Accuracy and Reproducibility of Telecytology Diagnosis of Cervical Smears

Abstract

We randomly selected 50 cervical smears (benign, 14; atypical squamous cells of undetermined significance [ASCUS], 5; low-grade squamous intraepithelial lesion [LSIL], 10; high-grade squamous intraepithelial lesion (HSIL), 12; squamous cell carcinoma, 6; adenocarcinoma, 3) and captured 1,181 digital images (518 MB) at a maximum resolution of 1,600 x 1,200 pixels and transmitted them by e-mail. Diagnosis of glass slides and digital images was done independently in a double-blind manner by 3 pathologists and 3 cytotechnologists, commencing with the diagnosis of digital images followed by diagnosis of glass slides 3 months later. The procedure was repeated after 3 months. Diagnoses were recorded as benign, ASCUS or atypical glandular cells of undetermined significance, LSIL, HSIL, squamous cell carcinoma or adenocarcinoma, and "inadequate for diagnosis." Diagnostic accuracy and interobserver reproducibility were analyzed using an intraclass correlation coefficient (ICC), which revealed good interobserver agreement for the first (0.72) and second (0.64) glass slide diagnoses and the first (0.72) and second (0.60) digital image diagnoses. The kappa values for intraobserver variation between first and second glass slide diagnoses and first and second digital image diagnoses showed moderate to excellent agreement. Digital images are suitable substitutes for glass slides; telecytology can be used as an alternative method for the cytologic diagnosis of cervical smears, particularly in quality assurance programs.

Digital Slide Imaging in Cervicovaginal Cytology: A Pilot Study

“…Previous studies have also concluded that hyperchromatic crowded groups are more difficult to diagnose on digital imaging, 3 likely because of the small number of atypical cells present as well as insufficient resolution to permit adequate evaluation at 340 without z-axis focusing ability. In some cases, 3100 magnification was necessary to accurately discern architecture and background.…”

“…In some cases, 3100 magnification was necessary to accurately discern architecture and background. 3 Among digital images, those scanned at 320 magnification had the lowest accuracy. Inability to examine cellular detail and inability to change the image focal plane limited the ability to interpret these digital images.…”

“…The development of greater image quality and resolution within digital pathology has promoted the use of telepathology, including telecytology, which has been shown to be acceptable for both adequacy checks and rapid cytology diagnoses. [1][2][3][4] Other uses of digital imaging in pathology include image-enhanced reports, live imaging through robotic microscopy, 5 remote surgical frozen section review, 6,7 quality assurance testing, 3 and image cytometry/ analysis.Whole slide imaging (WSI), a subset of digital imaging, is the process of scanning an entire glass slide and converting the data into a high-resolution digital image that is viewed and manipulated on a computer. Potential applications of WSI include case sign-out, archiving for consultation or legal cases, and education.…”

“…The development of greater image quality and resolution within digital pathology has promoted the use of telepathology, including telecytology, which has been shown to be acceptable for both adequacy checks and rapid cytology diagnoses. [1][2][3][4] Other uses of digital imaging in pathology include image-enhanced reports, live imaging through robotic microscopy, 5 remote surgical frozen section review, 6,7 quality assurance testing, 3 and image cytometry/ analysis.…”

Informatics for practicing anatomical pathologists: marking a new era in pathology practice

“…This can be attributed to many factors, including the less clear understanding of the nature and details of digital pathology, including its limitations. Some pathology cases (eg, the thick smear of cytology specimens) 30,61 cannot be simply diagnosed by telepathology. 3 Moreover, there is generally a lesser level of comfort with the new procedures as is the case with any new practice.…”