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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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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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3
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Alrafiah AR. Application and performance of artificial intelligence technology in cytopathology. Acta Histochem 2022; 124:151890. [PMID: 35366580 DOI: 10.1016/j.acthis.2022.151890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/17/2022] [Accepted: 03/24/2022] [Indexed: 11/27/2022]
Abstract
Deep learning algorithms and artificial intelligence (AI) are making great progress in their capacity to evaluate and interpret image data recent advancements in computer vision and machine learning. The first use of AI in a pathology lab was in cytopathology, when a computer-assisted Pap test screening was created. Initially designed to diagnose rather than screen, there was a lot of disagreement concerning their wide use to clinical specimens. However, whole-slide imaging of both gynaecological and non-gynaecological histopathology have been the subject of recent AI work. An overview of the literature on AI in cytopathology is provided in this brief review. To be more precise, it intends to emphasize the relevance of applications of AI algorithms to gynaecological and non-gynaecologic cytology. Between January 2000 and December 2021, a search on artificial intelligence in cytopathology was conducted in several well-known databases, including PubMed, Web of Science, Scopus, Embase, and Google Scholar. Only full-text papers that could be accessed online were evaluated.
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Chung MJ, Park SW, Kim SH, Cho CM, Choi JH, Choi EK, Lee TH, Cho E, Lee JK, Song TJ, Lee JM, Son JH, Park JS, Oh CH, Park DA, Byeon JS, Lee ST, Kim HG, Chun HJ, Choi HS, Park CG, Cho JY. [Clinical and Technical Guideline for Endoscopic Ultrasound-guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:73-93. [PMID: 34446631 DOI: 10.4166/kjg.2021.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence- based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.
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Affiliation(s)
- Moon Jae Chung
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Woo Park
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Chang Min Cho
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun-Ho Choi
- Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Eun Kwang Choi
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eunae Cho
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Kyu Lee
- Department of Internal Medicine, Dongguk University Medical Center, Dongguk University College of Medicine, Goyang, Korea
| | - Tae Jun Song
- Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Hyuk Son
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jin Suk Park
- Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine,Incheon, Korea
| | - Chi Hyuk Oh
- Department of Internal Medicine, KyungHee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, Office of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ho Gak Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hoon Jai Chun
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Guk Park
- Department of Internal Medicine, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Joo Young Cho
- Department of Internal Medicine, Cha University Bundang Medical Center, Cha University, Seongnam, Korea
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5
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Chung MJ, Park SW, Kim SH, Cho CM, Choi JH, Choi EK, Lee TH, Cho E, Lee JK, Song TJ, Lee JM, Son JH, Park JS, Oh CH, Park DA, Byeon JS, Lee ST, Kim HG, Chun HJ, Choi HS, Park CG, Cho JY. Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE). Gut Liver 2021; 15:354-374. [PMID: 33767027 PMCID: PMC8129669 DOI: 10.5009/gnl20302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/13/2020] [Accepted: 01/15/2021] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a task force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. (Gut Liver 2021;15:-374)
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Affiliation(s)
- Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Chang Min Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun-Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Eun Kwang Choi
- Division of Gastroenterology, Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jin Suk Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, Office of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha University College of Medicine, Seongnam, Korea
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6
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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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Chung MJ, Park SW, Kim SH, Cho CM, Choi JH, Choi EK, Lee TH, Cho E, Lee JK, Song TJ, Lee JM, Son JH, Park JS, Oh CH, Park DA, Byeon JS, Lee ST, Kim HG, Chun HJ, Choi HS, Park CG, Cho JY. Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE). Clin Endosc 2021; 54:161-181. [PMID: 33767027 PMCID: PMC8039738 DOI: 10.5946/ce.2021.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 12/13/2022] Open
Abstract
Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.
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Affiliation(s)
- Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, Korea
| | - Seong-Hun Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Chang Min Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jun-Ho Choi
- Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Eun Kwang Choi
- Division of Gastroenterology, Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Korea
| | - Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Jun Kyu Lee
- Division of Gastroenterology, Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Tae Jun Song
- Division of Gastroenterology, Department of Internal Medicine, Ulsan University College of Medicine, Seoul, Korea
| | - Jae Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jun Hyuk Son
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea
| | - Jin Suk Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Chi Hyuk Oh
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong-Ah Park
- Division of Healthcare Technology Assessment Research, Office of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jeong-Sik Byeon
- Division of Gastroenterology, Department of Internal Medicine, Ulsan University College of Medicine, Seoul, Korea
| | - Soo Teik Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Ho Gak Kim
- Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu College of Medicine, Daegu, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ho Soon Choi
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Chan Guk Park
- Division of Gastroenterology, Department of Internal Medicine, Chosun University College of Medicine, Korea, Gwangju, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha University College of Medicine, Seongnam, Korea
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Green DM, Boivin ME, Everts RM, Proskovec RE, Yaman LM, Dunn DR, Hallberg-Wallace KM, Bissell CE, Marotti JD. Implementation and assessment of a telecytology quality assurance program. J Am Soc Cytopathol 2020; 10:239-245. [PMID: 33189637 DOI: 10.1016/j.jasc.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The College of American Pathologists mandates that telepathology services are included in laboratory quality management programs. The aim of this study was to assess a telecytology quality assurance (QA) process that we implemented in 2015. MATERIALS AND METHODS Each month, a cytotechnologist randomly selected 3 telecytology fine-needle aspiration (FNA) cases from each cytopathologist on the FNA service that month. Data were recorded in a monthly worksheet and included onsite telecytology adequacy, final adequacy, concordance, onsite operator, cytopathologist, and reason for discrepancy, if present. The worksheet was reviewed monthly, discordant cases were re-examined, and feedback to cytologists was provided. For this study, worksheets from October 2015 to December 2019 were retrospectively reviewed. RESULTS The QA program captured 488 cases, representing 25% of total cases that utilized telecytology during the evaluation period (n = 1983). The telecytology onsite assessment was concordant with the final cytologic assessment in 84% (410 of 488) of cases. The majority of discordant cases (72 of 78, 92%) were the result of an "Inadequate" onsite telecytology assessment, but a final diagnosis was able to be rendered; 92% of these cases were attributed to diagnostic material being present in cytologic preparations not available during the onsite assessment. Nine telecytology onsite interpretation errors were identified, of which 7 were provided by cytopathologists with less than 2 years of experience. CONCLUSIONS Most telecytology cases with onsite assessment errors were evaluated by cytopathologists with less than 2 years of practice experience; therefore, careful monitoring of new staff should be considered when developing a telecytology QA program.
