Implementation of Telecytology for Immediate Assessment of Endoscopic Ultrasound-Guided Fine-Needle Aspirations Compared to Conventional On-Site Evaluation: Analysis of 240 Consecutive Cases

Marotti, Jonathan D.; Johncox, Vickie; Ng, David P; González, Jorge Luis Valdés; Padmanabhan, Vijayalakshmi

doi:10.1159/000339546

Cited by 47 publications

(24 citation statements)

References 21 publications

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“…9 However, using a prospective clinical evaluation comparing a telecytopathology system with conventional cytopathologic evaluation, we sought to further investigate whether telecytopathology could decrease procedure duration, operating room or procedure suite utilization, and other variables relevant to the surgeon.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Clinical Trial of Telecytopathology for Rapid Interpretation of Specimens Obtained During Endobronchial Ultrasound–Fine Needle Aspiration

Bott¹,

James²,

Collins³

et al. 2015

The Annals of Thoracic Surgery

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Background Cytopathologic interpretation of EBUS-FNA samples by a pathologist can be time-consuming and costly, and an onsite cytopathologist may not always be readily available. A telecytopathology system was instituted and evaluated to examine the impact on operative time for EBUS. Methods A prospective study was performed of sequential patients undergoing EBUS-FNA for the evaluation of mediastinal lymphadenopathy. The control group involved transportation of specimens to the pathology lab followed by remote cytologic interpretation. A subsequent cohort utilized a telecytopathology system with intra-op transmission of real-time live video microscopy to a remote cytopathologist (TCP group). The primary outcome was time to confirmation of cytology results. Results Of 46 patients entered into the study, 23 underwent traditional analysis (Control group) while 20 were analyzed using telecytopathology (TCP group). Lung cancer was the most common malignancy in both groups (12 TCP, 12 Control). There was no difference in mean number of lymph node stations sampled (1.3 TCP vs. 1.8 Control, p=0.76). Use of TCP was associated with fewer needle passes (4.9 vs. 7.3, p=0.02) and fewer slides for interpretation (8.4 vs. 13.5, p=0.01) per procedure. Time to result confirmation was significantly shorter in the TCP group (19.0 vs. 46.7 minutes, p<0.001). A diagnostic specimen was obtained in 70% of patients in the TCP group compared with 65% in the control group (p=0.5). False negative rates in patients undergoing both EBUS-FNA and mediastinoscopy were similar between the two groups (0 in TCP vs. 2 in Control, p=0.49). Mean procedural costs (excluding cost of the telecytology system and OR time) were equivalent between the two groups ($888 TCP vs. $887 Control). Conclusions Telecytopathology provides rapid interpretation of EBUS-FNA samples with diagnostic accuracy comparable to traditional methods, shortens procedure time, and is a more efficient model for delivery of on-site EBUS-FNA interpretation.

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Section: Introductionmentioning

confidence: 99%

A Prospective Clinical Trial of Telecytopathology for Rapid Interpretation of Specimens Obtained During Endobronchial Ultrasound–Fine Needle Aspiration

Bott¹,

James²,

Collins³

et al. 2015

The Annals of Thoracic Surgery

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“…Because of these difficulties, TSI, RTIT, and WSI cannot be used in primary cytopathologic diagnosis, but they are used for secondary opinion, consultation, remote material adequacy assessment, training and examinations, and meetings. 2,4,[12][13][14] The recently developed microscopic imaging system with the highest technology is WSI.…”

mentioning

confidence: 99%

Telecytology: Is it possible with smartphone images?

