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Post R, Doxzon K, Goldberg A. Telecytology rapid onsite evaluation, with real-time communication between cytopathologist, cytotechnologist, and proceduralist, offers better adequacy rates for lymph node, but not thyroid, fine-needle aspirations. J Am Soc Cytopathol 2023; 12:407-414. [PMID: 37620222 DOI: 10.1016/j.jasc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Rapid onsite evaluation (ROSE) decreases rates of inadequate fine-needle aspirations (FNAs). Telecytology allows pathologists to perform ROSE without being physically "on site", thereby saving cytopathologists' travel time and allowing them to perform ROSE for multiple institutions. Little research exists comparing telecytology to non-telecytology ROSE for FNA inadequacy rates. MATERIALS AND METHODS Using previously obtained quality metrics, we compared inadequacy rates for lymph node and thyroid FNAs with and without ROSE and with non-telecytology ROSE compared with telecytology ROSE. Use of ROSE was determined by the proceduralist. Type of ROSE was location-based, as only certain locations at our institution have telecytology capabilities. Chi-squared testing was used to compare proportions of populations and P value was set to 0.05. RESULTS A total of 1168 lymph node and 1177 thyroid FNAs were included in our adequacy analysis. We found any ROSE decreased our inadequacy rate for both lymph node (20.4% to 12.7%, P = 0.002) and thyroid (34.7% to 4.8%, P = 7.4 × 10-18) FNAs. We found telecytology further decreased our inadequacy rate for lymph node (13.8% to 5.9%, P = 0.016), but not thyroid (3.3% to 5.0%, P = 0.34), FNAs. CONCLUSIONS At our institution, when using telecytology, slides are read in real time with the cytotechnologist and the proceduralist looking at slides together near the patient bedside, while the cytopathologist is on the phone looking at slides on the computer screen via Dameware. When non-telecytology ROSE is performed, the cytotechnologist evaluates a slide, brings it to the cytopathologist's office and then the cytopathologist calls the proceduralist to discuss the slide. We believe telecytology offers an opportunity for more inclusive communication thereby improving adequacy rates for more complex cases, like lymph nodes, without affecting adequacy rates for cases where assessment of adequacy is less complex, like thyroid. This research supports use of telecytology especially for complex cases.
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Affiliation(s)
- Robert Post
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Kelly Doxzon
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Allison Goldberg
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Kouanda A, Mclean R, Faggen A, Demissie E, Balassanian R, Kamal F, Avila P, Arain M, Dai SC, Munroe C. Telecytology versus in-room cytopathologist for EUS-guided FNA or fine-needle biopsy sampling of solid pancreatic lesions. Gastrointest Endosc 2023; 97:466-471. [PMID: 36252871 DOI: 10.1016/j.gie.2022.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Rapid on-site-evaluation (ROSE) with an in-room cytopathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing EUS-guided FNA or fine-needle biopsy sampling (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and use of ROSE using telecytology (ROSE-T) to optimize clinical workflows and to address social distancing mandates created during the coronavirus disease 2019 pandemic. The purpose of this study was to compare diagnostic outcomes of ROSE-P and ROSE-T. METHODS A single-center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNAB were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis. RESULTS There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, P = .428). ROSE-T was associated with an increased use of 22-gauge needles (P = .006) and more needle passes (P < .001). No significant differences were found in age, gender, lesion size, needle type, procedure times, or adverse events between the 2 groups (P < .05 for all). More pancreatic tail lesions were sampled in the ROSE-P group (P < .001). CONCLUSIONS ROSE-T was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.
