Rapid On-site Evaluation and Final Cytologic Diagnoses Correlation During Endobronchial Ultrasonography. J Bronchology Interv Pulmonol 2021; 29:191-197. [DOI: 10.1097/lbr.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
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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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Sunny S, Baby A, James BL, Balaji D, N. V. A, Rana MH, Gurpur P, Skandarajah A, D’Ambrosio M, Ramanjinappa RD, Mohan SP, Raghavan N, Kandasarma U, N. S, Raghavan S, Hedne N, Koch F, Fletcher DA, Selvam S, Kollegal M, N. PB, Ladic L, Suresh A, Pandya HJ, Kuriakose MA. A smart tele-cytology point-of-care platform for oral cancer screening. PLoS One 2019; 14:e0224885. [PMID: 31730638 PMCID: PMC6857853 DOI: 10.1371/journal.pone.0224885] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/23/2019] [Indexed: 12/14/2022] Open
Abstract
Early detection of oral cancer necessitates a minimally invasive, tissue-specific diagnostic tool that facilitates screening/surveillance. Brush biopsy, though minimally invasive, demands skilled cyto-pathologist expertise. In this study, we explored the clinical utility/efficacy of a tele-cytology system in combination with Artificial Neural Network (ANN) based risk-stratification model for early detection of oral potentially malignant (OPML)/malignant lesion. A portable, automated tablet-based tele-cytology platform capable of digitization of cytology slides was evaluated for its efficacy in the detection of OPML/malignant lesions (n = 82) in comparison with conventional cytology and histology. Then, an image pre-processing algorithm was established to segregate cells, ANN was trained with images (n = 11,981) and a risk-stratification model developed. The specificity, sensitivity and accuracy of platform/ stratification model were computed, and agreement was examined using Kappa statistics. The tele-cytology platform, Cellscope, showed an overall accuracy of 84–86% with no difference between tele-cytology and conventional cytology in detection of oral lesions (kappa, 0.67–0.72). However, OPML could be detected with low sensitivity (18%) in accordance with the limitations of conventional cytology. The integration of image processing and development of an ANN-based risk stratification model improved the detection sensitivity of malignant lesions (93%) and high grade OPML (73%), thereby increasing the overall accuracy by 30%. Tele-cytology integrated with the risk stratification model, a novel strategy established in this study, can be an invaluable Point-of-Care (PoC) tool for early detection/screening in oral cancer. This study hence establishes the applicability of tele-cytology for accurate, remote diagnosis and use of automated ANN-based analysis in improving its efficacy.
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Affiliation(s)
- Sumsum Sunny
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health city, Bangalore, India
- Manipal Academy of Higher Education, Manipal, Karnataka, India
- Biomedical and Electronic (10-10) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
| | - Arun Baby
- Biomedical and Electronic (10-10) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
| | - Bonney Lee James
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health city, Bangalore, India
| | - Dev Balaji
- Biomedical and Electronic (10-10) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
| | - Aparna N. V.
- Biomedical and Electronic (10-10) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
| | - Maitreya H. Rana
- Biomedical and Electronic (10-10) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
| | | | - Arunan Skandarajah
- Department of Bioengineering & Biophysics Program, University of California, Berkeley, California, United States of America
| | - Michael D’Ambrosio
- Department of Bioengineering & Biophysics Program, University of California, Berkeley, California, United States of America
| | | | - Sunil Paramel Mohan
- Department of Oral and Maxillofacial pathology, Sree Anjaneya Dental College, Kozhikode, Kerala, India
| | - Nisheena Raghavan
- Department of Pathology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
| | - Uma Kandasarma
- Department of Oral and Maxillofacial Pathology, KLE Society’s Institute of Dental Sciences, Bangalore, India
| | - Sangeetha N.
- Department of oral medicine and radiology, KLE Society’s Institute of Dental Sciences, Bangalore, India
| | - Subhasini Raghavan
- Department of oral medicine and radiology, KLE Society’s Institute of Dental Sciences, Bangalore, India
| | - Naveen Hedne
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
| | - Felix Koch
- University of Mainz, 55099, Mainz, Germany
| | - Daniel A. Fletcher
- Department of Bioengineering & Biophysics Program, University of California, Berkeley, California, United States of America
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St. John’s Research Institute, St. John’s National Academy of Health Sciences, Bangalore, India
| | | | - Praveen Birur N.
