Two-Year Experience of the Implementation of the Milan for Reporting Salivary Gland Cytopathology at a Private Medical Laboratory

This study aimed to present the 2-year experience of the implementation of the Milan System for Reporting Salivary Gland Cytopathology at Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. A totaI of 102 Fine Needle Aspirations (FNAs) performed since 2018 were included in the study. Reports were issued according to the Milan System for Reporting Salivary Gland Cytopathology. Aspirates were prepared with both conventional and liquid-based cytological methods and were evaluated by two or three Board-certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. All cases included in this study had histologic follow-up. The diagnostic accuracy of FNA for differentiating between benign and malignant disease according to MSRSGC classification was 93.3%, the specificity was 97.5% and the sensitivity was 82.2%. The positive and negative predictive values were 93.2 and 87.2%, respectively. Our results show that FNA is a valuable examination technique in the preoperative evaluation of salivary gland lesions. The integration of the 2018 Milan System for Reporting Salivary Gland Cytopathology is effective, with an overall accuracy around 95%.

Implementation of pre-captured videos for remote diagnosis of cervical cytology specimens

OBJECTIVE

The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology.

METHODS

The study was performed on representative short videos captured from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; adenocarcinoma, 2) that were sent via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on the overall digital video quality. Contributors' and reviewers' diagnoses were collected, recorded, and statistically evaluated.

RESULTS

Statistical evaluation detected no significant difference in diagnostic accuracy between cytological diagnoses based on short videos versus conventional slides. The overall interobserver agreement ranged from substantial to almost perfect with κ values of 0.74-0.91.

CONCLUSIONS

Short videos produced by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into the daily workflow. Short pre-captured videos of cervical smears can be used for rapid and accurate diagnosis, diminishing turnaround times and improving small cytology departments' quality indices. They can also be used for archiving, teleconsultation, and second opinion purposes, improving the performance of already existing static telecytology stations.

The Implementation of Static Telecytology for Teleconsultation Purposes During Preoperative Evaluation of Thyroid Fine-Needle Aspiration Specimens

Objective: The objective of this study was to investigate the impact of applying static telecytology for teleconsultation purposes during preoperative evaluation of challenging thyroid fine-needle aspiration specimens. Materials and Methods: The study was performed on 141 cytologically challenging specimens of 125 patients referred to Alpha Prolipsis Cytopathology Department. All cases were finally confirmed histologically. During the study, 10 characteristic images from each case were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists, with documented experience in the field of thyroid cytology. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered based on digitized images and conventional slides. Telecytology is a prompt and valid method for acquisition of a second opinion diagnosis in challenging cases and can be integrated into daily workflow. The use of telecytology for teleconsultation purposes in the laboratory's daily workflow will further ensure the accuracy of preoperative cytological diagnoses and will contribute to cytopathologists continuous education and better understanding of the criteria applied in thyroid gland lesions cytomorphological diagnosis. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered based on digitized images among contributing cytopathologists. The overall interobserver agreement was very good with κ values of 0.73-0.88. Conclusions: The widespread availability of imaging technology and telecommunication enables instant access to global expert cytopathologists. Static telecytology can be used as an efficient method for acquisition of second opinion in challenging thyroid fine-needle aspiration specimens. It can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.

The Use of Static Telecytology for Quality Assessment Purposes in the Evaluation of Cervical Smears Prepared by Means of Liquid-Based Cytology

Objective: The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology. Materials and Methods: The study was performed on representative digital cytological images from a total of 808 cervical smears (benign, 270; atypical squamous cells of undetermined significance, 184; low-grade squamous intraepithelial lesion, 124; high-grade squamous intraepithelial lesion, 174; squamous cell carcinoma, 52; and adenocarcinoma, 4) that were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. Their reports were recorded and classified. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of digitized images and conventional slides. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97. Conclusions: Static telecytology can be used as an alternative method for the cytological diagnosis of cervical smears, particularly in quality assurance programs. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.

Mermaid and Potter's syndrome occurring simultaneously

We herein report a case of a female embryo who died in utero and at autopsy she was found to have bilateral renal agenesis with the extrarenal manifestations of Potter's syndrome together with mermaid syndrome which is a rare combination. From all the anomalies of the upper urinary tract bilateral renal agenesis seems to have a cardinal role in the survival of the embryo afflicted with the spectrum of associated anomalies.

Lichen sclerosus et atrophicus. Findings after complete circumcision

We prospectively evaluated 75 patients, 30-77 years old, with severe phimosis. All patients were treated surgically by complete circumcision and all surgical specimens were sent for histological evaluation. All patients with histologically proven lichen sclerosus et atrophicus (LSA) (eight patients, 10.6%) were re-evaluated 6 months postoperatively, and all but one were examined 5 years after the operation. All patients with histologically proven balanoposthitis (BP) (47 patients, 62.6%) were also re-evaluated 6 months postoperatively, and 41 patients 5 years after surgery. This group (BP) was the control group of our study. Six months after the operation, the eight patients with histologically proven LSA all had an excellent convalescence, and the lesions observed during the operation resolved in four patients and regressed in two patients. In one patient the glans presented with a pale grey-white-coloured plaque. Biopsy was performed and a well-differentiated squamous cell carcinoma infiltrating the glans was revealed. The control group of patients with histologically proven BP were also re-evaluated 6 months and 5 years after surgery. An excellent convalescence was observed in all patients who completed the follow-up examination. Care must be taken not to underestimate the potential relationship between LSA and squamous cell carcinoma, because the latter is usually invasive, very aggressive and requires immediate treatment.