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Affiliation(s)
- Diane M Green
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Megan E Boivin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Rachael M Everts
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Rebecca E Proskovec
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Linda M Yaman
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Danielle R Dunn
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Karyn M Hallberg-Wallace
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Chloe E Bissell
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan D Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
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9
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Naous R, Kobayashi K, Khurana KK. Dynamic Telecytopathology-Guided Rapid On-Site Assessment of Percutaneous Image-Guided Fine-Needle Aspiration of Hepatic Lesions: An Institutional Review of 178 Cases. Telemed J E Health 2019; 26:961-966. [PMID: 31657674 DOI: 10.1089/tmj.2019.0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Rapid on-site evaluation (ROSE) of image-guided fine-needle aspiration (IGFNA) of hepatic lesions is necessary to ensure adequate sample collection and render preliminary diagnosis. We review our experience with utilization of telecytopathology for ROSE of IGFNA of liver lesions. Materials and Methods: Cytotechnologists at a remote site transmitted real-time images of Diff-Quik-stained cytology smears of hepatic lesions obtained using an Olympus DP70 digital camera via Ethernet to a pathologist. All live communications were conducted using the Vocera voice communication system. Preliminary telecytopathology ROSE diagnosis was compared with the final diagnosis for accuracy. Results: ROSE using telecytopathology of IGFNAs of hepatic lesion was performed on a total of 178 cases. Preliminary diagnosis of unsatisfactory, benign, suspicious for malignancy, and positive for malignancy was 2%, 28%, 15%, and 55%, respectively, for telecytopathology. The overall concordance between the preliminary and final cytology diagnoses was 94.4%. Nine of the cases were upgraded to suspicious/malignant final diagnosis contributing to an upgrade rate of 5%. One case with preliminary evaluation of positive for malignancy was downgraded to benign cytology on final diagnosis resulting in a downgrade rate of 0.1%. Conclusion: Utilization of telecytopathology is highly effective and accurate for ROSE of IGFNAs of hepatic lesions and may serve as a substitute for conventional microscopy.
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Affiliation(s)
- Rana Naous
- Department of Pathology and SUNY Upstate Medical University, Syracuse, New York, USA
| | - Katsuhiro Kobayashi
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Kamal K Khurana
- Department of Pathology and SUNY Upstate Medical University, Syracuse, New York, USA
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Cazacu IM, Luzuriaga Chavez AA, Saftoiu A, Vilmann P, Bhutani MS. A quarter century of EUS-FNA: Progress, milestones, and future directions. Endosc Ultrasound 2018; 7:141-160. [PMID: 29941723 PMCID: PMC6032705 DOI: 10.4103/eus.eus_19_18] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 03/21/2018] [Indexed: 12/11/2022] Open
Abstract
Tissue acquisition using EUS has considerably evolved since the first EUS-FNA was reported 25 years ago. Its introduction was an important breakthrough in the endoscopic field. EUS-FNA has now become a part of the diagnostic and staging algorithm for the evaluation of benign and malignant diseases of the gastrointestinal tract and of the organs in its proximity, including lung diseases. This review aims to present the history of EUS-FNA development and to provide a perspective on the recent developments in procedural techniques and needle technologies that have significantly extended the role of EUS and its clinical applications. There is a bright future ahead for EUS-FNA in the years to come as extensive research is conducted in this field and various technologies are continuously implemented into clinical practice.
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Affiliation(s)
- Irina Mihaela Cazacu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - Peter Vilmann
- Gastrounit, Division of Surgery, Copenhagen University Hospital Herlev, Copenhagen, Denmark
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas – MD Anderson Cancer Center, Houston, Texas, USA
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11
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Pathological and Molecular Aspects to Improve Endoscopic Ultrasonography-Guided Fine-Needle Aspiration From Solid Pancreatic Lesions. Pancreas 2018; 47:163-172. [PMID: 29346217 DOI: 10.1097/mpa.0000000000000986] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been applied to pancreatic lesions since the 1990s, and its use is now widespread. Improvements in endoscopic devices and sampling techniques have resulted in excellent diagnostic ability for solid pancreatic lesions. However, clinical improvements alone are not responsible for it; pathological aspects have also played important roles. Rapid on-site evaluation minimizes endoscopic procedures, although its value at improving the diagnostic ratio is still debated. Diagnostic efficacy differs by sample preparations (direct smear, cytospin, liquid-based cytology, cell block, and biopsy) and by staining methods (Papanicoloau, Diff-Quik, hematoxylin-eosin, and Giemsa). Several immunocytochemistry protocols aid in diagnosing epithelial components with cytological atypia and in differentiating various tumor types. One cytopathology diagnostic system is telecytology, which uses transmitted digital images and enables real-time diagnosis of EUS-FNA samples by expert cytologists at remote locations. However, EUS-FNA samples are useful for more than just diagnoses, as molecular analysis of these samples allows the identification of prognostic markers, such as genetic alterations in K-ras and EGFR. Expression of drug-metabolizing enzymes, human equilibrative nucleoside transporter 1, correlates with the response to gemcitabine-based chemotherapy. These pathology efforts have enhanced the diagnostic efficacy of EUS-FNA, thereby leading to better outcomes for patients with pancreatic diseases.
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Farrell JM, Riben MW, Staerkel GA, Huang ML, Dawlett M, Caraway NP. Efficacy of telecytopathology for preliminary assessment of fine-needle aspirations performed at a remote facility. J Am Soc Cytopathol 2018; 7:22-30. [PMID: 31043247 DOI: 10.1016/j.jasc.2017.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The need for real time anatomic pathology services has grown as healthcare systems, traditionally found at large medical centers, expand into smaller communities. The placement of a pathologist is not cost-, time-, or resource-efficient. Telecytopathology can provide rapid offsite evaluation of cytology tissues. This study evaluated the accuracy rate of rendered preliminary assessments for telecytopathology of ultrasound (US)-guided fine-needle aspirations (FNAs) for an offsite facility by comparing preliminary assessment results with the final diagnosis. MATERIALS AND METHODS The pathology database was searched for telecytopathology US-guided FNAs with rapid offsite evaluation performed at a regional care center from August 2014 to June 2016. A total of 674 consecutive US-guided FNAs from 444 patients were obtained. FNA sites included lymph node (345 cases), breast (178 cases), thyroid gland (71 cases), and others (80 cases). RESULTS Preliminary assessments of the 674 FNAs were adequate/benign in 275 (41%) cases, adequate/malignant in 182 (27%) cases, adequate/further review needed in 162 (24%) cases, indeterminate/borderline cellularity in 37 (5%) cases, and nondiagnostic in 18 (3%) cases. Final FNA diagnoses rendered included 391 (58%) negative for malignancy, 205 (30%) malignant, 34 (5%) atypical/suspicious for malignancy, 26 (4%) indeterminate cellularity-favor benign, and 18 (3%) nondiagnostic specimens. Concurrent core biopsy was performed in 42 cases and 83 cases were triaged for ancillary studies. The majority (99%) of US-guided FNAs demonstrated concordant preliminary assessments with the final diagnoses. A major discrepancy occurred in 1 case; 5 cases had minor discrepancies. CONCLUSIONS Remote facility telecytopathology can be utilized as an accurate modality in guiding appropriate tissue acquisition and final diagnosis.