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Department of oral medicine and radiology, KLE Society’s Institute of Dental Sciences, Bangalore, India
| | - Lance Ladic
- Siemens Healthineers, Malvern, Pennsylvania, United States of America
| | - Amritha Suresh
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health city, Bangalore, India
| | - Hardik J. Pandya
- Biomedical and Electronic (10-10) Engineering Systems Laboratory, Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore, India
- * E-mail: (HJP); (MAK)
| | - Moni Abraham Kuriakose
- Head and Neck Oncology, Mazumdar Shaw Medical Centre, NH Health city, Bangalore, India
- Integrated Head and Neck Oncology Program (DSRG-5), Mazumdar Shaw Medical Foundation, NH Health city, Bangalore, India
- * E-mail: (HJP); (MAK)
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Muthu V, Sehgal IS, Dhooria S, Prasad KT, Gupta N, Aggarwal AN, Agarwal R. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Techniques and Challenges. J Cytol 2019; 36:65-70. [PMID: 30745744 PMCID: PMC6343395 DOI: 10.4103/joc.joc_171_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Intrathoracic lymphadenopathy is a common problem encountered in clinical practice and is caused by a wide variety of diseases. Traditionally, the mediastinal lymph nodes were sampled using conventional transbronchial needle aspiration (TBNA), or surgical methods such as mediastinoscopy, and thoracotomy (open or video-assisted thoracoscopy). However, surgical modalities including mediastinoscopy are invasive, expensive, and not universally available. Moreover, they are associated with considerable morbidity and mortality. Conventional TBNA although minimally invasive has a low diagnostic yield. In the last decade, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as the diagnostic procedure of choice in evaluating undiagnosed intrathoracic lymphadenopathy. EBUS-TBNA is also currently the preferred modality in the mediastinal staging of lung cancer. The procedure is minimally invasive, safe, and can be performed as a day-care procedure. In the era of personalized medicine in lung cancer, optimizing the procedure, sample collection, and processing are crucial, as more tissue is required for performing a wide array of molecular tests. Despite its widespread use and acceptance, the diagnostic sensitivity of EBUS-TBNA is still low. To maximize the yield, cytologists and physicians should be aware of the technical details of the procedure. Herein, we discuss the technique of performing EBUS-TBNA, its indications, contraindications, and the processing of the samples at our bronchoscopy suite. We also highlight the challenges faced by the cytologists and clinicians while processing EBUS aspirates.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy T. Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nalini Gupta
- Department of Cytology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N. Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Lin O, Rudomina D, Feratovic R, Sirintrapun SJ. Rapid on-site evaluation using telecytology: A major cancer center experience. Diagn Cytopathol 2019; 47:15-19. [PMID: 29575752 PMCID: PMC8059101 DOI: 10.1002/dc.23925] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) with cytology preparations plays a critical role in minimally invasive procedures. The time spent by a pathologist performing ROSE is unpredictable and could be used for more cost-effective activities. The solution encountered by several institutions to address this issue is the use of telecytology (TC). This study analyzes the experience of using telecytology for ROSE in a major cancer center over a period of over 2 years. METHODS A retrospective analysis of all remote TC evaluations for adequacy on fine needle aspiration (FNA) and touch preparations (TP) of core biopsies (CB) performed at a major cancer center was performed. The preliminary adequacy assessment was then compared to the adequacy assessment at final diagnosis. RESULTS A total of 12 949 adequacy assessments were analyzed. The most common sites biopsied in our institution were lymph node, lung, and liver. There were 7725 adequacy assessments for CB (59.7%), while adequacy assessment for FNA specimens represented 40.3% (n = 5224) of the total number of specimens evaluated by ROSE. Perfect concordance between initial adequacy assessment and the adequacy assessment at final cytologic diagnosis was 93% (12 049/12 949). The final diagnosis adequacy upgrade rate was 6.7% (n = 863), and the adequacy downgrade (a specimen considered adequate on-site that was determined to be nondiagnostic on final examination) was 0.3% (n = 37). CONCLUSIONS TC can be easily implemented with the current technologies available. It is cost-effective and allows for better patient care with a more efficient use of the pathologist's time and laboratory resources.
