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Gilley P, Zhang K, Abdoli N, Sadri Y, Adhikari L, Fung KM, Qiu Y. Development and Assessment of Multiple Illumination Color Fourier Ptychographic Microscopy for High Throughput Sample Digitization. SENSORS (BASEL, SWITZERLAND) 2024; 24:4505. [PMID: 39065905 PMCID: PMC11280611 DOI: 10.3390/s24144505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024]
Abstract
In this study, we proposed a multiplexed color illumination strategy to improve the data acquisition efficiency of Fourier ptychography microscopy (FPM). Instead of sequentially lighting up one single channel LED, our method turns on multiple white light LEDs for each image acquisition via a color camera. Thus, each raw image contains multiplexed spectral information. An FPM prototype was developed, which was equipped with a 4×/0.13 NA objective lens to achieve a spatial resolution equivalent to that of a 20×/0.4 NA objective lens. Both two- and four-LED illumination patterns were designed and applied during the experiments. A USAF 1951 resolution target was first imaged under these illumination conditions, based on which MTF curves were generated to assess the corresponding imaging performance. Next, H&E tissue samples and analyzable metaphase chromosome cells were used to evaluate the clinical utility of our strategy. The results show that the single and multiplexed (two- or four-LED) illumination results achieved comparable imaging performance on all the three channels of the MTF curves. Meanwhile, the reconstructed tissue or cell images successfully retain the definition of cell nuclei and cytoplasm and can better preserve the cell edges as compared to the results from the conventional microscopes. This study initially validates the feasibility of multiplexed color illumination for the future development of high-throughput FPM scanning systems.
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Affiliation(s)
- Patrik Gilley
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA; (P.G.); (Y.S.)
| | - Ke Zhang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Neman Abdoli
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA; (P.G.); (Y.S.)
| | - Youkabed Sadri
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA; (P.G.); (Y.S.)
| | - Laura Adhikari
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (L.A.); (K.-M.F.)
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (L.A.); (K.-M.F.)
| | - Yuchen Qiu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA; (P.G.); (Y.S.)
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
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Chen-Yost HI, Bammert C, Hao W, Heymann JJ, Lin DM, Marotti J, Waraksa-Deutsch T, Huang M, Krishnamurti U, Lin O, Ly A, Moatamed N, Pantanowitz L, Roy-Chowdhuri S. Changing digital and telecytology practices post COVID-19 comparing ASC survey results from 2016 to 2023. J Am Soc Cytopathol 2024; 13:194-204. [PMID: 38582697 DOI: 10.1016/j.jasc.2024.02.004] [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: 12/08/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION During the COVID-19 pandemic, the need for digital pathology tools became more urgent. However, there needs to be more knowledge of the use in cytology. We aimed to evaluate current digital cytology practices and attitudes and compare the results with a pre-COVID-19 American Society of Cytopathology (ASC) survey. MATERIALS AND METHODS Fourteen survey questions assessing current attitudes toward digital cytology were developed from a 2016 ASC Digital Pathology Survey. Ten new survey questions were also created to evaluate telecytology use. The survey was e-mailed to ASC members over 6 weeks in 2023. RESULTS A total of 123 individuals responded (116 in 2016). Attitudes toward digital cytology were unchanged; most participants stated digital cytology is beneficial (87% 2023 versus 90% 2016). The percentage of individuals using digital cytology was unchanged (56% in 2016 and 2023). However, telecytology for rapid onsite assessment (ROSE) is now considered the best application (55% 2023 versus 31% 2016). Forty-three institutions reported using digital and telecytology tools; 40% made implementations after 2020; most did not feel that COVID-19 affected digital cytology (56%). Telecytology for ROSE is the most common application now (78%) compared with education (30%) in 2016. Limitations for implementing digital imaging in cytology included inability to focus (38%) and expense (33%). CONCLUSIONS General attitudes toward digital tools by the cytology community have essentially remained the same between 2016 and now. However, telecytology for ROSE is increasingly being used, which supports a need for validation and competency guidelines.
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Affiliation(s)
| | - Catherine Bammert
- School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York
| | - Diana Murro Lin
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jonathan Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Min Huang
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Uma Krishnamurti
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Neda Moatamed
- Department of Pathology and Laboratory Medicine, University of California at Los Angeles, Los Angeles, California
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sinchita Roy-Chowdhuri
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas
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Boothe P, Martinez-Amador C, Hajarat T, Gonsalves C, Donthi D, Mukhtar F, Kresak J, Leon M. Validation and implementation of telecytology at an academic medical center using digital cameras and Microsoft Teams software. J Am Soc Cytopathol 2024:S2213-2945(24)00040-1. [PMID: 38834385 DOI: 10.1016/j.jasc.2024.04.004] [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: 02/07/2024] [Revised: 03/22/2024] [Accepted: 04/17/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Rapid On-Site Evaluation of cytological samples obtained through fine needle aspiration for adequacy is a critical component of a cytology service; however, it imposes a significant time and cost burden for the practicing pathologist and the cytology service. Telecytology enables adequacy assessment by a pathologist remotely, greatly saving time. Telecytology also allows slide preparation and manipulation at the procedure site by an employee with less training requirements, liberating the cytotechnologist to screen cases and perform other laboratory duties - an important aspect to consider during times of cytotechnologist shortages. We propose a telecytology system with a simple setup of a microscope, microscope camera, laptop, and Microsoft Teams software. MATERIALS AND METHODS We designed a system consisting of a mobile cart, backup battery, microscope, digital camera, and a laptop computer with microscope imaging software and Microsoft Teams software for image transmission. Validation was performed by 4 pathologists making adequacy assessments on randomly selected previously signed out cases using the telecytology system. RESULTS Our validation of this system demonstrated a greater than 90% concurrence rate between the original adequacy call and the call made by pathologists using the telecytology system - a benchmark used by most, if not all, published validations of similar telecytology systems. In addition, the adequacy assessment concordance rate between select pathologists exceeded 90%. CONCLUSIONS In summary, our telecytology system provides excellent adequacy services for the clinicians and patients we serve. The Microsoft Teams software is a great tool for transmission of video microscopy. This system will be used with the goal of saving time and increasing efficiency for the cytopathology department.
