Point-of-care oral cytology tool for the screening and assessment of potentially malignant oral lesions

BACKGROUND

The effective detection and monitoring of potentially malignant oral lesions (PMOL) are critical to identifying early-stage cancer and improving outcomes. In the current study, the authors described cytopathology tools, including machine learning algorithms, clinical algorithms, and test reports developed to assist pathologists and clinicians with PMOL evaluation.

METHODS

Data were acquired from a multisite clinical validation study of 999 subjects with PMOLs and oral squamous cell carcinoma (OSCC) using a cytology-on-a-chip approach. A machine learning model was trained to recognize and quantify the distributions of 4 cell phenotypes. A least absolute shrinkage and selection operator (lasso) logistic regression model was trained to distinguish PMOLs and cancer across a spectrum of histopathologic diagnoses ranging from benign, to increasing grades of oral epithelial dysplasia (OED), to OSCC using demographics, lesion characteristics, and cell phenotypes. Cytopathology software was developed to assist pathologists in reviewing brush cytology test results, including high-content cell analyses, data visualization tools, and results reporting.

RESULTS

Cell phenotypes were determined accurately through an automated cytological assay and machine learning approach (99.3% accuracy). Significant differences in cell phenotype distributions across diagnostic categories were found in 3 phenotypes (type 1 ["mature squamous"], type 2 ["small round"], and type 3 ["leukocytes"]). The clinical algorithms resulted in acceptable performance characteristics (area under the curve of 0.81 for benign vs mild dysplasia and 0.95 for benign vs malignancy).

CONCLUSIONS

These new cytopathology tools represent a practical solution for rapid PMOL assessment, with the potential to facilitate screening and longitudinal monitoring in primary, secondary, and tertiary clinical care settings.

A Clinical Trial to Verify the Efficiency of the LC-1000 Exfoliative Cell Analyzer as a New Method of Cervical Cancer Screening

OBJECTIVE

The exfoliative cell analyzer, LC-1000 (Sysmex Corporation, Japan), is a medical device that presents the cell proliferation index and 23 research parameters as indicators of cellular proliferative potential. The objective was to evaluate the clinical usability of qualitative assessment by LC-1000 compared with cytology, the human papillomavirus (HPV) test, and histology as gold standard.

STUDY DESIGN

Women that visited 3 sites between July 2015 and March 2017 were registered. The primary endpoint in this study was the comparison between LC-1000 measurement and HPV test for sensitivity and specificity for cervical intraepithelial neoplasia 2+ (CIN2+). A tree model algorithm was newly constructed by a statistical method and its relationship with histological results was evaluated.

RESULTS

The sensitivity and specificity of LC-1000 were 78.3 and 74.1%, while those of the HPV test were 94.7 and 85.4%, respectively. A tree model comprising five categories was constructed. The proportion of advanced lesions was higher with the change in the rank classification results from 1 to 5. The positive predictive values of CIN2+ in the categories 4 and 5 were high. Despite the small number of subjects, cancer was undetected in categories 1 and 2. In addition, the comparison with follow-up results in 19 women assessed as CIN1 showed that the rate of progression in the categories 3-5 was 50% (7/14); progression in the categories 1 and 2 was 0% (0/5).

CONCLUSIONS

LC-1000 may be useful for cervical cancer screening as an index to qualitatively evaluate CIN and cancer based on the changes in characteristics of cells.

Comparison of nylon-flocked swab and Dacron swab cytology for anal HSIL detection in transgender women and gay, bisexual, and other men who have sex with men

BACKGROUND

An anal histological high-grade squamous intraepithelial lesion (hHSIL) is an anal cancer precursor. Experts recommend Dacron swab anal cytology as a primary screen for anal hHSILs, especially among human immunodeficiency virus-infected and -uninfected men who have sex with men (MSM). Studies have shown that Dacron cytology inaccurately predicts anal hHSILs and results in unnecessary diagnostic procedures. Nylon-flocked (NF) swabs have been shown to trap pathogens and cells well. Thus, this study compared test characteristics of anal cytology using NF and Dacron swab collection protocols to predict anal hHSILs.

METHODS

A single-visit, randomized clinical trial compared NF and Dacron swab anal cytology specimens to predict high-resolution anoscopy and biopsy-diagnosed anal hHSILs. Data for 326 gay men, bisexual men, other MSM, and male-to-female transgender women contributed descriptive and tabular statistics with which unadjusted and fully adjusted logistic regression models were constructed. The models estimated the odds of hHSILs, test accuracy (area under the curve [AUC]) and sensitivity, and specificity as well as the positive and negative predictive values of abnormal NF and Dacron cytology for predicting hHSILs.

RESULTS

In the fully adjusted model, the sensitivities for NF and Dacron cytology were nearly equal (48% vs 47%), but the specificity was higher with NF cytology (76% vs 69%). Comparisons of the areas under receiver operating characteristic curves showed that NF cytology alone predicted hHSILs better than the covariate model (AUC, 0.69 vs 0.63; P = .02), but NF and Dacron cytology comparisons showed no statistically significant differences (AUC, 0.69 vs 0.67; P = .3).

CONCLUSIONS

NF cytology and Dacron cytology provide modest sensitivity, but NF cytology has higher specificity and accuracy, and this is important for lowering the costs of population-based screening.

Development of a cytology-based multivariate analytical risk index for oral cancer

OBJECTIVES

The diagnosis and management of oral cavity cancers are often complicated by the uncertainty of which patients will undergo malignant transformation, obligating close surveillance over time. However, serial biopsies are undesirable, highly invasive, and subject to inherent issues with poor inter-pathologist agreement and unpredictability as a surrogate for malignant transformation and clinical outcomes. The goal of this study was to develop and evaluate a Multivariate Analytical Risk Index for Oral Cancer (MARIO) with potential to provide non-invasive, sensitive, and quantitative risk assessments for monitoring lesion progression.

MATERIALS AND METHODS

A series of predictive models were developed and validated using previously recorded single-cell data from oral cytology samples resulting in a "continuous risk score". Model development consisted of: (1) training base classification models for each diagnostic class pair, (2) pairwise coupling to obtain diagnostic class probabilities, and (3) a weighted aggregation resulting in a continuous MARIO.

RESULTS AND CONCLUSIONS

Diagnostic accuracy based on optimized cut-points for the test dataset ranged from 76.0% for Benign, to 82.4% for Dysplastic, 89.6% for Malignant, and 97.6% for Normal controls for an overall MARIO accuracy of 72.8%. Furthermore, a strong positive relationship with diagnostic severity was demonstrated (Pearson's coefficient = 0.805 for test dataset) as well as the ability of the MARIO to respond to subtle changes in cell composition. The development of a continuous MARIO for PMOL is presented, resulting in a sensitive, accurate, and non-invasive method with potential for enabling monitoring disease progression, recurrence, and the need for therapeutic intervention of these lesions.