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Affiliation(s)
- Jessica M Farrell
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael W Riben
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregg A Staerkel
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monica L Huang
- Department of Diagnostic Radiology-Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marilyn Dawlett
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy P Caraway
- Section of Cytopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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13
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Tharian B, Krall K, Zhu X, George N, Chambers M, Varadarajulu S, Hebert-Magee S. Endosonographer-driven dynamic telecytopathology of pancreatic lesions-a pilot study. J Am Soc Cytopathol 2018; 7:86-91. [PMID: 31043257 DOI: 10.1016/j.jasc.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Telecytopathology for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been shown to be an alternative to rapid on-site evaluation (ROSE). Gastroenterologists (endosonographers) performing EUS-FNA can be trained to evaluate a specimen for adequacy. This study examined the ability of an endosonographer with focused cytopathologic training to assess the adequacy of pancreatic FNA specimens and transmit diagnostic images to a remotely located cytopathologist as compared to an experienced cytotechnologist. MATERIALS AND METHODS This was a retrospective study of consecutive pancreatic lesions sampled by EUS-FNA reviewed by an endosonographer and a cytotechnologist. The participants were assessed based on their ability to (1) determine adequacy, (2) locate and transmit representative cell groups, (3) provide a preliminary diagnosis, and (4) provide concordance with actual diagnosis. RESULTS 105 consecutive cases of EUS-FNA of the pancreas were analyzed, including: adenocarcinoma (n = 39), cyst (n = 17), neuroendocrine neoplasia (n = 7), pancreatitis (n = 14), benign pancreas (n = 9), other neoplasms (n = 6), suspicious/atypical (n = 3), and nondiagnostic (n = 10). The cytotechnologist demonstrated superiority in accuracy 92.7% versus 70% (P = 0.003) and subcategorization 95.0% versus 76% (P = 0.007). There was no difference in "broad" categorization (benign/malignant) between the endosonographer and cytotechnologist, 98% and 98.2% (P = 0.946), respectively. Also, there was no difference with regard to adequacy assessment (P = 0.29). A steady learning curve for the endosonographer was demonstrated in their cytologic assessment (P = 0.041). The endosonographer was shown to be able to remotely transmit diagnostic images to a pathologist. CONCLUSION An endosonographer with limited training can examine for specimen adequacy, transmit images, and demonstrate representative cell groups. Larger studies are required though preliminary results are encouraging.
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Affiliation(s)
- Benjamin Tharian
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida; University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas.
| | - Konrad Krall
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida
| | - Xiang Zhu
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida
| | - Nayana George
- University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas
| | - Michael Chambers
- University of Central Florida College of Medicine, Orlando, Florida
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida
| | - Shantel Hebert-Magee
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida; Center for Diagnostic Pathology, Florida Hospital, Orlando, Florida
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14
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Mohanty SK, Pradhan D, Sharma S, Sharma A, Patnaik N, Feuerman M, Bonasara R, Boyd A, Friedel D, Stavropoulos S, Gupta M. Endoscopic ultrasound guided fine-needle aspiration: What variables influence diagnostic yield? Diagn Cytopathol 2017; 46:293-298. [PMID: 29280329 DOI: 10.1002/dc.23883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 07/09/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) plays an important role in the diagnosis of various lesions. We sought to determine factors that influence the diagnostic yield of EUS-FNA, specifically, the presence of a cytopathologist, FNA site, and the endoscopist's skill. METHODS The data on cytopathologist's availability, duration of procedure, number of passes made, and diagnostic material for cell block (CB) preparation was collected over an 18 months period. RESULTS 230 specimens (218 patients) were obtained from pancreas (114), lymph node (64), submucosal lesions of the gastrointestinal tract (27), liver (8), and miscellaneous (17) sites. The results were classified as informative (77.8%) and non-informative (NI) (22.2%). The NI rate was significantly high, when a cytopathologist was absent (P = .0008). As the likelihood of cytopathologist's presence increased from 35.8% to 82.9%, the CB quality increased (P < .0001). In the absence of a cytopathologist, the likelihood of NI result increased more than 2-fold (P = .03) and of an inadequate CB increased 3-fold (P < .0001). The more experienced endoscopist "C" (compared to the less experienced "A + B") was less likely to get inadequate material (40.5% vs. 66.3%) (P = .0001). CONCLUSION The diagnostic yield of EUS-FNA is significantly related to the presence of an on-site cytopathologist and endoscopist's skill in procuring diagnostic material.
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Affiliation(s)
- Sambit K Mohanty
- Department of Pathology, Winthrop University Hospital, Mineola, New York.,Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Dinesh Pradhan
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Anurag Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, Haryana, India
| | - Niharika Patnaik
- Department of Pathology, Kalinga hospital, Bhubaneswar, Odisha, India
| | - Martin Feuerman
- Department of Biostatistics, Winthrop University Hospital, Mineola, New York
| | - Robert Bonasara
- Department of Gastroenterology, Winthrop University Hospital, Mineola, New York
| | - Adrienne Boyd
- Department of Pathology, Winthrop University Hospital, Mineola, New York
| | - David Friedel
- Department of Biostatistics, Winthrop University Hospital, Mineola, New York
| | | | - Mala Gupta
- Department of Pathology, Winthrop University Hospital, Mineola, New York
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15
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Sirintrapun SJ, Rudomina D, Mazzella A, Feratovic R, Alago W, Siegelbaum R, Lin O. Robotic Telecytology for Remote Cytologic Evaluation without an On-site Cytotechnologist or Cytopathologist: An Active Quality Assessment and Experience of Over 400 Cases. J Pathol Inform 2017; 8:35. [PMID: 28966835 PMCID: PMC5609392 DOI: 10.4103/jpi.jpi_25_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/08/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The first satellite center to offer interventional radiology procedures at Memorial Sloan Kettering Cancer Center opened in October 2014. Two of the procedures offered, fine needle aspirations and core biopsies, required a rapid on-site cytologic evaluation of smears and biopsy touch imprints for cellular content and adequacy. The volume and frequency of such evaluations did not justify hiring on-site cytotechnologists, and therefore, a dynamic robotic telecytology (TC) solution was created. In this article, we provide data on our experience with this active implementation. Sakura VisionTek was selected as our robotic TC solution. METHODS A retrospective analysis of all TC evaluations from this satellite site was performed. Information was collected on demographics, lesion location, imaging modality; a comparison of TC-assisted adequacy with final adequacy was also conducted. RESULTS An analysis of 439 cases was performed over a period of 23 months with perfect correlation in 92.7% (407/439) of the cases. An adequacy upgrade (inadequate specimen becomes adequate) in 6.6% (29/439) of the cases. An adequacy downgrade (adequate specimen becomes inadequate), is near zero at 0.7% (3/439) of the cases. CONCLUSIONS Dynamic robotic TC is effective for immediate evaluations performed without on-site cytotechnology staff. The overall intent of this article is to present data and concordance rates as outcome metrics. Thus far, such outcome metrics have exceeded our expectations. Our TC implementation shows high, perfect concordance. Adequacy upgrades are minor but more relevant and impressive is a near zero adequacy downgrade. Our full implementation has been so successful that plans are in place for configurations at future satellite sites.
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Affiliation(s)
| | - Dorota Rudomina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allix Mazzella
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rusmir Feratovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William Alago
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert Siegelbaum
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
The advancements in the fields of technology and networking have revolutionized the world including the fields of medicine and dentistry. Telemedicine and its various branches provide a broad platform to medical professionals for consultations and investigations and can also act as a valuable educational aid. This review highlights the components, methods employed, clinical applications, advantages, disadvantages of telepathology and telecytology.