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Affiliation(s)
- Paul Boothe
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida.
| | - Claudia Martinez-Amador
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Tara Hajarat
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Catherine Gonsalves
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Deepak Donthi
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Faisal Mukhtar
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Jesse Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Marino Leon
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
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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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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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Bychkov A, Yoshikawa A, Munkhdelger J, Hori T, Fukuoka J. Integrating cytology into routine digital pathology workflow: a 5-year journey. Virchows Arch 2023; 483:555-559. [PMID: 37119336 DOI: 10.1007/s00428-023-03547-0] [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: 01/22/2023] [Revised: 03/13/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
Despite recent advances in digital imaging, the adoption of digital cytology is challenging due to technical limitations. This study describes our 5-year institutional experience with the implementation of digital cytology. The routine cytology workflow included conventional two-step screening by cytotechnologists, followed by sign out by pathologists. We introduced sign out of cytologic cases using a microscopic digital imaging platform operated by cytotechnologists, which allowed for remote review of slides by cytopathologists via video streaming. We also provided cytologic correlation to support the virtual slide-based sign out of histopathological specimens and for a weekly pathology-radiology conference. In addition, positive cytology cases were archived for integration into the laboratory information system and for prospective computational pathology studies. We also summarized lessons learned over the years and outlined our vision for future developments. This unique experience may serve as a role model for other institutions.
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Affiliation(s)
- Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan.
| | - Akira Yoshikawa
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Jijgee Munkhdelger
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Takashi Hori
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
| | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, 929 Higashi-Cho, Kamogawa, Chiba, Japan
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Petersen JM, Jhala N, Jhala DN. The Critical Value of Telepathology in the COVID-19 Era. Fed Pract 2023; 40:186-193. [PMID: 37860072 PMCID: PMC10584409 DOI: 10.12788/fp.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background Telepathology, which includes the use of telecommunication links, helps enable transmission of digital pathology images for primary diagnosis, quality assurance, education, research, or second opinion diagnoses. Observations This review covers all aspects of telepathology implementation, including the selection of platforms, budgets and regulations, validation, implementation, education, quality monitoring, and the potential to improve practice. Considering the long-term trends, the lessons of the COVID-19 pandemic, and the potential for future pandemics or other disasters, the validation and implementation of telepathology remains a reasonable choice for laboratories looking to improve their practice. Conclusions Though barriers to implementation exist, there are potential benefits, such as the wide spectrum of uses like frozen section, telecytology, primary diagnosis, and second opinions. Telepathology represents an innovation that may transform the future of pathology practice.
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Affiliation(s)
- Jeffrey M Petersen
- Corporal Michael J Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia
| | | | - Darshana N Jhala
- Corporal Michael J Crescenz Veteran Affairs Medical Center, Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia
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Kim T, Rao J. "SMART" cytology: The next generation cytology for precision diagnosis. Semin Diagn Pathol 2023; 40:95-99. [PMID: 36639316 DOI: 10.1053/j.semdp.2023.01.001] [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: 10/31/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
Cytology plays an important role in diagnosing and managing human diseases, especially cancer, as it is often a simple, low cost yet effective, and non-invasive or minimally invasive diagnostic tool. However, traditional morphology-based cytology practice has limitations, especially in the era of precision diagnosis. Recently there have been tremendous efforts devoted to apply computational tools and to perform molecular analysis on cytological samples for a variety of clinical purposes. Now is probably the appropriate juncture to integrate morphology, machine learning, and molecular analysis together and transform cytology from a morphology-driven practice to the next level - "SMART" Cytology. In this article we will provide a rather brief review of the relevant works for computational analysis on cytology samples, focusing on single-cell-based multiplex quantitative analysis of biomarkers, and introduce the conceptual framework of "SMART (Single cell, Multiplex, AI-driven, and Real Time)" Cytology.
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Affiliation(s)
- Teresa Kim
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, United States of America
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, United States of America.
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Kouanda A, Mclean R, Faggen A, Demissie E, Balassanian R, Kamal F, Avila P, Arain M, Dai SC, Munroe C. Telecytology versus in-room cytopathologist for EUS-guided FNA or fine-needle biopsy sampling of solid pancreatic lesions. Gastrointest Endosc 2023; 97:466-471. [PMID: 36252871 DOI: 10.1016/j.gie.2022.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Rapid on-site-evaluation (ROSE) with an in-room cytopathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing EUS-guided FNA or fine-needle biopsy sampling (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and use of ROSE using telecytology (ROSE-T) to optimize clinical workflows and to address social distancing mandates created during the coronavirus disease 2019 pandemic. The purpose of this study was to compare diagnostic outcomes of ROSE-P and ROSE-T. METHODS A single-center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNAB were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis. RESULTS There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, P = .428). ROSE-T was associated with an increased use of 22-gauge needles (P = .006) and more needle passes (P < .001). No significant differences were found in age, gender, lesion size, needle type, procedure times, or adverse events between the 2 groups (P < .05 for all). More pancreatic tail lesions were sampled in the ROSE-P group (P < .001). CONCLUSIONS ROSE-T was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.