Transvaginal laparoscopy: A minimally invasive approach to obtain brush cytology of the Fallopian tube

OBJECTIVE

To evaluate in a prospective pilot study the feasibility of cytobrushing of the fimbrial end using a transvaginal endoscopic access.

STUDY DESIGN

Prospective feasibility study. The procedure was performed in a consecutive series of 15 infertile women referred for a transvaginal laparoscopy as part of their fertility investigation. Tubal cells were collected using a 5Fr cytobrush. Cytology and immunocytochemistry was done.

RESULTS

In all patients enough cell material was obtained for analysis, without traumatizing the fimbrial end. Specimens showed the presence of a sufficient amount of cells enabling standard cytologic examinations and immunocytochemistry (Ki 67, p53).

CONCLUSION

Fimbrial cytobrushing using the transvaginal approach is an easy and minimally invasive procedure. The easy accessibility of the fimbrial end and the distal ampullary part at TVL allows an accurate collection of tubal epithelial cells. In view of the recent data reporting the Fallopian tube and more specifically the fimbrial end as a possible origin of ovarian carcinoma, further research is needed to evaluate the potential of this technique as a possible screening method for patients at risk for ovarian cancer.

Liquid-Based Endometrial Cytology Using SurePath™ Is Not Inferior to Suction Endometrial Tissue Biopsy in Clinical Performance for Detecting Endometrial Cancer Including Atypical Endometrial Hyperplasia

OBJECTIVE

We evaluated the clinical performance of liquid-based endometrial cytology (SurePath™) for detecting endometrial malignancies by comparison with the performance of suction endometrial tissue biopsy.

STUDY DESIGN

From November 2011 to May 2013, we consecutively collected 1,118 liquid-based endometrial cytology specimens and 674 suction endometrial tissue biopsy specimens.

RESULTS

The rate of nonpositive final histology in nonpositive liquid-based endometrial cytology (98.2%) was higher than the rate of nonpositive final histology in nonpositive suction endometrial tissue biopsy (97.0%). None of the clinical performance values of liquid-based endometrial cytology for detecting the endometrial malignancies were statistically inferior to those of the suction endometrial tissue biopsy. When the positivity threshold was more than "atypical endometrial cells of undetermined significance," the rate of positive liquid-based endometrial cytology from cases with a positive final histology (84.5%) was higher than the rate of positive suction endometrial tissue biopsy from cases with a positive final histology (69.8%). However, there were still no significant differences among all the performance values.

CONCLUSIONS

Our liquid-based endometrial cytology would be more appropriate in various clinical situations as the initial detection tool for endometrial malignancies, rather than suction endometrial tissue biopsy. In addition, it could be used in screening for endometrial malignancies on a broader scale.

Range of pathologies diagnosed using a minimally invasive capsule sponge to evaluate patients with reflux symptoms

AIMS

Reflux symptoms are highly prevalent and non-specific; hence, in the absence of alarm symptoms, endoscopy referral decisions are challenging. This study evaluated whether a non-endoscopic Cytosponge could detect benign oesophageal pathologies and thus have future potential in triaging patients with persistent symptoms.

METHODS AND RESULTS

Two complementary cohorts were recruited: (i) patients with reflux symptoms and no prior endoscopy (n = 409), and (ii) patients with reflux symptoms referred for endoscopy (n = 411). All patients were investigated using the Cytosponge and endoscopy. Significant epithelial inflammation was present in 130 (16%) Cytosponge samples, 32 of which had ulcer slough. Candida and significant inflammation was detected in a further 22 (2.3%) cases; epithelial infiltration with >15 eosinophils/high-power field reflecting possible eosinophilic oesophagitis (EOE) in five (0.6%); and viral inclusions suggestive of herpes oesophagitis in one (0.1%). No significant pathology was detected in the majority, 662 (81%), of Cytosponge samples. Cytosponge and endoscopy findings were in agreement in 574 (70%) cases, in 165 (67%) of the discordant cases one investigation showed mild inflammation while the other was negative, with an additional 22 (8.9%) differing on the extent of inflammation. Eighteen cases with severe inflammation, six with candida and two with EOE were detected only at endoscopy, while 18 with candida and significant inflammation, 13 with ulcer slough, one probable EOE and one viral oesophagitis were identified on the Cytosponge only.

CONCLUSIONS

The Cytosponge detects a range of benign oesophageal pathologies, and therefore has potential clinical utility in the triaging of patients with troublesome reflux symptoms. This warrants further investigation.

High-quality cell block preparation from scraping of conventional cytology slide: a technical report on a modified cytoscrape cell block technique

BACKGROUND

Immunocytochemistry (ICC) on formalin-fixed paraffin embedded cell blocks is an ancillary tool commonly recruited for differential diagnoses of fine needle aspiration cytology (FNAC) samples. However, the quality of conventional cell blocks in terms of adequate cellularity and evenness of distribution of cytologic material is not always satisfactory for ICC. We introduce a modified agarose-based cytoscrape cell block (CCB) technique that can be effectively used for the preparation of cell blocks from scrapings of conventional FNAC slides.

METHODS

A decoverslipped FNAC slide was mounted with a small amount of water. The cytological material was scraped off the slide into a tissue mold by scraping with a cell scraper. The cytoscrape material was pelleted by centrifugation and pre-embedded in ultra-low gelling temperature agarose and then re-embedded in conventional agarose. The final agarose gel disk was processed and embedded in paraffin.

RESULTS

The quality of the ICC on the CCB sections was identical to that of the immunohistochemical stains on histological sections. By scrapping and harvesting the entirety of the cytological material off the cytology slide into a compact agarose cell button, we could avoid the risk of losing diagnostic material during the CCB preparation.

CONCLUSION

This modified CCB technique enables concentration and focusing of minute material while maintaining the entire amount of the cytoscrape material on the viewing spot of the CCB sections. We believe this technique can be effectively used to improve the level of confidence in diagnosis of FNAC especially when the FNAC slides are the only sample available.

Office Endometrial Cytological Sampling: Examining Predictors of Strenuousness

BACKGROUND/AIM

Endometrial cytology is an alternative perspective for the diagnosis of endometrial cancer. The present study examined the potential risk factors for strenuousness in endometrial cytology sampling.

PATIENTS AND METHODS

One hundred and eighty-one women who underwent endometrial cytological sampling with the Endogyn curette participated in the study. Strenuousness in obtaining the sample was graded into a five-level scale-score. Various parameters were assessed in association with the strenuousness score. Multivariate ordinal logistic regression analysis was performed.