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Affiliation(s)
- Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Dorota Rudomina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Rusmir Feratovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - S Joseph Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
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10
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Costa C, Pastorello RG, Mendonça A, Tamaro C, Morais C, Barbosa B, Ribeiro KB, Caivano A, Saieg MA. Use of a low-cost telecytopathology method for remote assessment of thyroid FNAs. Cancer Cytopathol 2018; 126:767-772. [DOI: 10.1002/cncy.22026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Camilla Costa
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | | | - André Mendonça
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | - Caroline Tamaro
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | - Caroline Morais
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | - Barbara Barbosa
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
| | | | | | - Mauro Ajaj Saieg
- Department of Pathology; Santa Casa Medical School; Sao Paulo Brazil
- Department of Pathology; AC Camargo Cancer Center; Sao Paulo Brazil
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Hopkins E, Moffat D, Smith C, Wong M, Parkinson I, Nespolon W, Buckseall J, Hill M, Jersmann H, Nguyen P. Accuracy of rapid on-site evaluation of endobronchial ultrasound guided transbronchial needle aspirates by respiratory registrars in training and medical scientists compared to specialist pathologists-an initial pilot study. J Thorac Dis 2018; 10:3922-3927. [PMID: 30174833 DOI: 10.21037/jtd.2018.06.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Rapid on-site evaluation (ROSE) of endobronchial ultrasound guided transbronchial needle aspirates (EBUS-TBNA) increases diagnostic accuracy but in many institutions requires a specialist pathologist. This study aimed to determine if medical scientists or respiratory registrars could adequately perform ROSE to determine sufficiency of EBUS samples. Methods ROSE was performed on the first two EBUS-TBNA passes per patient by a pathologist, a medical scientist and two respiratory registrars. The medical scientists involved had all previously performed ROSE on over 50 procedures. The two respiratory registrars received cytology education from a pathologist in four separate hour-long training sessions. Each ROSE reviewer recorded whether each sample was sufficient or insufficient. Pathologist interpretation was taken as gold standard. Specific diagnosis was not required. Final diagnosis and the total number of passes were also recorded. This study recruited 25 patients (50 passes) for statistical evaluation. Results Assessment by specialist pathologists deemed 16/50 (32%) to be sufficient and 34/50 (68%) insufficient respectively. Medical scientists were 90% concordant with the pathologist (K =0.774; 95% CI, 0.587-0.961). The two respiratory registrars were 78% (K =0.568; 95% CI, 0.338-0.798) and 72% (K =0.448; 95% CI, 0.222-0.674) concordant, respectively. The mean number of passes per patient was 4.9 (range, 3-7). A diagnosis was established in 21/25 (82%) patients from the first EBUS-TBNA procedures with the remaining four patients requiring a further procedure or monitoring with serial CT scans to establish the diagnosis. Malignancy was found in 14/25 (56%) patients and a benign process in 11/25 (44%) patients. Conclusions Medical scientist review of ROSE samples is not significantly different to a specialist pathologist and is an acceptable alternative. Respiratory registrars are not a realistic alternative for ROSE without more intensive training, which may be difficult to facilitate in addition to existing respiratory training commitments.
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Affiliation(s)
- Emily Hopkins
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - David Moffat
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Caroline Smith
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Michelle Wong
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ian Parkinson
- Department of Surgical Pathology/Cytopathology, SA Pathology, SA, Australia
| | - Walter Nespolon
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | | | - Madeline Hill
- Department of Anatomical Pathology, SA Pathology, SA, Australia
| | - Hubertus Jersmann
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Phan Nguyen
- Department of Thoracic Medicine, The Royal Adelaide Hospital, Adelaide, Australia.,School of Medicine, The University of Adelaide, Adelaide, Australia
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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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Chantziantoniou N, Mukherjee M, Donnelly AD, Pantanowitz L, Austin RM. Digital Applications in Cytopathology: Problems, Rationalizations, and Alternative Approaches. Acta Cytol 2017; 62:68-76. [PMID: 29183021 DOI: 10.1159/000484434] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to raise awareness of problems using digital applications for examining, teaching, and applying telecytology at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia; University of Nebraska Medical Center (UNMC), Omaha, NE, USA; and University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. The objective was to rationalize problems and propose alternative digital approaches. STUDY DESIGN We sought to identify solutions to improve the following: (a) interpretive examination scores at KAMC for complex cytological templates (i.e., high-grade squamous intraepithelial lesions [HSIL]) when using static digital images (SDI) of cells in regions of interest (ROI); (b) visualization of cells in 3D clusters when teaching at UNMC using 2D and 3D whole-slide imaging (WSI); and (c) visualization of cells through streaming telecytology at UPMC. RESULTS Composite SDI (CSDI) improved test scores for complex interpretations (i.e., HSIL) by converging diagnostic criteria from multiple ROI. Multiplane focusing through z-stacked WSI facilitated the teaching of cytological entities characterized by 3D cell clusters and consultative telecytology through robotic cell analysis. CONCLUSIONS Adequately visualized cytomorphology and multiplane focusing are essential for virtual cytopathology examinations, teaching, or consultative telecytology. Visualization of diagnostic criteria through 2D or 3D imaging is critical. Panoptiq panoramic WSI with integrated z-stacked video clips enables optimal applied telecytology.