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Affiliation(s)
- Abdul Kouanda
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Richard Mclean
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Alec Faggen
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Emanuel Demissie
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ronald Balassanian
- Department of Pathology, Division of Cytopathology and Surgical Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Faisal Kamal
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Avila
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Mustafa Arain
- Center for Interventional Endoscopy, Advent Health System, Orlando, Florida, USA
| | - Sun-Chuan Dai
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Craig Munroe
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
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Piccione J, Baker K. Digital Cytology. Vet Clin North Am Small Anim Pract 2022; 53:73-87. [DOI: 10.1016/j.cvsm.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Trabzonlu L, Chatt G, McIntire PJ, Eshraghi R, Lapadat R, Atieh M, Pambuccian SE, Wojcik EM, Mehrotra S, Barkan GA. Telecytology validation: is there a recipe for everybody? J Am Soc Cytopathol 2022; 11:218-225. [PMID: 35469774 DOI: 10.1016/j.jasc.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Telecytology offers a suitable solution to the cost and time efficiency questions on rapid onsite evaluation (ROSE). An increasing number of institutions are adopting new telecytology systems to meet the increasing ROSE requests, although there is no agreement on the details of how a telecytology validation study needs to be conducted. We propose a standardized approach for telecytology validation studies that could be done in a variety of practices. MATERIALS AND METHODS Consecutive cases from 6 months prior were chosen to reflect a case mix comparable to real life. A fellow assessed the slides at the ROSE site while 6 cytopathology faculty convened in a conference room with a television screen, and noted the adequacy, diagnostic category, and specific diagnoses. All participants were blinded to the original adequacy assessment and final diagnoses. For each case, evaluation time and the slides counts were noted. RESULTS Fine-needle aspiration specimens from 52 patients were included in the study. Of these, 13 cases were used in the first "test" session. The adequacy concordance rates ranged between 92.3% and 100%, with an overall concordance rate of 94.8%. The diagnostic category concordance rates ranged between 90.3% and 95.5%, with an overall concordance rate of 91.9%. The specific diagnosis concordance rates ranged between 84.6% and 92.9%, with an overall concordance rate of 88.1%. CONCLUSIONS Validation of telecytology requires a standardized approach just like any other new technology. In this study, we propose an efficient and accurate method for cytopathology departments of various case volumes to conduct telecytology validation studies.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Grazina Chatt
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Patrick J McIntire
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois; Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Reza Eshraghi
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois; Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Razvan Lapadat
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Mohammed Atieh
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Eva M Wojcik
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Swati Mehrotra
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois.
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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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13
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Marques F, Hauser J, Iseri E, Schliemann I, van der Wijngaart W, Roxhed N. Semi-automated preparation of fine-needle aspiration samples for rapid on-site evaluation. LAB ON A CHIP 2022; 22:2192-2199. [PMID: 35543374 DOI: 10.1039/d2lc00241h] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Rapid on-site evaluation (ROSE) significantly improves the diagnostic yield of fine needle aspiration (FNA) samples but critically depends on the skills and availability of cytopathologists. Here, we introduce a portable device for semi-automated sample preparation for ROSE. In a single platform, the device combines a smearing tool and a capillary-driven chamber for staining FNA samples. Using a human pancreatic cancer cell line (PANC-1) and liver, lymph node, and thyroid FNA model samples, we demonstrate the capability of the device to prepare samples for ROSE. By minimizing the equipment needed in the operating room, the device may simplify the performance of FNA sample preparation and lead to a wider implementation of ROSE.
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Affiliation(s)
- Filipe Marques
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, 10044 Stockholm, Sweden.
| | - Janosch Hauser
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, 10044 Stockholm, Sweden.
| | - Emre Iseri
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, 10044 Stockholm, Sweden.
| | - Igor Schliemann
- Pathology and Cytology Department, Karolinska University Hospital, Stockholm, Sweden
| | | | - Niclas Roxhed
- Division of Micro and Nanosystems, KTH Royal Institute of Technology, 10044 Stockholm, Sweden.
- Medtech Labs, Karolinska hospital, Stockholm, Sweden
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14
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Kim D, Burkhardt R, Alperstein SA, Gokozan HN, Goyal A, Heymann JJ, Patel A, Siddiqui MT. Evaluating the role of Z-stack to improve the morphologic evaluation of urine cytology whole slide images for high-grade urothelial carcinoma: Results and review of a pilot study. Cancer Cytopathol 2022; 130:630-639. [PMID: 35584402 DOI: 10.1002/cncy.22595] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Whole slide imaging (WSI) adoption has been slower in cytopathology due, in part, to challenges in multifocal plane scanning on 3-dimensional cell clusters. ThinPrep and other liquid-based preparations may alleviate the issue by reducing clusters in a concentrated area. This study investigates the use of Z-stacked images for diagnostic assessment and the experience of evaluating urine ThinPrep WSI. METHODS Thirty ThinPrep urine cases of high-grade urothelial carcinoma (n = 22) and cases of negative for high-grade urothelial carcinoma (n = 8) were included. Slides were scanned at 40× magnification without Z-stack and with Z-stack at 3 layers, 1 μm each. Six cytopathologists and 1 cytotechnologist evaluated the cases in 2 rounds with a 2-week wash-out period in a blinded manner. A Cohen's Kappa (CK) calculated concordance rates. A survey after each round evaluated participant experience. RESULTS CK with the original report ranged from 0.606 to 1.0 (P < .05) without Z-stack and 0.533 to 1.0 (P < .05) with Z-stack both indicating substantial-to-perfect concordance. For both rounds, interobserver CK was moderate-to-perfect (0.417-1.0, P < .05). Intraobserver CK was 0.697-1.0 (P < 0.05), indicating substantial to perfect concordance. The average scan time and file size for slides without Z-stack and with Z-stack are 6.27 minute/0.827 GB and 14.06 minute/2.650 GB, respectively. Surveys demonstrated a range in comfort and use with slightly more favorable opinions for Z-stacked cases. CONCLUSIONS Z-stack images provide minimal diagnostic benefit for urine ThinPrep WSI. In addition, Z-stacked urine WSI does not justify the prolonged scan times and larger storage needs compared to those without Z-stack.