RESULTS

Postmenopausal status (adjusted OR=2.63, 95%CI=1.52-4.56, p=0.001) and previous invasive/surgical procedures in the cervix (adjusted OR=2.15, 95%CI=1.10-4.24, p=0.026) were associated with higher strenuousness score. Participants' age at sampling, phase of menstrual cycle, endometrial thickness, obesity, current hormonal use and reproductive history of women were not significantly associated with the strenuousness of the procedure.

CONCLUSION

Increased difficulty during endometrial sampling is noted in postmenopausal women, and in patients with previous surgical procedures in the cervix.

Adjunctive methods and devices for clinical detection of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is the most prevalent cancer of the head and neck with over 500,000 new cases every year worldwide. The stage of disease at diagnosis is associated with the 5-year survival rate. Unfortunately, approximately two-thirds of patients are diagnosed with advanced disease with local and regional or distant spread. Earlier detection of OSCC may be improved with the development of adjunctive techniques for clinical detection and diagnosis, which is expected to enhance the prognosis of the disease. This narrative review aims to provide an overview of adjuncts that are available for clinical use to assist in improving detection of potentially malignant epithelial lesions and early-stage OSCC.

In vivo gastric mucosal histopathology using endocytoscopy

AIM: To study the ability of endocytoscopy to identify normal gastric mucosa and to exclude Helicobacter pylori (H. pylori) infection.

METHODS: Endocytoscopic examination of the gastric corpus and antrum was performed in 70 consecutive patients. Target biopsy specimens were also obtained from the assessed region and multiple H. pylori tests were performed. The normal endocytoscopy patterns of the corpus and antrum were divided into the normal pit-dominant type (n-Pit) or the normal papilla-dominant type (n-Pap), respectively characterized as either regular pits with capillary networks or round, smooth papillary structures with spiral capillaries. On the other hand, normal mucosa was defined as mucosa not demonstrating histological abnormalities, including inflammation and atrophy.

RESULTS: The sensitivity and specificity of n-Pit for normal mucosa in the gastric corpus were 94.4% and 97.1%, respectively, whereas those of n-Pap for normal mucosa in the antrum were 92.0% and 86.7%, respectively. The positive predictive values of n-Pit and n-Pap for H. pylori-negative tissue were 88.6% and 93.1%, respectively, and their negative predictive values for H. pylori-negative tissues were 42.9% and 41.5%, respectively. The inter-observer agreement for determining n-Pit and n-Pap for normal mucosa were 0.857 and 0.769, respectively, which is considered reliable.

CONCLUSION: N-Pit and n-Pap, seen using EC, are considered useful predictors of normal mucosa and the absence of H. pylori infection.

Validity and reliability of using a self-lavaging device for cytology and HPV testing for cervical cancer screening: findings from a pilot study

Self-sampling could increase cervical cancer screening uptake. While methods have been identified for human papillomavirus (HPV) testing, to date, self-sampling has not provided adequate specimens for cytology. We piloted the validity and reliability of using a self-lavaging device for cervical cytology and HPV testing. We enrolled 198 women in New York City in 2008–2009 from three ambulatory clinics where they received cervical cancer screening. All were asked to use the Delphi Screener™ to self-lavage 1–3 months after clinician-collected index cytological smear (100 normal; 98 abnormal). Women with abnormal cytology results from either specimen underwent colposcopy; 10 women with normal results from both specimens also underwent colposcopy. We calculated sensitivity of self-collected cytology to detect histologically confirmed high grade lesions (cervical intraepithelial neoplasia, CIN, 2+); specificity for histology-negative (CIN 1 or lower), paired cytology negative, or a third cytology negative; and kappa for paired results. One hundred and ninety-seven (99.5%) women self-collected a lavage. Seventy-five percent had moderate to excellent cellularity, two specimens were unsatisfactory for cytology. Seven of 167 (4%) women with definitive results had CIN2+; one had normal and six abnormal cytology results with the self-lavage (sensitivity = 86%, 95% Confidence Interval, CI: 42, 100). The kappa for paired cytology was low (0.36; 95% CI: 0.25, 0.47) primarily due to clinician specimens with atypical squamous cells of undetermined significance (ASC-US) and low grade squamous intraepithelial lesion (LSIL) coded as normal using Screener specimens. However, three cases of HSIL were coded as ASC-US and one as normal using Screener specimens. Seventy-three women had paired high-risk HPV tests with a kappa of 0.66 (95% CI: 0.49, 0.84). Based on these preliminary findings, a larger study to estimate the performance of the Screener for co-testing cytology and HPV or for HPV testing with cytology triage is warranted.

Trial Registration

ClinicalTrials.gov NCT00702208

A prototype tobacco-associated oral squamous cell carcinoma classifier using RNA from brush cytology

BACKGROUND

Oral cancer in the form of squamous cell carcinoma (OSCC) is typically detected in advanced stages when treatment is complex and may not be curative. The need for surgical biopsy may contribute to delays in diagnosis and impede early detection. Multiple studies of RNA from surgically obtained tumor samples have revealed many genes differentially expressed with this disease. We sought to determine whether the identified mRNAs could be used as markers by a non-invasive detection system for OSCC using RNA from brush cytology.

METHODS

Levels of mRNAs from 21 genes known to be differentially expressed in head and neck squamous cell carcinoma surgical samples, compared with controls, were shown to be quantifiable in oral brush cytology samples. These mRNAs were quantified in a training set of 14 tumor and 20 non-malignant brush cytology samples from tobacco/betel nut users. With the measurement of two additional mRNAs and analysis using support vector machines algorithm for class prediction of these cancers was produced.

RESULTS

This OSCC classifier based on the levels of 5 mRNAs in RNA from brush cytology initially showed 0.93 sensitivity and 0.91 specificity in differentiating OSCC from benign oral mucosal lesions based on leave-one-out cross-validation. When used on a test set of 19 samples from 6 OSCCs and 13 non-malignant oral lesions, we found misclassification of only one OSCC and one benign lesion.

CONCLUSIONS

This shows the promise of using RNA from brush cytology for early OSCC detection and the potential for clinical usage of this non-invasive classifier.