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Affiliation(s)
- Roquaiya Nishat
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Sujatha Ramachandra
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Shyam Sundar Behura
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Harish Kumar
- Department of Oral Pathology and Microbiology, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
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17
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Khurana KK, Xu W, Wang D, Swarnkar A. Rapid on-site evaluation with dynamic telecytopathology for ultrasound-guided fine-needle aspiration of head and neck nonthyroid lesions. J Pathol Inform 2015; 6:19. [PMID: 26110087 PMCID: PMC4466783 DOI: 10.4103/2153-3539.157781] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/17/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) at the time of ultrasound-guided fine-needle aspiration (USGFNA) of head and neck lesion is essential for obtaining adequate samples and providing the preliminary diagnosis. We summarize our experience with ROSE of USGFNA on head and neck nonthyroid lesions using telecytopathology. MATERIALS AND METHODS Real-time images of Diff-Quik stained cytology smears were obtained at ultrasound suite with an Olympus DP-70 digital camera attached to an Olympus CX41 microscope, and transmitted via ethernet by a cytotechnologist to a cytopathologist in cytopathology laboratory who rendered a preliminary diagnosis. Live communication was conducted with Vocera voice communication system. The ultrasound suite was located on different floor from the cytopathology laboratory. Accuracy of ROSE via telecytopathology was compared with an equal number of cases that received ROSE, prior to introduction of telecytopathology, via conventional microscopy. RESULTS Rapid on-site evaluation was performed on a total of 116 USGFNA of head and neck nonthyroid lesions. The telecytopathology system and conventional microscopy was used to evaluate equal number of cases (58 each). Preliminary diagnoses of benign, atypical/suspicious for malignancy, and positive for malignancy were 72.4%, 17.2% and 10.3% for telecytopathology, and 69.0%, 10.3% and 20.7% for conventional microscopy. None of the cases were deemed unsatisfactory. The overall concordance between the preliminary and final diagnoses was 94.8% for telecytopathology and 98.3% for conventional microscopy and was not statistically significant (P = 0.309). The causes of discordant preliminary and final diagnoses were mainly attributed to availability of cell block and Papanicolaou-stained slides for review or flow cytometry results for lymphoma cases at the time of final sign out. CONCLUSIONS Telecytopathology is comparable with conventional microscopy in ROSE of USGFNA of head and neck nonthyroid lesions.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, Syracuse, New York, USA
| | - Weisheng Xu
- Department of Pathology, State University of New York, Syracuse, New York, USA
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, State University of New York, Syracuse, New York, USA
| | - Amar Swarnkar
- Department of Radiology, State University of New York, Syracuse, New York, USA
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18
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Khurana KK, Graber B, Wang D, Roy A. Telecytopathology for On-Site Adequacy Evaluation Decreases the Nondiagnostic Rate in Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Lesions. Telemed J E Health 2014; 20:822-7. [DOI: 10.1089/tmj.2013.0316] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kamal K. Khurana
- Department of Pathology, State University of New York, Syracuse, New York
- Department of Internal Medicine, State University of New York, Syracuse, New York
| | - Bella Graber
- Department of Pathology, State University of New York, Syracuse, New York
| | - Dongliang Wang
- Department of Public Health and Preventive Medicine, State University of New York, Syracuse, New York
| | - Ajoy Roy
- Department of Internal Medicine, State University of New York, Syracuse, New York
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Thrall MJ, Rivera AL, Takei H, Powell SZ. Validation of a novel robotic telepathology platform for neuropathology intraoperative touch preparations. J Pathol Inform 2014; 5:21. [PMID: 25191620 PMCID: PMC4141358 DOI: 10.4103/2153-3539.137642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/10/2014] [Indexed: 11/06/2022] Open
Abstract
Background: Robotic telepathology (RT) allows a remote pathologist to control and view a glass slide over the internet. This technology has been demonstrated to be effective on several platforms, but we present the first report on the validation of RT using the iScan Coreo Au whole slide imaging scanner. Methods: One intraoperative touch preparation slide from each of 100 cases were examined twice (200 total cases) using glass slides and RT, with a 3 week washout period between viewings, on two different scanners at two remote sites. This included 75 consecutive neuropathology cases and 25 consecutive general surgical pathology cases. Interpretations were compared using intraobserver variability. Results: Of the 200 total cases, one failed on RT. There were 47 total interpretive variances. Most of these were the result of less specific interpretations or an inability to identify scant diagnostic material on RT. Nine interpretive variances had potentially significant clinical implications (4.5%). Using the final diagnosis as a basis for comparison to evaluate these nine cases, three RT interpretations and three glass slide interpretations were considered to be discrepant. In the other three cases, both modalities were discrepant. This distribution of discrepancies indicates that underlying case difficulty, not the RT technology, probably accounts for these major variances. For the subset of 68 neoplastic neuropathology cases, the unweighted kappa of agreement between glass slides and RT was 0.68 (good agreement). RT took 225 s on average versus only 71 s per glass slide. Conclusions: This validation demonstrates that RT using the iScan Coreo Au system is a reasonable method for supplying remote neuropathology expertise for the intraoperative interpretation of touch preparations, but is limited by the slowness of the robotics, crude focusing, and the challenge of determining where to examine the slide using small thumbnail images.
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Affiliation(s)
- Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Andreana L Rivera
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Hidehiro Takei
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Suzanne Z Powell
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
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Costache MI, Iordache S, Karstensen JG, Săftoiu A, Vilmann P. Endoscopic ultrasound-guided fine needle aspiration: from the past to the future. Endosc Ultrasound 2014; 2:77-85. [PMID: 24949369 PMCID: PMC4062239 DOI: 10.4103/2303-9027.117691] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 02/20/2013] [Indexed: 12/17/2022] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a technique which allows the study of cells obtained through aspiration in different locations near the gastrointestinal tract. EUS-FNA is used to acquire tissue from mucosal/submucosal tumors, as well as peri-intestinal structures including lymph nodes, pancreas, adrenal gland, gallbladder, bile duct, liver, kidney, lung, etc. The pancreas and lymph nodes are still the most common organs targeted in EUS-FNA. The overall accuracy of EUS is superior to computed tomography scan and magnetic resonance imaging for detecting pancreatic lesions. In most cases it is possible to avoid unnecessary surgical interventions in advanced pancreatic cancer, and EUS is considered the preferred method for loco-regional staging of pancreatic cancer. FNA improved the sensitivity and specificity compared to EUS imaging alone in detection of malignant lymph nodes. The negative predictive value of EUS-FNA is relatively low. The presence of a cytopathologist during EUS-FNA improves the diagnostic yield, decreasing unsatisfactory samples or need for additional passes, and consequently the procedural time. The size of the needle is another factor that could modify the diagnostic accuracy of EUS-FNA. Even though the EUS-FNA technique started in early nineteen's, there are many remarkable progresses culminating nowadays with the discovery and performance of needle-based confocal laser endomicroscopy. Last, but not least, identification and quantification of potential molecular markers for pancreatic cancer on cellular samples obtained by EUS-FNA could be a promising approach for the diagnosis of solid pancreatic masses.