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Affiliation(s)
- Abdul Kouanda
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Richard Mclean
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Alec Faggen
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Emanuel Demissie
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ronald Balassanian
- Department of Pathology, Division of Cytopathology and Surgical Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Faisal Kamal
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Patrick Avila
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Mustafa Arain
- Center for Interventional Endoscopy, Advent Health System, Orlando, Florida, USA
| | - Sun-Chuan Dai
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
| | - Craig Munroe
- Department of Medicine, Division of Gastroenterology, University of California, San Francisco, San Francisco, California, USA
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Al Zoughbi W, Kim D, Alperstein SA, Ohara K, Manohar J, Greco N, Khani F, Robinson BD, Rao RA, Elemento O, Mosquera JM, Siddiqui MT. Incorporating cytologic adequacy assessment into precision oncology workflow using telepathology: An institutional experience. Cancer Cytopathol 2021; 129:874-883. [PMID: 33929788 DOI: 10.1002/cncy.22441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tumor sample quality and quantity determine the success of somatic mutation analysis. Thus, a rapid on-site evaluation (ROSE) tumor cytology adequacy assessment was incorporated into the workflow of precision oncology at Weill Cornell Medicine in New York City. Optimal samples were obtained from 68 patients with metastatic cancer. METHODS Cytopathologists performed ROSE on fine-needle aspirate samples via telepathology, and subsequently core-needle biopsies were obtained. In a retrospective manner, the concordance between adequacy assessment and the success rate of the procedure was evaluated to obtain sufficient tumor tissue for next-generation sequencing (NGS). RESULTS Out of the 68 procedures, 43 were documented as adequate and 25 were documented as inadequate. The diagnostic yield of adequate procedures was 100%. Adequacy evaluation predicted the success rate of molecular profiling in 40 of 43 procedures (93%; 95% CI, 80.9-98.5 procedures). The success rate of molecular testing was significantly higher in the adequate group: 93% compared with 32% in the inadequate group (P < .0005). Seven procedures that failed to provide quality material for mutational analysis and pathological diagnosis were evaluated as inadequate. Cell block provided sufficient DNA for NGS in 6 cases. In 2 cases, a core biopsy could not be performed; hence, the fine-needle aspirate material confirmed the diagnosis and was used for NGS testing. CONCLUSION These results support the incorporation of ROSE into the workflow of precision oncology to obtain high-quality tissue samples from metastatic lesions. In addition, NGS testing of concurrent cytology specimens with adequate cellularity can be a surrogate for NGS testing of biopsy specimens.
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Affiliation(s)
- Wael Al Zoughbi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - David Kim
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Susan Ann Alperstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- Papanicolaou Cytology Laboratory, Weill Cornell Medicine, New York, New York
| | - Kentaro Ohara
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Jyothi Manohar
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Noah Greco
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Olivier Elemento
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- The Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York-Presbyterian Hospital, New York, New York
- Papanicolaou Cytology Laboratory, Weill Cornell Medicine, New York, New York
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Lin DM, Tracht J, Rosenblum F, Kouba E, Bahl D, Patel A, Eltoum IE. Rapid On-Site Evaluation With Telecytology Significantly Reduced Unsatisfactory Rates of Thyroid Fine-Needle Aspiration. Am J Clin Pathol 2020; 153:342-345. [PMID: 31628844 DOI: 10.1093/ajcp/aqz164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We evaluated telecytology rapid on-site evaluation (ROSE) for thyroid ultrasound-guided fine-needle aspiration. To the best of our knowledge, this study is the first case-control clinical trial of thyroid telecytology. METHODS We introduced on-site ROSE in our institution's thyroid clinic for 6 months, followed by telecytology for 12 months. Our institution's ultrasound clinic, where ROSE is not provided, was used as a control group for each period. RESULTS Both groups had similar initial unsatisfactory rates (thyroid clinic: 8.8%; ultrasound clinic: 8.0%) before the study began. The thyroid clinic's unsatisfactory rate was significantly reduced to 1.6% after on-site ROSE (P = .001) and to 3.8% after telecytology ROSE (P = .010), with no significant difference between on-site and telecytology ROSE periods (P > .05). The ultrasound clinic's unsatisfactory rate was unchanged for both periods. Concordance between telecytology ROSE and final adequacy was 97% (κ = 0.699). CONCLUSIONS Telecytology ROSE reduces unsatisfactory rates for ultrasound-guided fine-needle aspiration without compromising patient care.