An extended fluorescence in situ hybridization approach for the cytogenetic study of cholangiocarcinoma on endoscopic retrograde cholangiopancreatography brushing cytology preparations

The cytological diagnosis of cholangiocarcinoma has been significantly aided by applying a 4-probe fluorescence in situ hybridization system on endoscopic retrograde cholangiopancreatography brushing smears, aiming mainly at the detection of hyperdiploidy. However, this approach adds little to our understanding of the genetic background of the disease. With the prospect of obtaining additional data on chromosomal aberrations, we have extended the fluorescence in situ hybridization study, with the application of 4 independent 2-probe systems in 35 patients with documented cholangiocarcinoma. Fluorescence in situ hybridization assays were performed on endoscopic retrograde cholangiopancreatography brushing smears, with probes for the 7q31, 11q13 (CCND1), 17p53 (TP53), and 9p21 (INK4 locus) bands, together with the respective centromeric probe. Hyperdiploidy, involving at least 2 of the 4 chromosomes targeted, was found in 31 patients. 17p13 deletion was detected in 3, and 9p21 deletion, in 5 of the hyperdiploid cases, with the 2 aberrations concurrent in 1. CCND1 amplification was found in 1 case as the sole abnormality and in another together with hyperdiploidy, but in apparently unrelated clones. This work indicates that interphase fluorescence in situ hybridization is a practical and useful tool for the cytogenetic study of cholangiocarcinoma on endoscopic retrograde cholangiopancreatography brushing smears, which is often the only available tissue specimen of the tumor. Apart from hyperdiploidy, it provides additional data on the genetic profile of cholangiocarcinoma, especially regarding structural chromosomal aberrations and clonal diversity. This line of investigation may prove useful in the delineation of oncogenesis and the interpretation of the diverse clinical features of the disease.

Optical coherence tomography for rapid tissue screening and directed histological sectioning

In pathology, histological examination of the tissue is the "gold standard" to diagnose various diseases. It has contributed significantly toward identifying the abnormalities in tissues and cells, but has inherent drawbacks when used for fast and accurate diagnosis. These limitations include the lack of in vivo observation in real time and sampling errors due to limited number and area coverage of tissue sections. Its diagnostic yield also varies depending on the ability of the physician and the effectiveness of any image guidance technique that may be used for tissue screening during excisional biopsy. In order to overcome these current limitations of histology-based diagnostics, there are significant needs for either complementary or alternative imaging techniques which perform non-destructive, high resolution, and rapid tissue screening. Optical coherence tomography (OCT) is an emerging imaging modality which allows real-time cross-sectional imaging with high resolutions that approach those of histology. OCT could be a very promising technique which has the potential to be used as an adjunct to histological tissue observation when it is not practical to take specimens for histological processing, when large areas of tissue need investigating, or when rapid microscopic imaging is needed. This review will describe the use of OCT as an image guidance tool for fast tissue screening and directed histological tissue sectioning in pathology.

Real-time pathology through in vivo microscopy

Miniature microscopes are being developed to examine tissue in situ for early anatomic and molecular indicators of disease, in real time, and at cellular resolution. These new devices will lead to a shift from the current diagnostic paradigm of biopsy followed by histopathology and recommended therapy, to one of non-invasive point-of-care diagnosis with the possibility of treatment in the same session. This potential revolution in disease management may have a major impact on the training of future physicians to include the use and interpretation of real-time in vivo microscopic data, and will also affect the emerging fields of telepathology and telemedicine. Implementation of new technologies into clinical practice is a complex process that requires multidisciplinary communication and collaboration among clinicians, engineers and scientists. As such, our aim is to provide a forward-looking view of the critical issues facing the development of new technologies and directing clinical education. Here, we focus on the use of in vivo microscopy for detection of malignant and pre-malignant lesions as well as for guiding therapy. We will highlight some of the areas in which in vivo microscopy could address unmet clinical needs, and then review the technological challenges that are being addressed, or need to be addressed, for in vivo microscopy to become an effective clinical tool.

Spectral imaging in preclinical research and clinical pathology

Spectral imaging methods are attracting increased interest from researchers and practitioners in basic science, preclinical and clinical arenas. A combination of better labeling reagents and better optics creates opportunities to detect and measure multiple parameters at the molecular and cellular level. These tools can provide valuable insights into the basic mechanisms of life, and yield diagnostic and prognostic information for clinical applications. There are many multispectral technologies available, each with its own advantages and limitations. This chapter will present an overview of the rationale for spectral imaging, and discuss the hardware, software and sample labeling strategies that can optimize its usefulness in clinical settings.

Advanced methods in fluorescence microscopy

It requires a good deal of will power to resist hyperbole in considering the advances that have been achieved in fluorescence microscopy in the last 25 years. Our effort has been to survey the modalities of microscopic fluorescence imaging available to cell biologists and perhaps useful for diagnostic pathologists. The gamut extends from established confocal laser scanning through multiphoton and TIRF to the emerging technologies of super-resolution microscopy that breech the Abbe limit of resolution. Also considered are the recent innovations in structured and light sheet illumination, the use of FRET and molecular beacons that exploit specific characteristics of designer fluorescent proteins, fluorescence speckles, and second harmonic generation for native anisometric structures like collagen, microtubules and sarcomeres.

Physics and engineering aspects of cell and tissue imaging systems: microscopic devices and computer assisted diagnosis

The conventional optical microscopes have been used widely in scientific research and in clinical practice. The modern digital microscopic devices combine the power of optical imaging and computerized analysis, archiving and communication techniques. It has a great potential in pathological examinations for improving the efficiency and accuracy of clinical diagnosis. This chapter reviews the basic optical principles of conventional microscopes, fluorescence microscopes and electron microscopes. The recent developments and future clinical applications of advanced digital microscopic imaging methods and computer assisted diagnosis schemes are also discussed.

Lensfree computational microscopy tools for cell and tissue imaging at the point-of-care and in low-resource settings

The recent revolution in digital technologies and information processing methods present important opportunities to transform the way optical imaging is performed, particularly toward improving the throughput of microscopes while at the same time reducing their relative cost and complexity. Lensfree computational microscopy is rapidly emerging toward this end, and by discarding lenses and other bulky optical components of conventional imaging systems, and relying on digital computation instead, it can achieve both reflection and transmission mode microscopy over a large field-of-view within compact, cost-effective and mechanically robust architectures. Such high throughput and miniaturized imaging devices can provide a complementary toolset for telemedicine applications and point-of-care diagnostics by facilitating complex and critical tasks such as cytometry and microscopic analysis of e.g., blood smears, Papanicolaou (Pap) tests and tissue samples. In this article, the basics of these lensfree microscopy modalities will be reviewed, and their clinically relevant applications will be discussed.

Implementation of telecytology for immediate assessment of endoscopic ultrasound-guided fine-needle aspirations compared to conventional on-site evaluation: analysis of 240 consecutive cases

OBJECTIVE

To evaluate the implementation of telecytology in an academic cytology service for immediate assessment of endoscopic ultrasound (EUS) and endobronchoscopic ultrasound (EBUS) fine-needle aspiration (FNA).