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Affiliation(s)
- Mădălin-Ionuț Costache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania
| | - Sevastița Iordache
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania
| | | | - Adrian Săftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova 200638, Romania ; Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark
| | - Peter Vilmann
- Department of Surgery, Endoscopic Unit, Copenhagen University-Hospital Herlev, Denmark
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Hudson JB, Murray BA, Guiney M, Chen AC, Collins BT, Wang JF. Telecytology for EBUS-FNA immediate adequacy assessment: implementation experience at a large academic medical center. J Am Soc Cytopathol 2014; 3:137-141. [PMID: 31051737 DOI: 10.1016/j.jasc.2014.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/29/2013] [Accepted: 01/06/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Performing immediate assessment (IA) has become the standard of care for endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA) specimens. Despite the benefits of aiding interventional pulmonologists to achieve higher adequacy rates and fewer unnecessary passes, the time required by attending cytopathologists to be present for on-site assessments is significant and affects other clinical responsibilities. Telepathology, as implemented here, consists of a cytotechnologist-driven or trainee-driven microscope attached to a Nikon DS-Fi1 Camera and DS-L2 controller that displays dynamic microscopic images in real time on the attending pathologist's office computer. MATERIALS AND METHODS Preliminary assessment results, final diagnoses, and corresponding surgical pathology diagnoses, when available, were compared between consecutive EBUS-FNA specimens acquired before and after implementation of telepathology-assisted IA. Cases were divided into 3 categories: satisfactory for evaluation, indeterminate for evaluation, and unsatisfactory for evaluation. RESULTS During the first half of 2012, immediate assessments for adequacy were performed in person by attending pathologists for all cases in the EBUS-FNA suite. There were 209 adequacy assessments performed without the use of telepathology and 289 with telepathology. There were no differences in the relative distribution of satisfactory, indeterminate, and unsatisfactory for evaluation cases, the percentages of diagnostic samples relative to the adequacy category or in the histologic concordance between pretelepathology and post-telepathology cases. CONCLUSIONS Telepathology-assisted IA of EBUS-FNA allowed for the same diagnostic accuracy as traditional on-site IA and is saves time for pathologists.
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Affiliation(s)
- Jena B Hudson
- Department of Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri.
| | | | - Margaux Guiney
- Cytology Department, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Alexander C Chen
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Brian T Collins
- Department of Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri
| | - Jeff F Wang
- Department of Pathology and Immunology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri
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McMahon RQ, McCarthy EE, Hetzel SJ, Das K, Stewart J. Focus on technology: How important is resolution in telecytopathology? Cancer Cytopathol 2014; 122:546-52. [PMID: 24678000 DOI: 10.1002/cncy.21404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND The authors conducted an analysis of 2 telepathology systems with different resolutions to determine how resolution affects the pathologists' ability to provide preliminary diagnoses for fine-needle aspirations (FNA). METHODS FNA cases evaluated by telepathology between February 1, 2011 and January 18, 2012 were reviewed. Concordance indices between preliminary and final diagnoses were calculated for cases assessed with two proprietary systems (the Remote Meeting Technologies iMedHD system and the Olympus NetCam system) using 3 diagnostic classifications (negative, atypical, and suspicious/positive). A Wilcoxon rank-sum test was used to compare the number of passes necessary to determine adequacy. RESULTS In total, 298 NetCam cases and 26 iMedHD cases were evaluated. The concordance index, which was calculated using the 3 classifications, was 0.943 (95% confidence interval, 0.922-0.963) for NetCam compared with 0.951 (95% confidence interval, 0.898-1.000) for iMedHD. The mean value for the number of passes required to determine adequacy was 2.2 for NetCam and 2.1 for iMedHD (P = .838). CONCLUSIONS The results from statistical analyses demonstrated no difference in the concordance indices between preliminary and final diagnoses or in the number of passes necessary to render adequacy between the 2 telepathology systems. However, because it had higher resolution along with other features, the iMedHD system achieved greater user satisfaction.
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Affiliation(s)
- Rachel Q McMahon
- Department of Cytopathology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Khurana KK, Kovalovsky A, Wang D, Lenox R. Feasibility of dynamic telecytopathology for rapid on-site evaluation of endobronchial ultrasound-guided transbronchial fine needle aspiration. Telemed J E Health 2014; 19:265-71. [PMID: 23540276 DOI: 10.1089/tmj.2012.0168] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Rapid on-site evaluation (ROSE) at the time of endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBFNA) is useful in obtaining adequate samples and providing preliminary diagnosis. We present our experience with ROSE of EBUS-TBFNA using telecytopathology. MATERIALS AND METHODS Real-time images of Diff-Quik (Mercedes Medical, Sarasota, FL)-stained cytology smears were obtained with an Olympus (Olympus America, Center Valley, PA) digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a cytopathologist in a cytopathology laboratory who rendered a preliminary diagnosis while communicating with an on-site cytotechnologist via the Vocera (San Jose, CA) voice communication system. The endoscopy suite was located a block away from the cytopathology laboratory. Accuracy of ROSE via telecytopathology was compared with an equal number of cases that received ROSE, prior to introduction of telecytopathology, via conventional microscopy. RESULTS ROSE was performed on a total of 200 EBUS-TBFNAs. The telecytopathology system and conventional microscopy were used to evaluate equal numbers of cases (100 each). Preliminary diagnoses of negative/benign, atypical/suspicious, and positive for malignancy were 58%, 14%, and 24% for telecytopathology and 57%, 10%, and 31% for conventional microscopy. Four percent of telecytopathology cases and 2% of conventional microscopy cases were deemed unsatisfactory at the time of ROSE. The overall concordance between the preliminary and final diagnoses was 96% for telecytopathology and 93% for conventional microscopy. The causes of discordant preliminary and final diagnoses could be mainly attributed to difficulty in distinguishing small cell carcinoma versus reactive lymph node due to crush artifact, atypia related to reactive bronchial epithelial cells, and availability of cell block material and Papanicolaou-stained slides for review at the time of final cytologic sign out. CONCLUSIONS Telecytopathology is comparable with conventional microscopy in ROSE of EBUS-TBFNA. It can serve as a valid substitute for conventional microscopy for on-site assessment of EBUS-TBFNA.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, Syracuse, NY 13210, USA.
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Dudas R, VandenBussche C, Baras A, Ali SZ, Olson MT. Inexpensive telecytology solutions that use the Raspberry Pi and the iPhone. J Am Soc Cytopathol 2014; 3:49-55. [PMID: 31051730 DOI: 10.1016/j.jasc.2013.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION There is currently substantial interest in dynamic telecytology-the presentation of microscopic findings by live video feed to a cytopathologist at a remote location. However, the initial costs of a telecytology system can be high. We present several low-cost alternatives along with their performance characteristics. MATERIALS AND METHODS We tested 3 low-cost telecytology systems: a Raspberry Pi with a webcam, an iPhone 4S with FaceTime, and an iPhone 4S with a live streaming app. Costs, resolution capacities, and latency periods for image transmission were determined. RESULTS At $85.55, the Raspberry Pi system is the least expensive telecytology solution described to date. When the cost per megapixel of resolution is considered, the cost of a Raspberry Pi system is 120× less than the most expensive commercially available option and about 7-fold less than the iPhone-based alternatives. Latency periods were substantially lower for the iPhone systems: 2.5 ± 1 seconds for FaceTime and 2.8 ± 0.3 seconds for iPhone live streaming versus 6.6 ± 0.6 seconds for the Raspberry Pi system at comparable frame rates. CONCLUSIONS This proof-of-principle study demonstrates that inexpensive telecytology systems are able to stream live video feeds of cytology slides from a microscope to a remote location at useable resolutions.