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Affiliation(s)
- David Kim
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Robert Burkhardt
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Susan A Alperstein
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Hamza N Gokozan
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Abha Goyal
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Jonas J Heymann
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Ami Patel
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Momin T Siddiqui
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
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15
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Krishnamurthy S, Ban K. Feasibility of using digital confocal microscopy for cytopathological examination in clinical practice. Mod Pathol 2022; 35:319-325. [PMID: 34628480 PMCID: PMC8860740 DOI: 10.1038/s41379-021-00925-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/11/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
Optical imaging modalities are emerging as digital microscopy tools for tissue examination. The investigation of these techniques for potential applications in anatomic pathology practice has focused primarily on surgical pathology and has not included cytopathological specimens. We evaluated the feasibility of using digital confocal microscopy (CM) to examine cytopathological specimens. Smears and cell suspensions collected in RPMI solution were prepared from tissue scrapes obtained from surgical resections of breast, lung, liver, and kidney. Air-dried smears and cell pellets obtained from centrifugation of the cell suspensions were stained with 0.6 mM acridine orange and imaged with a CM platform. After completion of imaging, the smears were stained with Diff-Quik (DQ), and cell pellets were routinely processed, embedded in paraffin wax, cut, and stained with hematoxylin and eosin (H&E). We evaluated the mean time to acquire digital CM images; quality of images based on the extent of tissue recognition (0%, grade 0; 1-19%, grade 1; 20-50%, grade 2; >50%, grade 3); comparison of images with DQ- and H&E-stained specimens; and ability to make specific diagnoses. We imaged 91 smears and 52 cell pellets and acquired digital CM images within 2-3 min, with 92% and 88% of images, respectively, from smears and cell pellets showing grade 3 quality. On the basis of CM images, 8 smears (9%) and 7 cell pellets (14%) were categorized as benign, and 83 (91%) and 45 (88%), respectively, as malignant. Specific diagnoses were made by using digital CM images of smears and cell pellets that matched accurately with corresponding DQ- and H&E-stained preparations. The results of our first feasibility study clearly indicated the utility of CM as a next-generation digital microscopy tool for evaluating cytology specimens. Prospective clinical studies are warranted for validating our findings for potential incorporation into cytopathological clinical practice.
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Affiliation(s)
- Savitri Krishnamurthy
- Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
| | - Kechen Ban
- grid.240145.60000 0001 2291 4776Department of Neurosurgery Research, The University of Texas, MD Anderson Cancer Center Houston, Houston, TX USA
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Selective deployment of dynamic telecytology for rapid evaluation of cytology smears: assessment of workflow processes and role of cytopathology fellows as on-site operators. J Am Soc Cytopathol 2021; 10:577-584. [PMID: 34238730 DOI: 10.1016/j.jasc.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The deployment of telecytology (TC) requires a substantial investment of financial and human resources. To offset the high demand for rapid on-site evaluation, we performed a limited deployment of dynamic TC and have detailed the workflow processes and the role of trainees. MATERIALS AND METHODS TC systems were installed in radiology suites with a high volume of cases. Validation was performed using retrospective and prospective cases. Cytotechnologists and cytopathology fellows were the operators of the instrument. TC malignant and benign diagnoses were correlated with the final sign-out diagnoses. RESULTS Of the 120 cases, 50 (41.6%) were fine needle aspirations and 70 (58.3%) were touch imprint smears of core biopsy specimens. The cytotechnologists were the operators for 34 cases (28.3%) and cytology fellows for 86 cases (71.6%). Adequacy concordance with the final diagnosis was 100% and 98.5% in the retrospective and prospective cases, respectively. In the prospective cases, concordance of TC with the final diagnosis of malignancy was 42 of 45 (93.3%), with 2 of 45 (4.4%) discordant and a downgrade rate of 2.7%. For the benign diagnoses, the concordance was 90%. For the malignant diagnoses, the sensitivity of TC was 97.67% (95% confidence interval [CI], 87.71 to 99.94%; specificity, 81.82%; 95% CI, 48.22% to 97.72%). The positive predictive value was 95.45% (95% CI, 85.69% to 98.66%), the negative predictive value was 90.00% (95% CI, 55.98% to 98.45%), and the accuracy was 94.44% (95% CI, 84.61% to 98.84%). CONCLUSIONS TC can be deployed in a limited fashion as an option for cytopathologists to offset the high demand for rapid on-site evaluations. Trainee participation in TC service is important for building confidence and honing their cytology skills.
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Al Zoughbi W, Kim D, Alperstein SA, Ohara K, Manohar J, Greco N, Khani F, Robinson BD, Rao RA, Elemento O, Mosquera JM, Siddiqui MT. Incorporating cytologic adequacy assessment into precision oncology workflow using telepathology: An institutional experience. Cancer Cytopathol 2021; 129:874-883. [PMID: 33929788 DOI: 10.1002/cncy.22441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tumor sample quality and quantity determine the success of somatic mutation analysis. Thus, a rapid on-site evaluation (ROSE) tumor cytology adequacy assessment was incorporated into the workflow of precision oncology at Weill Cornell Medicine in New York City. Optimal samples were obtained from 68 patients with metastatic cancer. METHODS Cytopathologists performed ROSE on fine-needle aspirate samples via telepathology, and subsequently core-needle biopsies were obtained. In a retrospective manner, the concordance between adequacy assessment and the success rate of the procedure was evaluated to obtain sufficient tumor tissue for next-generation sequencing (NGS). RESULTS Out of the 68 procedures, 43 were documented as adequate and 25 were documented as inadequate. The diagnostic yield of adequate procedures was 100%. Adequacy evaluation predicted the success rate of molecular profiling in 40 of 43 procedures (93%; 95% CI, 80.9-98.5 procedures). The success rate of molecular testing was significantly higher in the adequate group: 93% compared with 32% in the inadequate group (P < .0005). Seven procedures that failed to provide quality material for mutational analysis and pathological diagnosis were evaluated as inadequate. Cell block provided sufficient DNA for NGS in 6 cases. In 2 cases, a core biopsy could not be performed; hence, the fine-needle aspirate material confirmed the diagnosis and was used for NGS testing. CONCLUSION These results support the incorporation of ROSE into the workflow of precision oncology to obtain high-quality tissue samples from metastatic lesions. In addition, NGS testing of concurrent cytology specimens with adequate cellularity can be a surrogate for NGS testing of biopsy specimens.