STUDY DESIGN

Telecytology was evaluated over a 10-month period. Using an Olympus BX41(®) microscope and an Olympus DP72(®) camera with Olympus cellSens(®) software, real-time dynamic images of air-dried Diff-Quik(®)-stained smears were transmitted by a cytopathology fellow or cytotechnologist using a secure internet connection. The cytopathologists remotely accessed the real-time images on a computer in their office and rendered immediate assessments. Mean procedure times, and preliminary and final diagnoses were compared between telecytology and conventional on-site evaluation.

RESULTS

Two hundred and forty consecutive EUS-FNA and EBUS-FNA procedures with immediate assessments were performed during the evaluation period, of which 158 (66%) utilized telecytology and 82 (34%) did not utilize telecytology. The mean procedure time required for cytotechnologists and cytology fellows was 1.1 h for both conventional on-site and telecytology evaluations. The mean procedure time for cytopathologists was 0.74 h for conventional on-site evaluations and 0.2 h for telecytology.

CONCLUSIONS

Incorporation of telecytology for immediate assessment of EUS-FNA increased cytopathologist efficiency.

[The liquid cytology in clinical practice: a lecture]

The lecture covers one of the most perspective directions in clinical cytology. The emergence of liquid cytology is related to preparation of thin-layer specimens of organism liquids. Nowadays, the liquid cytology spreads more and more due to eephi application in different areas of cytological diagnostics, including screening of cervix uteri diseases, automatic screening, punctate tests, endoscopic and other materials. The lecture presents the basics of method, the characteristics of pre-analytic stage, the approaches to preparation of cytological specimens and cell blocks. The main possibilities, characteristics and perspectives of liquid cytology on the stage of rapid development of molecular genetic studies are discussed.

Detection of circulating tumor cells in advanced head and neck cancer using the CellSearch system

BACKGROUND

Early detection of circulating tumor cells (CTCs) offers the possibility of improved outcome for patients with head and neck squamous cell cancer (HNSCC).

METHODS

Patients with advanced-stage HNSCC (stage III/IV) were tested for CTCs using the CellSearch system (a registered trade name), which has been approved by the U.S. Food and Drug Administration (FDA) for monitoring CTCs in other cancers.

RESULTS

CTCs were detected in 6 of 15 patients with advanced-stage HNSCC (range, 1-2 cells/7.5 mL of blood). CTCs were significantly associated with patients with lung nodules >1 cm (p = .04). There was also a suggestion of improved survival in the CTC-negative versus the CTC-positive patients (p = .11).

CONCLUSIONS

CTCs can be successfully isolated in patients with advanced-stage HNSCC using the CellSearch system. CTC detection may be important for prognosis, evaluating treatment outcome, and for determining efficacy of adjuvant treatments.

Exfoliative cytology of the oral mucosa: comparison of two collection methods

This study compared the sampling efficacy of a cytobrush and metal spatula for exfoliative cytology of the oral mucosa. Thirty students with no detectable oral alterations upon clinical examination were submitted to exfoliative cytology of the lateral border of the tongue, using a metal spatula on the left side and a cytobrush on the right side. The smears were stained using the Papanicolaou technique and evaluated for cellularity, cell type, cell distribution, homogeneity, and cellular distortion, as well as the presence of mucus, inflammatory infiltrate, and hemorrhage. A statistical test (Z-test) with a 95% confidence interval (CI) showed a significant difference between the metal spatula and cytobrush in terms of cellularity (p = 0.02) and homogeneity (p = 0.01). No difference between the two methods was observed regarding cell type (p = 0.4, Z-test) or cell distribution for the 95% confidence interval (p = 0.2, Fisher's test). Cell distortion and the presence of mucus were observed in five cases that used the metal spatula and in two cases that used the cytobrush. No hemorrhage or inflammatory infiltrate was detected in any of the slides. Based on the results of this study, the cytobrush produced qualitatively better smears in terms of cellularity and homogeneity compared to the metal spatula.

[Evaluation of capability of cell count and detection of tumor cells in cerebrospinal and body fluids by automated hematology analyzer]

Sysmex XE-5000 offers the body fluid modus which provides the opportunity to count and differentiate leukocytes in body fluids and cerebrospinal fluid (CFS). In this study, we evaluated the basic performance of this application using routinely obtained samples in comparison with manual counting. Reproducibility study yielded good results in samples with a high white blood cell (WBC) count, whereas relatively high imprecision was observed at low WBC counts. Linearity was established up to 1,500 cells/microL in CFS and 5,600 cells/microL in body fluid. The cell count by XE-5000 was highly correlated with that of the microscopic reference method. Highly fluorescent body fluid cells percent (HF-BF%) was observed in samples with tumor cells or activated macrophages, which provides information about the possible presence of tumor cells. In conclusion, total and differential WBC counts in body fluid and CFS can be reliably determined by XE-5000 in samples with increased cell counts. XE-5000 also provides screening information about the presence of tumor cells for further manual examination.

Fast track biopsy method: a rapid approach to preoperative diagnoses

INTRODUCTION

It is well known that the use of a microwave oven greatly reduces the time for histoprocessing.

OBJECTIVE

Apply the microwave-based histoprocessing method "Fast Track Biopsy" (FTB), previously described for breast needle-core biopsies, to samples of other organs.

METHODS

From 01/09/2008 to 31/12/2008, 125 normal and neoplastic tissue samples (thickness from 0.2 and 1.2 cm) were collected, processed according to the FTB technique, stained with haematoxylin/eosin (H/E) and analysed with tissue-specific immunohistochemical (IHC) markers.

RESULTS

The quality of both H/E and IHC stained sections was comparable to that obtained with standard methods. Sample thickness less than 0.5 cm gave better results.

DISCUSSION

the FTB method is suitable for most tissue types, and is thus useful for preoperatory diagnoses.

Exploiting the residual of cervical thin layer brush samples through cytohistology in cases with invasive carcinoma with application of antibodies

OBJECTIVE

To exploit cervical thin layer brush samples through cytohistology in cases with invasive carcinoma with application of antibodies.

STUDY DESIGN

Fourteen cases from women with carcinoma diagnosed in 2006 were selected out of 29 invasive carcinomas. From these 14 cases liquid-based cervical cytology material was available to prepare cytohistology. Eight women had squamous cell carcinoma, 4 endocervical adenocarcinoma, 1 endometrial adenocarcinoma and 1 ovarian adenocarcinoma. The residual material from the thin layer sample, collected by brushes by general practitioners, was used to prepare paraffin sections. These were stained with the Papanicolaou method and for the biomarkers Ki-67 and p16 and, if desired, for differentiation markers, including carcinoembryonic antigen, vimentin, cytokeratin 7 and cytokeratin 20 to establish the immunoprofile of the carcinoma.