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Affiliation(s)
- Diana M Lin
- Department of Pathology, University of Alabama at Birmingham
| | - Jessica Tracht
- Department of Pathology, University of Alabama at Birmingham
| | - Frida Rosenblum
- Department of Pathology, University of Alabama at Birmingham
| | - Erik Kouba
- Department of Pathology, University of Alabama at Birmingham
| | - Deepti Bahl
- Department of Endocrinology, University of Alabama at Birmingham
| | - Anish Patel
- Department of Endocrinology, University of Alabama at Birmingham
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Monaco SE, Han M, Dietz R, Xing J, Cuda J, Pantanowitz L. Assessing competency for remote telecytology rapid on‐site evaluation using pre‐recorded dynamic video streaming. Cytopathology 2020; 31:411-418. [DOI: 10.1111/cyt.12794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Sara E. Monaco
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Min Han
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Robin Dietz
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Juan Xing
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Jacqueline Cuda
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
| | - Liron Pantanowitz
- Department of PathologyUniversity of Pittsburgh Medical Center (UPMC) Pittsburgh PA USA
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Gutmann EJ. Something’s lost, but something’s gained: On‐site evaluation, telecytology, and the cytopathologist. Cancer Cytopathol 2019; 127:222-224. [DOI: 10.1002/cncy.22111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/02/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Edward J. Gutmann
- Department of Pathology and Laboratory Medicine Dartmouth‐Hitchcock Medical Center Lebanon New Hampshire
- Department of Pathology and Laboratory Medicine Dartmouth (Geisel) School of Medicine Hanover New Hampshire
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Monaco SE, Koah AE, Xing J, Ahmed I, Cuda J, Cunningham J, Metahri D, Progar A, Pantanowitz L. Telecytology implementation: Deployment of telecytology for rapid on-site evaluations at an Academic Medical Center. Diagn Cytopathol 2018; 47:206-213. [PMID: 30588767 DOI: 10.1002/dc.24077] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There are limited publications that address technical and practical informatics considerations when implementing telecytology for rapid on-site evaluation (ROSE). Our aim was to share the experience of deploying telecytology for ROSE at our institution. MATERIALS AND METHODS Key informatics issues relevant to adopting telecytology for ROSE at our institution were appraised including workflow, information technology (IT), validation, training, and quality assurance (QA). RESULTS A dynamic telemicroscopy solution was selected that required trained cytotechnologists to attend on-site procedures for ROSE. For validation 60 cases were reviewed using the first camera at each facility, but only 20 cases to validate subsequent cameras. A concordance rate of >90% between ROSE interpretation performed digitally to original interpretations was required for clinical validation. After reviewing 440 cases from two comparable time periods before and after implementation, employing telecytology was shown to decrease cytopathologists' work time per ROSE case from an average of 20.95 min per case to 2.91 min per case (86% time savings). The non-diagnostic rate for traditional ROSE was 7.7% compared with 4.1% after the implementation of telecytology, and the deferral rate went from 43.6% for traditional ROSE to 44.1% with telecytology. Traditional ROSE diagnoses correlated with final diagnoses in 91.8% cases, compared to 95.5% with telecytology. CONCLUSIONS Challenges when implementing telecytology for ROSE included technical issues, workflow concerns, and incorporating trainees into daily practice. The end result of our implementation was the adoption of an innovative way to deliver a ROSE service that maximised efficiency for cytopathologists without compromising diagnostic performance.
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Affiliation(s)
- Sara E Monaco
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber E Koah
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan Xing
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ishtiaque Ahmed
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jayna Cunningham
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Djamila Metahri
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Abbigal Progar
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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