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Affiliation(s)
- Wael Al Zoughbi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - David Kim
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Susan Ann Alperstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- Papanicolaou Cytology Laboratory, Weill Cornell Medicine, New York, New York
| | - Kentaro Ohara
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Jyothi Manohar
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Noah Greco
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Olivier Elemento
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
- Papanicolaou Cytology Laboratory, Weill Cornell Medicine, New York, New York
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Hupp MM, Khan S, Dincer HE, Mallery JS, Shyne MT, Mettler T, Stewart J, Amin K. Evaluation and Comparison of Performance Parameters and Impact of Telepathology and Operator Experience on Endobronchial and Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Am J Clin Pathol 2021; 155:755-765. [PMID: 33295964 DOI: 10.1093/ajcp/aqaa179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Endobronchial ultrasound- and endoscopic ultrasound-guided fine-needle aspiration (EBUS-/EUS-FNA) are minimally invasive techniques of diagnosing and staging malignancies. The procedures are difficult to master, requiring specific feedback for optimizing yield. METHODS Over 2 years, EBUS-/EUS-FNA cases were gathered using the institutional pathology database. Patient and specimen characteristics were collected from the pathology database and electronic medical record. RESULTS In 2 years, 789 unique FNA specimens were collected (356 EBUS and 433 EUS specimens). The cohort and each subgroup had excellent performance, which was enhanced by telepathology. The discrepancy rate was satisfactorily low. Hematolymphoid neoplasms are overrepresented in discrepant EBUS cases. The malignancy rates of cytology diagnostic categories were comparable to the literature. CONCLUSIONS Using diagnostic yield and concordance results allow for comprehensive evaluation of the entire process of EBUS-/EUS-FNAs. This study's findings can influence patient management, training methods, and interpretation of results, while also acting as a model for others to investigate their own sources of inadequacy, discrepancy, and training gaps.
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Affiliation(s)
- Meghan M Hupp
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Subhan Khan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - H Erhan Dincer
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis
| | - J Shawn Mallery
- Department of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis
| | - Michael T Shyne
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis
| | - Tetyana Mettler
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Jimmie Stewart
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Khalid Amin
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
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Mathew R, Meena N, Roy WE, Chen C, Macchiraella M, Bartter T. Rapid On-Site Cytologic Evaluation: A Feasibility Study Using Ancillary Interventional Pulmonary Personnel. Respiration 2021; 100:1-6. [PMID: 33540414 DOI: 10.1159/000513432] [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: 08/22/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ancillary health professionals helping in a procedural service is a common practice everywhere. OBJECTIVES This was a proof-of-concept study to assess feasibility of using ancillary personnel for rapid on-site cytologic evaluation (ROSE) at interventional pulmonary procedures. METHODS After a training interval, a respiratory therapist (RT) performed ROSE on consecutive interventional pulmonary specimens. Sample sites included lymph nodes, lung, liver, and the left adrenal gland. RT findings were subsequently correlated with blinded cytopathology-performed ROSE and with final histopathology results, with primary foci of adequacy and the presence or absence of malignancy. RESULTS Seventy consecutive cases involved 163 separate sites for ROSE analysis. Adequacy: There was a high level of concordance between RT-performed ROSE (RT-ROSE) and cytopathology ROSE (CYTO-ROSE). They agreed upon the adequacy of 159 specimens. The Cohen's κ coefficient ± asymptotic standard error (ASE) was 0.74 ± 0.175, with p < 0.0001. Malignancy: RT-ROSE concurred highly with CYTO-ROSE, with agreement on 150 (92%) of the 163 specimens. Cohen's κ coefficient ± ASE was 0.83 ± 0.045, with p < 0.0001. When the comparison was for malignancy by case rather than individual site, Cohen's κ coefficient ± ASE was 0.68 ± 0.08, with p < 0.0001. CONCLUSION This study demonstrates that ancillary personnel supporting an interventional pulmonary service can be trained to perform initial ROSE. Cytopathology can be called after sampling and staining have produced adequate samples. This setup streamlines ROSE evaluation with regard to time and cost.
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Affiliation(s)
- Roshen Mathew
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA,
| | - Nikhil Meena
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Winnie Elma Roy
- University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Chien Chen
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Maggie Macchiraella
- Respiratory Department, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Thaddeus Bartter
- Division of Pulmonary and Critical Care Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Baskota SU, Chandra A, Cross P. The practice of cytopathology during the era of COVID-19: challenges and changes. ACTA ACUST UNITED AC 2020; 27:116-122. [PMID: 33072189 PMCID: PMC7550117 DOI: 10.1016/j.mpdhp.2020.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper reviews the challenges faced by cytology laboratories during the COVID-19 pandemic. Various safety guidelines regarding collection, handling, transport and sampling in cytology laboratory are presented. A brief literature overview of adapted changes regarding new safety techniques, processing, sampling techniques implemented by the cytology laboratories in this part of the world is presented. The use of cytology in COVID-19 patients is discussed. The authors have also tried to present the challenges and changes faced for training and education during this time. Migration from multi-headed scope in-person sign-out to digital based platforms were adapted to continue medical education. The potential long-term implications of these adaptations on cytology services are also touched upon.