RESULTS

The morphologic details in the cancer nuclei in the paraffin sections were excellent, while in all cases the thin layer cytology slide contained thick epithelial fragments with blurred nuclei. In 5 of the 6 adenocarcinomas, the glandular architecture diagnostic of adenocarcinoma was visible in the cytohistology, which was highlighted in the biomarker stainings, particularly so in the Ki-67 sections. With the exception of endometrial adenocarcinoma, all p16(INK4a) stainings were positive, as they were in the ovarian adenocarcinoma case.

CONCLUSION

Cytohistology is an adjunct to routine cervical cytologic examination of thin layer samples, allowing an unequivocal and refined diagnosis.

Cytologic examination of hemorrhagic fluid by capillary centrifugation: a new technique

OBJECTIVE

To develop a simplified technique for processing hemorrhagic body fluids, allowing elimination of red blood cells (RBCs) to obtain tumor cell-rich cytosmears for accurate diagnosis of malignancy.

STUDY DESIGN

Hemorrhagic fluid is collected with ethylenediamine tetraacetic acid anticoagulant. The cells are separated by centrifugation in glass capillaries into 3 layers, with the uppermost containing supernatant, middle buffy coat and lowermost dark layer of RBCs. The smears of the buffy coat are prepared by breaking the capillaries at the junction of buffy coat and RBC layer. The procedure is named capillary centrifugation technique. This procedure was developed in the cytology laboratory at King George's Medical College, Lucknow, India in 1974.

RESULTS

Cell yield is good and cellular details are well preserved. No cell debris is present on the slides. The background of the smears is absolutely clear. Any number of slides may be prepared for special study for exact typing of tumor cells

CONCLUSION

This is a simple, economical procedure and a good substitute for a cytocentrifuge machine for preparing smears from small amount of fluids. Technicians learn it quickly and are quite comfortable with the procedure.

Rapid detection and profiling of cancer cells in fine-needle aspirates

There is a growing need for fast, highly sensitive and quantitative technologies to detect and profile unaltered cells in biological samples. Technologies in current clinical use are often time consuming, expensive, or require considerable sample sizes. Here, we report a diagnostic magnetic resonance (DMR) sensor that combines a miniaturized NMR probe with targeted magnetic nanoparticles for detection and molecular profiling of cancer cells. The sensor measures the transverse relaxation rate of water molecules in biological samples in which target cells of interest are labeled with magnetic nanoparticles. We achieved remarkable sensitivity improvements over our prior DMR prototypes by synthesizing new nanoparticles with higher transverse relaxivity and by optimizing assay protocols. We detected as few as 2 cancer cells in 1-microL sample volumes of unprocessed fine-needle aspirates of tumors and profiled the expression of several cellular markers in <15 min.

[Automatization of microscopic blood smear analyses and quality control using reference virtual slides]

MEKOC microscopy complexes have a group of specialized automatic functions for medical analyses of biomaterials integrated with general virtual microscopy accessories. Such functions provide a way of making specialized reference virtual slides (RVS). The latter contain the results of virtual analysis or expert evidence of the automatic analysis results presented in the virtual slide. The use of RVS yields an open system with a step-by-step control of the quality of automatic operations. RVS as realistic preparation models are also used to train staff. The results of step-by-step trials of the MEKOC--2 are presented in the paper.

Utility of imprint cytology for early presumptive diagnosis in clinically suspicious cervical cancer

OBJECTIVE

To determine the utility of imprint cytology (IC) in providing an early presumptive diagnosis of clinically suspected cervical carcinoma.

STUDY DESIGN

A total of 219 clinically suspicious cervical cancer cases underwent Pap test, punch biopsy and IC at the same sitting. Correlations were performed between these diagnostic modalities to determine the sensitivity and specificity of IC in diagnosis of cervical cancer.

RESULTS

The overall accuracy of IC in detecting cervical cancers was 96.2%. About 78% of squamous cell carcinomas (SCC), 60% of adenocarcinomas and 100% of small cell carcinoma could be accurately typed on imprints. Twelve malignant lesions were diagnosed on IC among 26 unsatisfactory biopsies. Although there was no false positive result, 3.5% false negative diagnoses were given on IC. The sensitivity and specificity of imprint smear cytology to detect malignancy was 96.2% and 100%. Agreement between imprint cytology and Pap smear diagnosis of malignancy was 95.3%. kappa Statistics revealed excellent agreement between imprints and biopsies and between imprints and Pap smears in diagnosis of malignant lesions.

CONCLUSION

IC can be used as an adjunctive technique for an early and reliable preliminary presumptive diagnosis of cancer of the uterine cervix.

Increased sensitivity of anal cytology in evaluation of internal compared with external lesions

OBJECTIVE

To investigate the impact of keratin on the accuracy of internal and external anal brush sampling of known lesions.

STUDY DESIGN

A group of 46 human immunodeficiency virus (HIV)-seropositive patients underwent external and internal anal brush sampling before biopsy of known lesions. RESULTS; A total of 92 ThinPrep (46 external, 46 internal) an 211 biopsies were examined. The sensitivity and specificity for internal lesions positive and negative for anal squa mous intraepithelial lesion (ASIL) was 91.1% and 42.8%, respectively; and for external lesions was 79.4% and 100%, respectively. Low cellularity on cytology and markedly thickened keratin on biopsy were significantly more common in external compared with internal lesions (p < 0.0001).

CONCLUSION

We conclude that hyperkeratosis interferes with adequate sampling and accurate grading of external anal lesions by brush sampling.

[The clinical significance and management of cervico-cytologically diagnosed ASCUS/LSIL]

PURPOSE

To investigate the clinical significance and management of ASCUS/LSIL.

METHODS

254 patients who were examined with cervical cytology in the Cancer Institute and Hospital Chinese Academy of Medical Sciences were ASCUS/LSIL, of whom 136 cases underwent colposcopy, Data were analyzed retrospectively according to the golden criterion of pathology outcome.