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Hanna MG, Pantanowitz L. The role of informatics in patient-centered care and personalized medicine. Cancer Cytopathol 2017; 125:494-501. [PMID: 28609000 DOI: 10.1002/cncy.21833] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 01/05/2023]
Abstract
The practice of cytopathology has dramatically changed due to advances in genomics and information technology. Cytology laboratories have accordingly become increasingly dependent on pathology informatics support to meet the emerging demands of precision medicine. Pathology informatics deals with information technology in the laboratory, and the impact of this technology on workflow processes and staff who interact with these tools. This article covers the critical role that laboratory information systems, electronic medical records, and digital imaging plays in patient-centered personalized medicine. The value of integrated diagnostic reports, clinical decision support, and the use of whole-slide imaging to better evaluate cytology samples destined for molecular testing is discussed. Image analysis that offers more precise and quantitative measurements in cytology is addressed, as well as the role of bioinformatics tools to cope with Big Data from next-generation sequencing. This article also highlights the barriers to the widespread adoption of these disruptive technologies due to regulatory obstacles, limited commercial solutions, poor interoperability, and lack of standardization. Cancer Cytopathol 2017;125(6 suppl):494-501. © 2017 American Cancer Society.
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Affiliation(s)
- Matthew G Hanna
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Roy-Chowdhuri S, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M. Rapid On-Site Evaluation of Endobronchial Ultrasound–Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017. [DOI: 10.5858/arpa.2017-0114-sa] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer.
Objective.—
To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer.
Data Sources.—
An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review.
Conclusions.—
Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications; it is also helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.
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Kraft AO. Specimen acquisition: ROSEs, gardeners, and gatekeepers. Cancer Cytopathol 2017; 125:449-454. [DOI: 10.1002/cncy.21870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Adele O. Kraft
- Department of Pathology; Virginia Commonwealth University; Richmond Virginia
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Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects. Telemed J E Health 2017; 23:155-191. [PMID: 28170313 DOI: 10.1089/tmj.2016.0278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Telepathology evolved from video microscopy (i.e., "television microscopy") research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of telepathology. METHODS A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.
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Affiliation(s)
- Rashid L Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Matthew R Dunn
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
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Farris AB, Cohen C, Rogers TE, Smith GH. Whole Slide Imaging for Analytical Anatomic Pathology and Telepathology: Practical Applications Today, Promises, and Perils. Arch Pathol Lab Med 2017; 141:542-550. [PMID: 28157404 DOI: 10.5858/arpa.2016-0265-sa] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Whole slide imaging (WSI) offers a convenient, tractable platform for measuring features of routine and special-stain histology or in immunohistochemistry staining by using digital image analysis (IA). We now routinely use IA for quantitative and qualitative analysis of theranostic markers such as human epidermal growth factor 2 (HER2/neu), estrogen and progesterone receptors, and Ki-67. Quantitative IA requires extensive validation, however, and may not always be the best approach, with pancreatic neuroendocrine tumors being one example in which a semiautomated approach may be preferable for patient care. We find that IA has great utility for objective assessment of gastrointestinal tract dysplasia, microvessel density in hepatocellular carcinoma, hepatic fibrosis and steatosis, renal fibrosis, and general quality analysis/quality control, although the applications of these to daily practice are still in development. Collaborations with bioinformatics specialists have explored novel applications to gliomas, including in silico approaches for mining histologic data and correlating with molecular and radiologic findings. We and many others are using WSI for rapid, remote-access slide reviews (telepathology), though technical factors currently limit its utility for routine, high-volume diagnostics. In our experience, the greatest current practical impact of WSI lies in facilitating long-term storage and retrieval of images while obviating the need to keep slides on site. Once the existing barriers of capital cost, validation, operator training, software design, and storage/back-up concerns are overcome, these technologies appear destined to be a cornerstone of precision medicine and personalized patient care, and to become a routine part of pathology practice.
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Affiliation(s)
| | | | | | - Geoffrey H Smith
- From the Department of Pathology, Emory University, Atlanta, Georgia
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Canberk S, Ince U, Schmitt F. Telecytology: “Cells beyond the borders”-The example in two countries. Diagn Cytopathol 2017; 45:381-383. [DOI: 10.1002/dc.23663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Sule Canberk
- Department of Pathology subdivision of Cytopathology; Acibadem University; Kayısdagı cd. Ataşehir-Istanbul-TR Turkey
| | - Umit Ince
- Department of Pathology subdivision of Cytopathology; Acibadem University; Kayısdagı cd. Ataşehir-Istanbul-TR Turkey
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