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Affiliation(s)
- Swikrity Upadhyay Baskota
- Department of Pathology, University of Pittsburgh Medical Center Pittsburgh, PA, USA.Conflicts of interest: none declared.,, Consultant Cellular Pathologist, Department of Pathology, St.Thomas' Hospital, London, UK.Conflicts of interest: none declared.,, Consultant Cellular Pathologist, Department of Cellular Pathology, South of Tyne Pathology Service, Queen Elizabeth Hospital, Gateshead, UK.Conflicts of interest: none declared
| | - Ashish Chandra
- Department of Pathology, University of Pittsburgh Medical Center Pittsburgh, PA, USA.Conflicts of interest: none declared.,, Consultant Cellular Pathologist, Department of Pathology, St.Thomas' Hospital, London, UK.Conflicts of interest: none declared.,, Consultant Cellular Pathologist, Department of Cellular Pathology, South of Tyne Pathology Service, Queen Elizabeth Hospital, Gateshead, UK.Conflicts of interest: none declared
| | - Paul Cross
- Department of Pathology, University of Pittsburgh Medical Center Pittsburgh, PA, USA.Conflicts of interest: none declared.,, Consultant Cellular Pathologist, Department of Pathology, St.Thomas' Hospital, London, UK.Conflicts of interest: none declared.,, Consultant Cellular Pathologist, Department of Cellular Pathology, South of Tyne Pathology Service, Queen Elizabeth Hospital, Gateshead, UK.Conflicts of interest: none declared
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21
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Mukhopadhyay S, Booth AL, Calkins SM, Doxtader EE, Fine SW, Gardner JM, Gonzalez RS, Mirza KM, Jiang XS. Leveraging Technology for Remote Learning in the Era of COVID-19 and Social Distancing. Arch Pathol Lab Med 2020; 144:1027-1036. [PMID: 32364793 DOI: 10.5858/arpa.2020-0201-ed] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/06/2022]
Abstract
The ongoing global pandemic of coronavirus disease 2019 (COVID-19) has rapidly disrupted traditional modes of operation in health care and education. In March 2020, institutions in the United States began to implement a range of policies to discourage direct contact and encourage social distancing. These measures have placed us in an unprecedented position where education can no longer occur at close quarters-most notably, around a multiheaded microscope-but must instead continue at a distance. This guide is intended to be a resource for pathologists and pathologists-in-training who wish to leverage technology to continue collaboration, teaching, and education in this era. The article is focused mainly on anatomic pathology; however, the technologies easily lend themselves to clinical pathology education as well. Our aim is to provide curated lists of various online resources that can be used for virtual learning in pathology, provide tips and tricks, and share our personal experience with these technologies. The lists include videoconferencing platforms; pathology Web sites; free online educational resources, including social media; and whole slide imaging collections. We are currently living through a unique situation without a precedent or guidebook, and we hope that this guide will enable the community of pathology educators worldwide to embrace the opportunities that 21st century technology provides.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Mukhopadhyay, Doxtader)
| | - Adam L Booth
- Department of Pathology, University of Texas Medical Branch, Galveston (Booth)
| | - Sarah M Calkins
- Department of Pathology, University of California, San Francisco (Calkins)
| | - Erika E Doxtader
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Mukhopadhyay, Doxtader)
| | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Fine)
| | - Jerad M Gardner
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock (Gardner)
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Gonzalez)
| | - Kamran M Mirza
- Department of Pathology and Laboratory Medicine, Loyola University Health System, Maywood, Illinois (Mirza)
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina (Jiang)
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22
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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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Sauter JL, Chen Y, Alex D, Balassanian R, Cuda J, Flanagan MB, Griffith CC, Illei P, Johnson DN, McGrath CM, Randolph ML, Reynolds JP, Spiczka AJ, van Zante A, VanderLaan PA. Results from the 2019 American Society of Cytopathology survey on rapid onsite evaluation (ROSE)-part 2: subjective views among the cytopathology community. J Am Soc Cytopathol 2020; 9:570-578. [PMID: 32861593 DOI: 10.1016/j.jasc.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aims to improve understanding of the cytopathology community's perspective regarding the value of rapid onsite evaluation (ROSE) in clinical practice. MATERIALS AND METHODS The American Society of Cytopathology membership was surveyed in 2019 to obtain subjective data on the cytopathology community's perceptions regarding ROSE. Comments were categorized by major themes and attitudes and analyzed by respondent's role in laboratory, practice size, and practice setting (Fisher's exact and χ2 tests). RESULTS A total of 541 responses were received from 255 cytopathologists/pathologists, 261 cytotechnologists, 19 trainees, and 6 others (as previously reported). Reasons for which cytopathology personnel provide this service aligned with their perceptions of why clinicians request ROSE. A minority of respondents, disproportionally from high volume centers, felt ROSE is unnecessary. Overall attitude regarding ROSE was generally positive. There were no significant differences in attitude regarding ROSE according to role in laboratory or practice size, but respondents from academic centers provided a significantly higher percentage of positive comments than those in private or community practice. Although survey respondents generally felt that ROSE is valuable to patient care, they also highlighted several challenges, including staffing, time commitment, and inadequate reimbursement. Implementation of telecytology was felt to potentially alleviate some of these challenges. CONCLUSIONS Survey results show that the cytology community views ROSE favorably, practices vary considerably, and there is a perceived need for improved reimbursement. Data from this study may be used to identify areas that warrant additional research to clarify the clinical value of ROSE.
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Affiliation(s)
- Jennifer L Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Deepu Alex
- Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, Canada
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melina B Flanagan
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, West Virginia
| | - Christopher C Griffith
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter Illei
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Daniel N Johnson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cindy M McGrath
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center and Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Melissa L Randolph
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amy J Spiczka
- American Society for Clinical Pathology, Chicago, Illinois
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Yao K, Li Z. Review of different platforms to perform rapid onsite evaluation via telecytology. Cytopathology 2020; 31:379-384. [PMID: 32506692 DOI: 10.1111/cyt.12871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022]
Abstract
There is increased utilisation of cytopathology to provide a rapid onsite evaluation (ROSE) of fine needle aspiration and touch preparations of small biopsies. A well-executed ROSE procedure can significantly impact the diagnostic quality and appropriate specimen triage of procured biopsy materials. To accommodate the demand for ROSE, telecytology has been increasingly implemented to facilitate ROSE occurring remotely. Telecytology can be categorised based on camera systems including eyepiece system, camera port system and robotic microscope/whole slide image scanner system. Image sharing methods include static images, broadcast only live video streaming, teleconferencing and whole slide image management system. In this review, we will discuss the advantages and disadvantages of each of these systems and deployment considerations.