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Affiliation(s)
- Radu Dudas
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alex Baras
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T Olson
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Kubik MJ, Mohammadi A, Rosa M. Diagnostic benefits and cost-effectiveness of on-site imprint cytology adequacy evaluation of core needle biopsies of bone lesions. Diagn Cytopathol 2013; 42:506-13. [PMID: 24574374 DOI: 10.1002/dc.23065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 09/05/2013] [Accepted: 10/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Core needle biopsy (CNB) is a well-established, successful technique for the diagnosis of various organ system lesions. To increase diagnostic yield, on-site cytologic evaluation of adequacy (OCA) is routinely performed at many institutions. Numerous studies evaluating the impact of OCA on CNB have been published. However, little has been said regarding accuracy of OCA for bone lesions. METHODS To evaluate this, we reviewed our experience during a two-year period, and compared OCA results with the final diagnosis of the corresponding CNB. For the study, diagnoses were divided into three categories: malignant, benign, and nonspecific/nondiagnostic findings. RESULTS Sixty-one cases were included. During OCA, 25 cases were diagnosed as malignant, three cases as benign, and 33 as nonspecific/nondiagnostic. On histologic evaluation, 29 cases were malignant, 16 were benign, and 16 were classified as nonspecific/nondiagnostic. Concordance with final CNB diagnosis was seen in 100% of malignant, 67% of benign, and 45% of nonspecific/nondiagnostic on-site cytology evaluations. The overall diagnostic success rate of OCA for malignancy was 86% (25/29). The success rate of OCA for benign lesions was only 13%. Fifty-four percent of cases were diagnosed as nonspecific/nondiagnostic on-site. This category included four false negative cases. CONCLUSIONS We conclude that for lesions with a suspicion of malignancy, OCA is a valuable adjuvant diagnostic tool. However, for cases with a benign or nonspecific clinical impression, OCA has a limited diagnostic role. Careful selection of cases in which OCA is beneficial is necessary to maintain accuracy and to limit procedure costs.
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Affiliation(s)
- Melanie J Kubik
- Department of Pathology and Laboratory Medicine, University of Florida, College of Medicine, Jacksonville, Florida
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Buxbaum JL, Eloubeidi MA, Lane CJ, Varadarajulu S, Linder A, Crowe AE, Jhala D, Jhala NC, Crowe DR, Eltoum IA. Dynamic telecytology compares favorably to rapid onsite evaluation of endoscopic ultrasound fine needle aspirates. Dig Dis Sci 2012; 57:3092-7. [PMID: 22729624 PMCID: PMC3640867 DOI: 10.1007/s10620-012-2275-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 06/04/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Rapid onsite evaluation (ROSE) has been demonstrated to correlate with final cytologic interpretations and improves the diagnostic yield of endoscopic ultrasound (EUS)-fine needle aspiration (FNA); however, its availability is variable across centers. The aim of this prospective study was to evaluate whether remote telecytology can substitute for ROSE. METHODS Consecutive patients who underwent EUS-FNA for diverse indications at a high volume referral center were enrolled and all samples were prospectively evaluated by three methods. ROSE was performed by a cytopathologist in the procedure room; simultaneously dynamic telecytology was done by a different cytopathologist in a remote location at our institution. The third method, final cytologic interpretation in the laboratory, was the gold standard. Telecytology was performed using an Olympus microscope system (BX) which broadcasts live images over the Internet. Accuracy of telecytology and agreement with other methods were the principle outcome measurements. RESULTS Twenty-five consecutive samples were obtained from participants 40-87 years old (median age 63, 48 % male). There was 88 % agreement between telecytology and final cytology (p < 0.001) and 92 % agreement between ROSE and final cytology (p < 0.001). There was consistency between telecytology and ROSE (p value for McNemar's χ(2) = 1.0). Cohen's kappa for agreement for telecytology and ROSE was 0.80 (SE = 0.11), confirming favorable correlation. CONCLUSION Dynamic telecytology compares favorably to ROSE in the assessment of EUS acquired fine needle aspirates. If confirmed by larger trials, this system might obviate the need for onsite interpretation of EUS-FNA specimens.
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Affiliation(s)
- James L. Buxbaum
- Division of Gastroenterology, University of Southern California, Los Angeles, California
| | - Mohamad A. Eloubeidi
- Division of Gastroenterology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Christianne J. Lane
- Division of Gastroenterology, University of Southern California, Los Angeles, California
| | - Shyam Varadarajulu
- Division of Gastroenterology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Ami Linder
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Amanda E. Crowe
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Darshana Jhala
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Nirag C. Jhala
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - David R. Crowe
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
| | - Isam A. Eltoum
- Department of Pathology, University of Alabama in Birmingham, Birmingham, Alabama
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Suzuki R, Irisawa A, Bhutani MS, Hikichi T, Takagi T, Sato A, Sato M, Ikeda T, Watanabe K, Nakamura J, Tasaki K, Obara K, Ohira H. Prospective evaluation of the optimal number of 25-gauge needle passes for endoscopic ultrasound-guided fine-needle aspiration biopsy of solid pancreatic lesions in the absence of an onsite cytopathologist. Dig Endosc 2012; 24:452-6. [PMID: 23078439 DOI: 10.1111/j.1443-1661.2012.01311.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION A prior study with 22-gauge needles recommended more than seven needle passes for endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) of solid pancreatic lesions (SPL) without onsite cytopathology for optimal acquisition of cytopathological diagnosis. The feasibility of this recommendation should be re-evaluated considering the later development and popularity of 25-gauge EUS-FNA needles. We aimed to determine the optimal number of needle passes for cytopathological specimen acquisition with 25-gauge needles for EUS-FNA of SPL. METHODS A preliminary prospective study of 22 patients with an onsite cytopathology technician showed a sensitivity of 93.3% and a specificity of 100% with four needle passes that was not statistically different from five needle passes. Based on our preliminary study, we fixed the number of needle passes to four (Group A). As a control group, we carried out sampling in consecutive patients using 25-gauge needles with an onsite cytopathologist (Group B). Sampling rate, diagnostic value and complications were evaluated. RESULTS We enrolled 20 patients in each group. Sampling rate was higher in Group B (20/20, 100%) than in Group A (19/20, 95%), but there was no statistical difference between them (P-value = 0.31). In Group A, sensitivity, specificity and accuracy were 100% among 19. In Group B, sensitivity was 94.1%, specificity 100%, accuracy 95%. There were also no statistical differences between the groups. No complications were seen. CONCLUSION Our study suggests that four needle passes using a 25-gauge needle may be sufficient for EUS-FNA of SPL where onsite cytology is not available.
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Affiliation(s)
- Rei Suzuki
- Department of Gastroenterology and Rheumatology, Division of Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan.
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Khurana KK, Kovalovsky A, Masrani D. Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center. J Pathol Inform 2012; 3:36. [PMID: 23243554 PMCID: PMC3519010 DOI: 10.4103/2153-3539.101803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 07/25/2012] [Indexed: 11/08/2022] Open
Abstract
Background: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA) specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA) of axillary lymph nodes in a remote breast care center. Materials and Methods: Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. Results: A total of 39 female patients (mean age: 50.5 years) seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. Conclusions: This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate compared with the final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, 750 East Adams Street, Syracuse, New York
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Endoscopic-ultrasound-guided fine-needle aspiration and the role of the cytopathologist in solid pancreatic lesion diagnosis. PATHOLOGY RESEARCH INTERNATIONAL 2012; 2012:317167. [PMID: 22666633 PMCID: PMC3362237 DOI: 10.1155/2012/317167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 12/12/2022]
Abstract
Endoscopic ultrasound (EUS) is the most sensitive imaging modality for solid pancreatic lesions. The specificity, however, is low (about 75%). It can be increased to 100% with an accuracy of 95% by the addition of fine-needle aspiration (FNA). Cytopathology plays an important role. The final diagnosis is based upon the correlation of clinical, EUS, and cytologic features. A close interaction with the cytopathologist is required in improving the diagnostic yield. In this paper, we present an overview of the role of EUS-guided FNA and importance of close interaction with the cytopathologist. Day to day examples of different solid pancreatic lesions have been presented at the end.