RESULTS

140 cases were ASCUS, and 114 cases were LSIL. Cervical intra-epithelial neoplasia (CIN) were diagnosed in 51.5% of patients with ASCUS, compared with 59.6% of patients with LSIL (P>0.05). High-grade cervical intraepithelial neoplasia were diagnosed in 22.9% of patients with ASCUS, compared with 30.7% of patients with LSIL (P >0.05). In the 136 patients examined with colposcopy, inflammation was found in 47 cases, low-grade intraepithelial lesion in 53 cases, High-grade intraepithelial lesion in 36 cases. The pathological results show inflammation in 55 cases, low-grade intraepithelial lesion in 41 cases, High-grade intraepithelial lesion in 40 cases (Kappa=0.314, U=0.064, P less than 0.05). CIN were diagnosed in 79% (67/84) of HPV-positive patients identified by pathology, compared with 43.5% (74/170) of HPV-negative patients (chi2=29.88 P less than 0.05). 83.5% of 254 patients were between 35 to 55 years old, and that was consistent with HPV-positive women age peak.

CONCLUSION

Patients with ASCUS should be paid the same attention with LSIL patients and colposcopy examination should be done immediately to avoid missed diagnosis and missed follow-up examination, especially for HPV positive patients between 35 to 55 years old.

The role of ThinPrep cytology in the investigation of SLN status in patients with cutaneous melanoma

INTRODUCTION

The sentinel lymph node (SLN) biopsy in melanoma assesses reliably the status of the regional lymph node basins, provides valuable prognostic information, facilitates early therapeutic lymphadenectomy and identifies patients who are candidates for different adjuvant treatments. The current study was designed to evaluate the feasibility of cytological specimens being placed in PreservCyt as a practical collection methodology for performing evaluation of the SLN status in patients with melanomas.

PATIENTS AND METHODS

From January 2004 to December 2006, 70 patients with histologically confirmed cutaneous melanoma underwent intraoperative FNA biopsy of the SLN. After identification of the SLN(s), FNA biopsy of the SLN was performed with a 0.6 mm (23 gauge) diameter needle. All the SLNs specimens were examined (using light microscopy 40 x and 200 x) by the same pathologist and cytopathologist, neither of had any knowledge of the medical history of the patient. The histological result of the excised SLN was considered as the final diagnosis.

RESULTS

The unsatisfactory rate for TP cytology was 2.17%. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (OA) for the TP technique were 92.31%, 100%, 100%, 97.06%, and 97.83%, respectively. Using TP cytology, there was greater intensity and distribution of the staining in comparison with immunohistochemistry.

DISCUSSION

The accuracy of TP technique in the evaluation of the SLN status is comparable to those of the histological evaluation, and could be of paramount importance for the preoperative planning of treatment.

Significance and possible causes of false-negative results of reflex human papillomavirus infection testing

BACKGROUND

The objective of this study was to assess the rate and possible reasons for false-negative (FN) reflex human papillomavirus (HPV)-DNA tests.

METHODS

The authors reviewed all ThinPrep cervical specimens that were submitted for reflex HPV-DNA testing using the Digene Hybrid Capture II (HC2) method from January 2002 to January 2004. Follow-up biopsies were reviewed. The results were considered HPV-FN if the HPV-DNA test was negative and the biopsy was positive for grade > or =2 cervical intraepithelial neoplasia (CIN2+), and the results were considered true positive (HPV-TP) if the HPV-DNA test was positive and the biopsy showed CIN2+. HPV-FN cases were compared with HPV-TP cases regarding the grade and extent of CIN, the number of abnormal cells on the original ThinPrep slide, and the presence of amplifiable, viral DNA on biopsy.

RESULTS

In total, 1520 (66%) of 2309 patients who had diagnoses of atypical squamous cells of undetermined significance (ASCUS) were negative for HPV DNA and 789 patients of 2309 patients (34%) were positive for HPV DNA. Three hundred sixteen women (40%) who had a positive HPV-DNA test underwent a biopsy. Of those, 36 biopsies (11%) showed CIN2+ (HPV-TP), and 154 biopsies (66%) showed CIN1. Cervical tissue was available for review from 82 women who had negative HPV-DNA tests; of these, 6 tissue samples (7%) showed CIN2+ (HPV-FN), and 13 tissue samples (16%) showed CIN1. Therefore, in the total ASCUS population that was triaged with reflex HPV testing, there were at least 42 women who were diagnosed with CIN2+, for an estimated CIN2+ FN fraction of 14% (6 of 42 women). HPV-FN lesions were smaller (but the difference was not statistically significant) and shed significantly fewer abnormal cells than HPV-TP cases. Polymerase chain reaction testing for viral DNA in the biopsy was detected in 3 of 6 women who had HPV-FN results; none of those positive results demonstrated a viral type that was not included in the Digene probes.

CONCLUSIONS

Although the rate of FN high-grade lesions was significantly higher than that reported in the ASCUS/Low-grade Squamous Intraepithelial Lesion Triage trial, most missed lesions were small and shed few abnormal cells. It was assumed that those lesions were either in early stages or in regressing stages, which made their clinical significance uncertain.

Safety and efficacy of cytology brushings versus standard FNA in evaluating cystic lesions of the pancreas: a pilot study

BACKGROUND

Cystic neoplastic lesions of the pancreas (CNLP) are increasingly detected and are associated with a potential for malignant transformation. Diagnostic assessment of these lesions is often limited by the cystic nature and focality of neoplastic progression of these lesions. EUS-guided FNA (EUS-FNA) of cyst fluid and exfoliated cells is one of the most accurate methods of diagnosis but still has limited sensitivity. A new, through-the-needle cytologic brush system has recently been approved for use during EUS evaluation of cystic lesions of the pancreas.

OBJECTIVE

To evaluate the cytologic yield and safety profile of the new cytobrush compared with conventional FNA in evaluating CNLP.

DESIGN

Ten consecutive patients with CNLP were included. All cysts were sampled by standard EUS-FNA (0.5 of cyst volume) followed by brush cytology, then by aspiration of the remaining fluid. Fluid samples were separately submitted (standard FNA and cytobrushings FNA) but were read by the same pathologist. Complications were assessed during the immediate postprocedure period (2-3 hours) and by a telephone call conducted approximately 30 days after the procedure to inquire about any new symptoms, including abdominal pain, melena, hematochezia, hematemesis, fever, nausea, and vomiting.

SETTING

High-volume EUS referral center.

PATIENTS

Ten consecutive patients with CNLP that measured at least 20 mm in maximal dimension were included.

MAIN OUTCOME MEASUREMENTS

Cellularity and presence of diagnostic cells on the FNA.

RESULTS

In 7 of 10 cases, the EchoBrush specimen was superior to FNA in terms of cellularity and detection of diagnostic cells. Two cases had complications: 1 major and 1 minor intracystic bleed. No infection or pancreatitis was observed.

LIMITATIONS

The interpreting pathologist for the case was not blinded to the results of either of the samples. In addition, this pilot study represents only a single-center experience.