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Affiliation(s)
- Keluo Yao
- Department of Pathology, University of California, San Francisco, California, USA
| | - Zaibo Li
- Deparment of Pathology, The Ohio State Unversity, Columbus, Ohio, USA
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Archondakis SK. Remote Evaluation of Short Videos Captured by Static Telecytological Applications for Obtaining Expert Opinions. ACTA ACUST UNITED AC 2020. [DOI: 10.4018/ijrqeh.2020070104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the last decade, cytopathology laboratories wishing to achieve an automated and seamless workflow process, to diminish turnaround times and to improve their diagnostic accuracy have successfully adopted information technologies and automation. New types of cameras and microscopes, connected to computers, have made possible image capture and transmission (telecytology). New innovative information technologies, including e-health and telemedical applications, constitute a valuable tool for interlaboratory collaboration and quality improvement. New applications are expected to enhance the opportunities for improvement in the field of cytological data management and sharing. In this article, we emphasize on the possible use of short videos captured by static telecytology applications in a modern cytopathology laboratory wishing to establish an effective interlaboratory comparison system and obtain expert opinions in diagnostically challenging cases from distant consultants with well recognized diagnostic competence and experience in the field of thyroid cytology.
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Small but powerful: the promising role of small specimens for biomarker testing. J Am Soc Cytopathol 2020; 9:450-460. [PMID: 32507626 DOI: 10.1016/j.jasc.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/22/2022]
Abstract
Emphasis on the use of small specimens for biomarker testing to provide prognostic and predictive information for guiding clinical management for patients with advanced-stage cancer has been increasing. These biomarker tests include molecular analysis, cytogenetic tests, and immunohistochemical assays. Owing to the limited nature of the cellular material procured in these small specimens, which are collected using minimally invasive techniques (ie, fine needle aspiration and core needle biopsy), pathologists have been required to triage these samples judiciously and provide the clinically relevant genomic information required for patient care. Awareness of the advantages and limitations of these specimen preparations and the specific preanalytic requirements for the testing methods will help pathologists to develop optimal strategies to maximize the chances of effectively using these samples for comprehensive diagnostic and relevant biomarker testing.
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Xing J, Monaco SE, Cuda J, Pantanowitz L. Telecytology rapid on-site evaluation: Diagnostic challenges, technical issues and lessons learned. Cytopathology 2020; 31:402-410. [PMID: 31984572 DOI: 10.1111/cyt.12801] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/16/2020] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Rapid on-site evaluation (ROSE) has been widely used to improve diagnostic adequacy and facilitate specimen triage. Telecytology ROSE has gained popularity recently and shown high concordance with traditional ROSE. However, telecytology involves multiple personnel and technical devices that could introduce additional errors. The aim of this paper is to share errors encountered and lessons learned since employing telecytology for ROSE at our institution. METHODS The laboratory information system was searched for all documented telecytology ROSE errors from 2017 to 2019. These errors were subclassified as technical errors, cytotechnologist-related errors and pathologist-related errors. The following details were recorded for each reported event: type of error, reason for error, ROSE diagnosis, final diagnosis and actions taken to avoid future errors. RESULTS Telecytology ROSE errors were documented in 46 (1.3%) sessions. Ten (22%) had technical errors, 13 (28%) were owing to cytotechnologist errors and 23 (50%) were attributed to pathologist interpretation errors. The majority of the technical (90%) and cytotechnologist errors (85%) occurred within the first year of implementation of telecytology. Common ROSE misinterpretation errors included missing microorganisms, misclassifying neuroendocrine tumours as other neoplasms and overcalling malignancy on gastrointestinal endoscopic procedures. CONCLUSIONS A variety of errors may occur during telecytology ROSE. While some errors are inevitable (eg, information technology downtime), certain telecytology errors can be reduced by increasing staff familiarity with the system, providing timely feedbacks and taking prompt corrective actions. We recommend establishing a mechanism to document and act upon recorded errors as part of a telecytology quality improvement programme.
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Affiliation(s)
- Juan Xing
- 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
| | - Jacqueline Cuda
- 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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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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Results from the 2019 American Society of Cytopathology survey on rapid on-site evaluation-Part 1: objective practice patterns. J Am Soc Cytopathol 2019; 8:333-341. [PMID: 31495750 DOI: 10.1016/j.jasc.2019.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Rapid on-site evaluation (ROSE) is a service provided by cytologists that helps ensure specimen adequacy and appropriate triage for ancillary testing. However, data on the current usage patterns across different practice settings have been lacking. MATERIALS AND METHODS To obtain an accurate and timely assessment of the current state of practice of ROSE, a 14-question online survey was constructed by the Clinical Practice Committee of the American Society for Cytopathology. The survey was available to the membership of the American Society for Cytopathology for a 3-week period in early 2019. RESULTS A total of 541 responses were received, including from 255 cytopathologists/pathologists, 261 cytotechnologists, 19 cytology resident/fellow trainees, and 6 others. ROSE was offered as a clinical service by 95.4% of the respondents, with telecytology for ROSE used in 21.9% of the practices. Endobronchial ultrasound-guided transbronchial needle aspiration was the procedure most frequently reported to use ROSE (mean, 59.1%; median, 70%). Cytotechnologists were involved in ROSE in most practices. The number of daily ROSE procedures correlated with the annual nongynecologic cytology volumes. Approximately 70% of ROSE procedures were reported to require >30 minutes, on average, for the cytologist. CONCLUSIONS The results from our survey of cytologists have shown that the reported practice patterns for the usage of ROSE vary considerably. The presented data can help inform future guideline recommendations and the implementation of ROSE in different clinical settings.