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Donnelly AD, Mukherjee MS, Lyden ER, Radio SJ. Virtual microscopy in cytotechnology education: Application of knowledge from virtual to glass. Cytojournal 2012; 9:12. [PMID: 22675395 PMCID: PMC3352673 DOI: 10.4103/1742-6413.95827] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/12/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Virtual microscopy (VM) is a technology in which the glass slides are converted into digital images. The main objective of this study is to determine if cellular morphology, learned through virtual microscopy, can be applied to glass slide screening. Materials and Methods: A total of 142 glass slides (61 teaching and 81 practice) of breast, thyroid, and lymph node fine needle aspiration body sites were scanned with a single focal plane (at 40X) using iScanCoreo Au (Ventana, Tuscan, AZ, USA, formerly known as BioImagene, California, USA). Six students including one distant student used these digital images to learn cellular morphology and conduct daily screening. Subsequently, all the students were tested on 10 glass slides using light microscopy (LM). At the end of the study, the students were asked to respond to an online survey on their virtual microscopy experience. The glass slide screening test scores of the participating students who were taught through VM and tested on glass slides (VMLM group) were compared with the last three classes of students who were taught through LM and tested on glass slides (LMLM group). Results: A non-parametric statistical analysis indicated no difference (P = 0.20) in the glass screening test scores between VMLM (median = 93.5) and LMLM groups (median = 87). The survey indicated that the annotated teaching slides and access to the VM, off campus, were well appreciated by the students. Conclusions: Although the students preferred LM, they were able to apply the cytological criteria learned through VM to glass slide screening. Overall, VM was considered a great teaching tool.
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Affiliation(s)
- Amber D Donnelly
- Division of Cytotechnology Education, School of Allied Health Professions, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Khurana KK, Rong R, Wang D, Roy A. Dynamic telecytopathology for on-site preliminary diagnosis of endoscopic ultrasound-guided fine needle aspiration of pancreatic masses. J Telemed Telecare 2012; 18:253-9. [PMID: 22302762 DOI: 10.1258/jtt.2011.110706] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We evaluated dynamic telecytopathology for on-site-evaluation of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of the pancreas. Realtime images of stained cytology smears were assessed by a cytopathologist while communicating with the on-site operator by telephone. A total of 55 consecutive cases was assessed; preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 69%, 7% and 24%. We also reviewed 55 consecutive cases of EUS-guided FNA of pancreas which had had conventional microscopic on-site evaluation prior to the introduction of telecytopathology. Preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 60%, 9% and 31%. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Neuroendocrine neoplasms and well-differentiated adenocarcinoma were diagnostically challenging for both telecytopathology and conventional microscopy. Telecytopathology was similar in accuracy of preliminary diagnosis to conventional microscopy during EUS-FNA of pancreas.
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Affiliation(s)
- Kamal K Khurana
- Department of Pathology, State University of New York, 750 East Adams Street, Syracuse, New York 13210, USA.
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Thrall M, Pantanowitz L, Khalbuss W. Telecytology: Clinical applications, current challenges, and future benefits. J Pathol Inform 2011; 2:51. [PMID: 22276242 PMCID: PMC3263027 DOI: 10.4103/2153-3539.91129] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 11/17/2011] [Indexed: 11/04/2022] Open
Abstract
Telecytology is the interpretation of cytology material at a distance using digital images. For more than a decade, pioneering efforts to introduce telecytology into clinical practice have been reported. A Medline search for "telecytology" and "cytology" reveals a voluminous literature, though much of what has been published to date is based on technologies that are rapidly becoming obsolete. The technological limitations of previous techniques, including the transmission of static digital images and dynamic streaming images, have limited telecytology to minor niches. The primary problem with these technologies is that the remote viewer can only see a small fraction of the material on the original slides, introducing the possibility of diagnostic error based not only on image quality but also on image selection. Remote robotic microscopy offers one possible solution to this problem, but to date has found limited acceptance, principally attributable to slow operating times. Whole slide imaging seems to be a much more promising solution, though cytology-specific literature regarding its use is still scant. The advent of whole slide imaging opens up new possibilities for telecytology by enabling high-quality images of entire cytology specimens to be available to anyone, anywhere via the Internet. Although challenges remain, especially with regard to capturing the full microscopy experience including multiple planes of focus and sharp high-powered images, rapidly advancing technology promises to overcome these limitations. Increasing application of whole slide imaging technology in surgical pathology will undoubtedly also increase its application to cytology due to the increasing affordability and practicality of the equipment as it serves a larger number of useful roles within a pathology department. The current and expanding applications of telecytology for clinical practice, education, quality assurance, and testing will be reviewed.
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Affiliation(s)
- Michael Thrall
- Department of Pathology and Genomic Medicine, The Methodist Hospital, 6565 Fannin M227, Houston, TX 77030, USA
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
| | - Walid Khalbuss
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
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Khurana KK, Swati I, Kasturi R, Lambert R, Izquierdo R. Telecytopathology for Rapid Preliminary Diagnosis of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules. Telemed J E Health 2011; 17:763-7. [DOI: 10.1089/tmj.2011.0052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kamal K. Khurana
- Department of Pathology, State University of New York, Syracuse, New York
| | - Ismatun Swati
- Department of Pathology, State University of New York, Syracuse, New York
| | - Rohini Kasturi
- Endocrinology Division, Department of Internal Medicine, State University of New York, Syracuse, New York
| | - Robert Lambert
- Department of Surgery, State University of New York, Syracuse, New York
| | - Roberto Izquierdo
- Endocrinology Division, Department of Internal Medicine, State University of New York, Syracuse, New York
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35
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Dynamic telecytologic evaluation of imprint cytology samples from CT-guided lung biopsies: A feasibility study. Eur Radiol 2011; 21:1922-7. [DOI: 10.1007/s00330-011-2137-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 03/09/2011] [Accepted: 04/08/2011] [Indexed: 12/11/2022]
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Dhillon I, Pitman MB, Demay RM, Archuletta P, Shidham VB. Compensation crisis related to the onsite adequacy evaluation during FNA procedures-Urgent proactive input from cytopathology community is critical to establish appropriate reimbursement for CPT code 88172 (or its new counterpart if introduced in the future). Cytojournal 2010; 7:23. [PMID: 21082041 PMCID: PMC2980694 DOI: 10.4103/1742-6413.71741] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 10/01/2010] [Indexed: 11/04/2022] Open
Abstract
The confusion centered around appropriate use of the CPT billing code 88172 is addressed in the commentary from the Economic and Government Affairs Committee of the American Society of Cytopathology (ASC) who have written a timely commentary in this issue of Cytojournal, "Adequate Reimbursement is Crucial to Support Cost-Effective Rapid Onsite Cytopathology Evaluations". Currently, lack of standardized use within and between pathology departments is stirring unhealthy practices of denying reimbursements for this critical and legitimate cytopathology service. This editorial discusses the important concerns raised in this commentary and recommends immediate corrective action. (See also Al-Abbadi MA, et al. Adequate reimbursement is crucial to support cost-effective rapid on-site cytopathology evaluations. CytoJournal 2010;7:22).