CONCLUSIONS

This study suggests that brush cytology specimens obtained at the time of EUS are superior to conventional FNA because of the higher yield of epithelial cells. It is unclear whether bleeding is more common after EchoBrush sampling; however, caution should be taken in patients who require anticoagulation until further data are available.

Fluorescence in situ hybridization of ductal lavage samples identifies malignant phenotypes from cytologically normal cells in women with breast cancer

BACKGROUND

Ductal lavage (DL) does not routinely identify cytologically malignant cells. For this study, the authors asked whether molecular analyses of DL specimens from women with cancer would identify abnormal cells, even if they appeared cytologically normal.

METHODS

DL was performed and yielded fluid in 29 of 45 consenting women who were undergoing breast cancer surgery. Array comparative genomic hybridization (CGH) was performed on the corresponding tumor tissue from 14 women. There was no single, common alteration; thus, bacterial artificial chromosome-specific fluorescence in situ hybridization (FISH) probes were selected based on CGH alterations.

RESULTS

FISH copy number changes were detected in tumor sections in 9 women. In the corresponding 9 DL samples, 1 sample was clearly malignant on cytology, 1 showed marked atypia, 1 showed mild atypia, and the rest were benign. Five of the 9 DL samples had epithelial cells that showed genetic changes identical to those observed in the tumor by FISH. The remaining 4 of 9 DL samples that did not show molecular changes were probably (N = 1) or possibly (N = 3) from the same duct as the tumor.

CONCLUSIONS

Although only 11% of the DL samples were identified as malignant cytologically, 55% showed molecular changes that were identical to those observed in the tumor. FISH was more sensitive for finding tumor in DL specimens than cytology. However, the ductal system in which the tumor was located did not always yield fluid, limiting the sensitivity of DL. The results from this study showed that genetic changes can be detected in the absence of morphologic changes in cytologically benign cells, but the application will be limited without a better approach for acquiring cells and a common set of probes for detecting molecular abnormalities that are found in breast malignancies.

Ontology-based lymphocyte population description using mathematical morphology on colour blood images

Despite modern technologies (immunophenotyping, molecular probing, etc.) cytomorphologic examination of stained peripheral blood smears by microscopy remains the main way of diagnosis in a large variety of diseases (e.g. leukaemic disorders). Using tools from mathematical morphology for processing peripheral blood colour images, we have developed an image-based approach, to provide an objective and understandable description of lymphocyte populations according to a specifically designed ontology. This ontology-based framework needs a conceptualisation of the problem from a morphological viewpoint, the introduction of an adapted language, the generation of representative image databases, the development of image processing and data classification algorithms to automate the procedure and the validation of the system by human expertise. In this paper we present the main concepts, algorithms and some results to illustrate the high-performance of the approach. The aim of our work is to reconcile the automatisation with the medical expertise, so that they can reinforce each other.

Development of an automated malaria discriminant factor using VCS technology

Malaria diagnosis presents a challenge to all laboratories. There is a need for rapid, sensitive, and cost-effective screening on all samples, particularly in areas where malaria is endemic. Response to malaria infection involves an increased monocyte count and production of large activated monocytes. These changes can be detected by volume, conductivity, and scatter (VCS) technology on certain automated blood cell counters (Beckman Coulter, Miami, FL). The SD of the volume of lymphocytes and monocytes demonstrates a significant difference from normal when malaria is present. By using a calculation derived from the SD volume of the lymphocytes and monocytes, herein termed the malaria factor, sensitivity of 98% and specificity 94% were demonstrated for the detection of malaria. Based on this derived discriminant, VCS technology should become a useful tool in the detection of malaria. A flag to indicate the potential presence of malaria could then be generated by the instrument if the user or manufacturer chose to do so.

Evaluation of static telepathology in veterinary diagnostic cytology

BACKGROUND

Telepathology is the process of diagnostic pathology performed on digital images viewed on a display screen rather than by conventional light microscopy with glass slides. At present, electronic mail (e-mail) attachment is the most common communication medium for telepathology, because it is relatively simple and incurs minimal cost.

OBJECTIVE

Our objective was to test whether telediagnosis through Internet e-mail could be applied to veterinary diagnostic cytology.

METHODS

Using 20 cytology cases, on which a consensus diagnosis was reached by 3 experienced pathologists, a total of 130 images were digitized and sent as e-mail attachments from the Unit of Anatomic Pathology of the Faculty of Veterinary Medicine of Naples to the Unit of Pathology of the Faculty of Veterinary Medicine of Messina, Italy. The images were reviewed at the Unit of Pathology of Messina, where the consulting pathologist formulated his diagnoses by visualizing the images on the monitor of a computer. The telediagnoses were compared with the consensus diagnoses and with the consulting pathologist's interpretation using conventional light microscopy at a later date.

RESULTS

The median time to capture images was approximately 30 minutes for each case. The median time to make a telecytodiagnosis was a few seconds for each case. Overall, there was good agreement (85%) between the consensus diagnosis and the consultant's telediagnosis. In 100% of the cases there was agreement between the consulting pathologist's telediagnosis and conventional glass slide diagnosis.

CONCLUSION

Telepathology by e-mail provides acceptable efficacy and a faster turnaround time than post and can be applied to veterinary diagnostic cytology.

An evaluation of ThinPrep UroCyte filters for the preparation of slides for fluorescence in situ hybridization

The purpose of this study was to assess the performance of ThinPrep UroCyte filters, which were designed specifically for the preparation of slides for fluorescence in situ hybridization (FISH) analysis of urine specimens. One hundred urine specimens were evenly split, and one portion was utilized to prepare a slide with the UroCyte filter method and the other portion was used to prepare a slide with a manual dropping method. All 17 of the 100 specimens identified as positive by the manual method were also identified as positive with the UroCyte method. No significant differences were noted in the percentage of chromosomally abnormal cells (P = 0.227), cellularity (P = 0.857), signal quality (P = 0.816), and DAPI counterstain quality (P = 0.369) between the two methodologies. The average time taken to prepare a batch of 10 slides using the UroCyte method, and that using manual method was 103 min (10.3 min/case) and 194 min (19.4 min/case), respectively. This study suggests that the UroCyte filter method of preparing slides for FISH analysis reduces the time required to prepare these slides with overall results that are similar to the currently utilized manual dropping method.

[An automated microscopy system MECOS-Ts2 and its trial use for blood and bone-marrow smear analysis]

Disadvantages of conventional procedures for testing of medical automated microscopy systems are considered. A testing procedure based on step-by-step testing of the system units is suggested. The procedure makes use of remote data analysis through communication lines. The structure of MECOS-Ts2 automated microscopy system and the procedure for its testing are considered.