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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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31
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Sussman R, Rosenbaum JN. Development and Validation of Molecular Assays for Limited Tissue Samples. Acta Cytol 2019; 64:147-154. [PMID: 30995656 DOI: 10.1159/000499109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/23/2019] [Indexed: 12/11/2022]
Abstract
As the value of molecular testing of cancer specimens increases, the number of tests imposed on tumor specimens also increases, often in tension with the amount of tumor material available. To develop and validate molecular assays for limited specimens, there are specific concerns that must be addressed, including DNA quality, quantity, and abundance; the number of targets/ability to multiplex; and the analytical sensitivity and specificity of the assay itself. Ultimately, weighing these considerations during assay validation in the overall context of clinical utility and laboratory workflow is critical for delivering the highest level of personalized care to patients.
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Affiliation(s)
- Robyn Sussman
- Center for Personalized Diagnostics, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason N Rosenbaum
- Center for Personalized Diagnostics, Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
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32
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Gutmann EJ. Something’s lost, but something’s gained: On‐site evaluation, telecytology, and the cytopathologist. Cancer Cytopathol 2019; 127:222-224. [DOI: 10.1002/cncy.22111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Edward J. Gutmann
- Department of Pathology and Laboratory Medicine Dartmouth‐Hitchcock Medical Center Lebanon New Hampshire
- Department of Pathology and Laboratory Medicine Dartmouth (Geisel) School of Medicine Hanover New Hampshire
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Monaco SE, Koah AE, Xing J, Ahmed I, Cuda J, Cunningham J, Metahri D, Progar A, Pantanowitz L. Telecytology implementation: Deployment of telecytology for rapid on-site evaluations at an Academic Medical Center. Diagn Cytopathol 2018; 47:206-213. [PMID: 30588767 DOI: 10.1002/dc.24077] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There are limited publications that address technical and practical informatics considerations when implementing telecytology for rapid on-site evaluation (ROSE). Our aim was to share the experience of deploying telecytology for ROSE at our institution. MATERIALS AND METHODS Key informatics issues relevant to adopting telecytology for ROSE at our institution were appraised including workflow, information technology (IT), validation, training, and quality assurance (QA). RESULTS A dynamic telemicroscopy solution was selected that required trained cytotechnologists to attend on-site procedures for ROSE. For validation 60 cases were reviewed using the first camera at each facility, but only 20 cases to validate subsequent cameras. A concordance rate of >90% between ROSE interpretation performed digitally to original interpretations was required for clinical validation. After reviewing 440 cases from two comparable time periods before and after implementation, employing telecytology was shown to decrease cytopathologists' work time per ROSE case from an average of 20.95 min per case to 2.91 min per case (86% time savings). The non-diagnostic rate for traditional ROSE was 7.7% compared with 4.1% after the implementation of telecytology, and the deferral rate went from 43.6% for traditional ROSE to 44.1% with telecytology. Traditional ROSE diagnoses correlated with final diagnoses in 91.8% cases, compared to 95.5% with telecytology. CONCLUSIONS Challenges when implementing telecytology for ROSE included technical issues, workflow concerns, and incorporating trainees into daily practice. The end result of our implementation was the adoption of an innovative way to deliver a ROSE service that maximised efficiency for cytopathologists without compromising diagnostic performance.
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Affiliation(s)
- Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber E Koah
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ishtiaque Ahmed
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jayna Cunningham
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Djamila Metahri
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Abbigal Progar
- 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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Yao K, Shen R, Parwani A, Li Z. Comprehensive Study of Telecytology Using Robotic Digital Microscope and Single Z-Stack Digital Scan for Fine-Needle Aspiration-Rapid On-Site Evaluation. J Pathol Inform 2018; 9:49. [PMID: 30662795 PMCID: PMC6319035 DOI: 10.4103/jpi.jpi_75_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022] Open
Abstract
Background: The current technology for remote assessment of fine-needle aspiration-rapid on-site evaluation (FNA-ROSE) is limited. Recent advances may provide solutions. This study compared the performance of VisionTek digital microscope (VDM) (Sakura, Japan) and Hamamatsu NanoZoomer C9600-12 single Z-stack digital scan (SZDS) to conventional light microscopy (CLM) for FNA-ROSE. Methods: We assembled sixty FNA cases from the thyroid (n = 16), lymph node (n = 16), pancreas (n = 9), head and neck (n = 9), salivary gland (n = 5), lung (n = 4), and rectum (n = 1) based on a single institution's routine workflow. One Diff-Quik-stained slide was selected for each case. Two board-certified cytopathologists independently evaluated the cases using VDM, SZDS, and CLM. A “washout” period of at least 14 days was placed between the reviews. The results were categorized into satisfactory versus unsatisfactory for adequacy assessment (AA) and unsatisfactory, benign, atypical, suspicious, and malignant for preliminary diagnosis (PD). Results: For AA, the Cohen's kappa statistics (CKS) scores of intermodality agreement (IMA) were 0.74–0.94 (CLM vs. VDM) and 0.86–1 (CLM vs. SZDS). The discordant rates of IMA were 3.3% (4/120) for VDM versus CLM, and 1.7% (2/120) for SZDS versus CLM. For PD, the CKS scores of IMA ranged 0.7–0.93. The overall discordant rates of IMA were 15% (18/120) for CLM versus VDM and 10.8% (13/120) for CLM versus SZDS. The discordant rates of IMA with 2 or higher degrees were 5.8% (7/120) for CLM versus VDM and 1.7% (2/120) for CLM versus SZDS. The average time spent per slide was 270 s for VDM, significantly longer than that for CLM (113 s) or for SZDS (122 s). Conclusions: Our data demonstrate that both VDM and SZDS are suitable to provide AA and reasonable PD evaluation. VDM, however, has a significantly longer turnaround time and worse diagnostic performance. The study demonstrates both the potentials and challenges of using VDM and SZDS for FNA-ROSE.
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Affiliation(s)
- Keluo Yao
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rulong Shen
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Anil Parwani
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Zaibo Li
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA
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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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