Delphi expert consensus for whole slide imaging in thyroid cytopathology

Abstract

ObjectiveDespite an increase in thyroid fine needle aspiration (FNA) and advances in whole slide imaging (WSI) adoption, digital pathology is still considered inadequate for primary diagnosis of these cases. Herein, we aim to validate the utility of WSI in thyroid FNAs employing the Delphi method strategy.MethodsA panel of experts from seven reference cytology centres was recruited. The study consisted of two consecutive rounds: (1) an open‐ended, free‐response questionnaire generating a list of survey items; and (2) a consensus analysis of 80 selected shared WSIs from 80 cases by six investigators answering six morphological questions utilising a 1 to 5 Likert scale.ResultsHigh consensus was achieved for all parameters, with an overall average score of 4.27. The broad majority of items (84%) were ranked either 4 or 5 by each physician. Two badly scanned cases were responsible for more than half of the low‐ranked (≤2) values (57%). Good to excellent (≥3) diagnostic confidence was reached in more than 95.2% of cases. For most cases (78%) WSI assessment was not limited by technical issues linked to the image acquisition process.ConclusionThis systematic Delphi study indicates broad consensus among participating physicians on the application of DP to thyroid cytopathology, supporting expert opinion that WSI is reliable and safe for primary diagnostic purposes.

Diagnostic Significance of Ultrasound-Guided Fine-Needle Aspiration Biopsy and on-Site Assessment by Pathologists for Thyroid Micronodules

“…Recently, innovative research, including whole slide imaging and digital pathology, has been effectively improving cytopathology diagnosis. [21][22][23] In addition, multiple guidelines suggest that molecular testing of Bethesda III and IV samples could effectively improve the sensitivity of the preoperative diagnosis of thyroid nodules. 24,25 Therefore, reducing the proportion of Bethesda III specimens and developing molecular testing are effective ways to improve the diagnostic value of US-FNAB.…”

Intraoperative thyroid frozen section: indications, results and consequences

“…However, there are other situations in which FS can play an important role such as transplantation: donors show the same prevalence of thyroid nodules as the general population. Although recent literature showed a higher accuracy for FNB based on the current techniques ( 25 ), digital pathology will possibly help in the future reducing FS time and increase precision ( 26 , 27 ).…”

Detection of malignant lesions in cytologically indeterminate thyroid nodules using a dual-layer spectral detector CT-clinical nomogram

“…Studies reported that artificial intelligence algorithms allow for precise quantification of features such as nuclear area and elongation factor or crowding of nuclei, which appear to be differently distributed between benign and malignant nodules, revealing the potential to efficiently evaluate FNA cytology cases ( 36 ). The whole slide imaging, a digital pathology modality, facilitates the use of artificial intelligence in the field of pathology ( 37 ). In the future study, we will develop an artificial intelligence model with multidimensional features including radiological images, clinical indicators, genetic features, and pathological features to reduce the indeterminate diagnosis of patients with TNs, especially for organ donors who might contribute to the transmission of thyroid cancer ( 38 ).…”