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Affiliation(s)
- Inderpreet Dhillon
- Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, Detroit, MI
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Al-Abbadi MA, Bloom LI, Fatheree LA, Haack LA, Minkowitz G, Wilbur DC, Austin MR. Adequate reimbursement is crucial to support cost-effective rapid on-site cytopathology evaluations. Cytojournal 2010; 7:22. [PMID: 21085619 PMCID: PMC2980693 DOI: 10.4103/1742-6413.71740] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/12/2010] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mousa A Al-Abbadi
- James H. Quillen VA Medical Center, Department of Pathology, East Teneesee State University, Johnson City, USA
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Alsharif M, Carlo-Demovich J, Massey C, Madory JE, Lewin D, Medina AM, Recavarren R, Houser PM, Yang J. Telecytopathology for immediate evaluation of fine-needle aspiration specimens. Cancer Cytopathol 2010; 118:119-26. [DOI: 10.1002/cncy.20074] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nguyen YP, Maple JT, Zhang Q, Ylagan LR, Zhai J, Kohlmeier C, Jonnalagadda S, Early DS, Edmundowicz SA, Azar RR. Reliability of gross visual assessment of specimen adequacy during EUS-guided FNA of pancreatic masses. Gastrointest Endosc 2009; 69:1264-70. [PMID: 19243768 DOI: 10.1016/j.gie.2008.08.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2008] [Accepted: 08/21/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND In many centers, on-site cytopathologists are not available during EUS-guided FNA (EUS-FNA) examinations. Often, endosonographers request that technologists assess the adequacy of FNA by gross inspection of the slides. To date, there has not been a study that assessed the accuracy of experienced technologists in predicting tissue sampling adequacy by gross inspection before cytologic staining. OBJECTIVES To assess a grading system used by cytotechnologists and EUS technologists during gross inspection of FNA slides in reliably predicting specimen adequacy compared with the final cytologic diagnoses. DESIGN Prospective, double-blind, controlled study. SETTING Academic tertiary-referral center with a high-volume EUS practice. PATIENTS Fifty-one patients with a suspected solid pancreatic mass who were undergoing planned EUS-FNA. MAIN OUTCOME MEASUREMENTS The degree of correlation in the assessment of specimen adequacy as exhibited by a weighted kappa statistic between 2 groups of technologists and a board-certified cytopathologist. RESULTS FNA was performed in 37 cases with 234 individual slide specimens available for analysis. Only fair agreement was observed between cytotechnologists and EUS technologists versus final cytopathologic assessment of adequacy (kappa 0.20 and 0.19, respectively). The routine practice of 6 to 7 FNA passes yielded adequate tissue for assessment in 36 of 37 patients (97%). LIMITATIONS Interobserver variability, single center, and findings applicable only to solid pancreatic lesions. CONCLUSIONS Neither trained EUS technologists nor cytotechnologists were able to provide a reliable assessment of pancreatic-mass FNA adequacy by using gross visual inspection of the specimen on a slide. Rapid on-site cytopathology reduced the number of passes, ensured specimen adequacy, provided definitive diagnosis, and should be used in centers where available.
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Affiliation(s)
- Yume P Nguyen
- Gastroenterology Division, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Pantanowitz L, Hornish M, Goulart RA. The impact of digital imaging in the field of cytopathology. Cytojournal 2009; 6:6. [PMID: 19495408 PMCID: PMC2678829 DOI: 10.4103/1742-6413.48606] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Accepted: 12/29/2008] [Indexed: 11/04/2022] Open
Abstract
With the introduction of digital imaging, pathology is undergoing a digital transformation. In the field of cytology, digital images are being used for telecytology, automated screening of Pap test slides, training and education (e.g. online digital atlases), and proficiency testing. To date, there has been no systematic review on the impact of digital imaging on the practice of cytopathology. This article critically addresses the emerging role of computer-assisted screening and the application of digital imaging to the field of cytology, including telecytology, virtual microscopy, and the impact of online cytology resources. The role of novel diagnostic techniques like image cytometry is also reviewed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Maryanne Hornish
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Robert A. Goulart
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Pinco J, Goulart RA, Otis CN, Garb J, Pantanowitz L. Impact of digital image manipulation in cytology. Arch Pathol Lab Med 2009; 133:57-61. [PMID: 19123737 DOI: 10.5858/133.1.57] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Digital images have become an important component of cytology practice. They are used in telecytology, automated screening, educational material, and Web sites and have potential for use in proficiency testing. However, there has been no formal evaluation to date to determine if digital image manipulation (intentional or unintentional) can affect their interpretation. OBJECTIVE To investigate whether alteration of digital cytology images affects diagnosis. DESIGN Acquired digital images of ThinPrep Papanicolaou test slides were manipulated (rotated 90 degrees and brightness, contrast, red-green-blue color, and luminosity adjusted) using Photoshop. A test composed of these altered images, along with their original (unaltered) image and exact duplicates was given to 22 cytologists (13 cytotechnologists, 8 cytopathologists, and 1 fellow). All images were rated as negative, atypical (atypical squamous cells of undetermined significance), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or positive for cancer. Weighted kappa and heterogeneity chi(2) statistics were used to measure levels of agreement and assess concordance between groups. RESULTS The level of agreement for identical duplicate images was excellent (kappa = 0.81), compared with the poor agreement for manipulated image pairs (kappa = 0.21), a statistically significant difference (P < .001). For all altered image types agreement was poor. There was no significant difference between cytotechnologists and cytopathologists in level of agreement (P = .56). CONCLUSIONS Manipulation of a Papanicolaou test digital image, irrespective of the specific category of cytologic material photographed, significantly affects its interpretation by both cytotechnologists and cytopathologists. This suggests that care needs to be taken when digital cytology images are used, to specifically ensure that their alteration does not affect diagnosis.
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Affiliation(s)
- Jeffery Pinco
- Departments of Pathology, Tufts University School of Medicine, Springfield, MA 01199, USA
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Shidham VB, Pitman MB, Demay RM, Atkinson BF. CytoJournal's move to the new platform: More on financial model to the support open-access charter in cytopathology, publication quality indicators, and other issues. Cytojournal 2008; 5:15. [PMID: 19495401 PMCID: PMC2669682 DOI: 10.4103/1742-6413.44572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 12/02/2008] [Indexed: 02/07/2023] Open
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Abstract
This year CytoJournal celebrates the second full year of publication with its Best of CytoJournal: 2006. Like last year, it recognizes the work of the authors in thyroid FNAB. And, importantly, this years award, which was handed out at USCAP, was endowed by a gift from the Pathikonda family.
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Affiliation(s)
- Michael B Cohen
- Department of Pathology, 200 Hawkins Drive, C670 GH, The University of Iowa, Iowa City, IA, USA.
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Abstract
Significant efforts, time, and resources are devoted for peer-reviewing numerous CytoJournal manuscripts. The Editorial Board of CytoJournal shares a significant proportion of this activity. Additional peers are requested to join periodically as 'academic editors' and reviewers to review CytoJournal manuscripts. We thank all the reviewers and academic editors for their time and efforts for completing the peer-review of CytoJournal manuscripts during 2006. The continued success of this important academic exercise depends on their continued enthusiasm to support with their highest standards. We also thank all the contributing authors for selecting CytoJournal and supporting open access initiative, which allows retention of the copyrights to their corresponding academic accomplishments.
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Affiliation(s)
- Vinod B Shidham
- Executive editor and coeditor-in-chief, CytoJournal, Dept of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Barbara F Atkinson
- Coeditor-in-chief, CytoJournal, University of Kansas School of Medicine, Kansas City, KS, USA
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