Şahin

Hacısalihoğlu

Kirimlioglu

2017

Diagnostic Cytopathology

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IntroductionThis study aimed to discuss smartphone usage in telecytology and determine intraobserver concordance between microscopic cytopathological diagnoses and diagnoses derived via static smartphone images.MethodsThe study was conducted with 172 cytologic material. A pathologist captured static images of the cytology slides from the ocular lens of a microscope using a smartphone. The images were transferred via WhatsApp® to a cytopathologist working in another center who made all the microscopic cytopathological diagnoses 5‐27 months ago. The cytopathologist diagnosed images on a smartphone without knowledge of their previous microscopic diagnoses. The Kappa agreement between microscopic cytopathological diagnoses and smartphone image diagnoses was determined.ResultsThe average image capturing, transfer, and remote cytopathological diagnostic time for one case was 6.20 minutes. The percentage of cases whose microscopic and smartphone image diagnoses were concordant was 84.30%, and the percentage of those whose diagnoses were discordant was 15.69%. The highest Kappa agreement was observed in endoscopic ultrasound‐guided fine needle aspiration (1.000), and the lowest agreement was observed in urine cytology (0.665). Patient management changed with smart phone image diagnoses at 11.04%.ConclusionsThis study showed that easy, fast, and high‐quality image capturing and transfer is possible from cytology slides using smartphones. The intraobserver Kappa agreement between the microscopic cytopathological diagnoses and remote smartphone image diagnoses was high. It was found that remote diagnosis due to difficulties in telecytology might change patient management. The developments in the smartphone camera technology and transfer software make them efficient telepathology and telecytology tools.

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“…Their work demonstrated high intraobserver concordance (97.5%) and showed remarkably accurate intraobserver classification of diagnoses (92.5-95%). In a study in which 240 consecutive EUS-FNA and EBUS-FNA procedures with immediate assessments were performed using an Olympus DP72 camera with Olympus cellSens software, the mean procedure time for cytopathologists was 0.74 h for conventional on-site evaluations versus only 0.2 h for telecytology [38]. However, digital slides may take longer to screen, especially when not captured through z-stacking due to problematic focusing through 3D cell groups.…”

Section: Discussionmentioning

confidence: 99%

Digital Applications in Cytopathology: Problems, Rationalizations, and Alternative Approaches

et al. 2017

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Objective: The aim of this work was to raise awareness of problems using digital applications for examining, teaching, and applying telecytology at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia; University of Nebraska Medical Center (UNMC), Omaha, NE, USA; and University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. The objective was to rationalize problems and propose alternative digital approaches. Study Design: We sought to identify solutions to improve the following: (a) interpretive examination scores at KAMC for complex cytological templates (i.e., high-grade squamous intraepithelial lesions [HSIL]) when using static digital images (SDI) of cells in regions of interest (ROI); (b) visualization of cells in 3D clusters when teaching at UNMC using 2D and 3D whole-slide imaging (WSI); and (c) visualization of cells through streaming telecytology at UPMC. Results: Composite SDI (CSDI) improved test scores for complex interpretations (i.e., HSIL) by converging diagnostic criteria from multiple ROI. Multiplane focusing through z-stacked WSI facilitated the teaching of cytological entities characterized by 3D cell clusters and consultative telecytology through robotic cell analysis. Conclusions: Adequately visualized cytomorphology and multiplane focusing are essential for virtual cytopathology examinations, teaching, or consultative telecytology. Visualization of diagnostic criteria through 2D or 3D imaging is critical. Panoptiq panoramic WSI with integrated z-stacked video clips enables optimal applied telecytology.

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Implementation of Telecytology for Immediate Assessment of Endoscopic Ultrasound-Guided Fine-Needle Aspirations Compared to Conventional On-Site Evaluation: Analysis of 240 Consecutive Cases

Cited by 47 publications

References 21 publications

A Prospective Clinical Trial of Telecytopathology for Rapid Interpretation of Specimens Obtained During Endobronchial Ultrasound–Fine Needle Aspiration

A Prospective Clinical Trial of Telecytopathology for Rapid Interpretation of Specimens Obtained During Endobronchial Ultrasound–Fine Needle Aspiration

Telecytology: Is it possible with smartphone images?

Digital Applications in Cytopathology: Problems, Rationalizations, and Alternative Approaches

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