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

Chantziantoniou, Nikolaos; Mukherjee, Maheswari; Donnelly, Amber; Pantanowitz, Liron; Austin, R. Marshall

doi:10.1159/000484434

Cited by 33 publications

(41 citation statements)

References 35 publications

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“…After the implementation of the whole-slide imaging (WSI) technology, the use of digital pathology for diagnostic purposes rapidly spread, due to the superiority of the technique in comparison with both static and robotic telepathology. To date, digital pathology has largely been studied; however; the application of telecytology (TC) for primary diagnosis is still in early stages, especially due to technical difficulties reported in the literature [1].…”

Section: Introductionmentioning

confidence: 99%

The Role of Telecytology in the Primary Diagnosis of Thyroid Fine-Needle Aspiration Specimens

et al. 2019

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Introduction: The Acibadem Health Group (AHG) has been using telepathology/digital pathology stations since 2006. In 2013, the system was changed from videoconferencing to digital pathology (whole-slide imaging) utilizing 3DHISTECH scanners and software. In 2017, digital cytology started to be used for routine cytopathologic diagnosis for thyroid fine-needle aspiration (FNA) cases. Material and Methods: Two hundred and twenty-seven thyroid cases were received for analysis using telecytology (TC) during the period from November 2017 to May 2018. Rapid on-site evaluation was performed at the Atakent Hospital of the AHG by a cytotechnologist and scanned on the same day. For every case, there were Diff-Quik- and Papanicolaou-stained FNA smears. Each glass slide was digitized with a 3DHISTECH whole-slide scanner in 1 focal Z-plane at ×40 magnification. Results: Two hundred and twenty-seven thyroid FNA specimens were retrieved, of which 25 had histologic follow-up. Samples were classified as nondiagnostic in 3%, benign in 74%, atypia of undetermined significance/follicular lesion of undetermined significance in 13%, suspicious for follicular neoplasia/follicular neoplasia in 3%, suspicious for malignancy in 4%, and malignant in 3%. When only the “suspicious for malignancy” and “malignancy” categories were considered positive tests, cytology sensitivity and specificity using TC for diagnosis was 100%. Conclusions: Our data demonstrate that TC is suitable to provide a primary diagnosis in daily routine cytology practice. Despite the promising results, there were some challenges stemming from the novelty of using TC for the primary diagnosis. The study also addresses both advantages and disadvantages of TC in daily practice to increase the efficiency of the technique in primary diagnosis.

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Section: Introductionmentioning

confidence: 99%

The Role of Telecytology in the Primary Diagnosis of Thyroid Fine-Needle Aspiration Specimens

et al. 2019

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“…The practice of digital cytology is gaining traction worldwide, and is particularly suitable for applications such as telecytology . For this purpose, there are various imaging modalities available including static, video (streaming), live robotic and/or whole slide imaging.…”

Section: Introductionmentioning

confidence: 99%

“…The practice of digital cytology is gaining traction worldwide, and is particularly suitable for applications such as telecytology. [3][4][5] For this purpose, there are various imaging modalities available including static, video (streaming), live robotic and/or whole slide imaging. However, there are several attributes unique to cytology specimens and workflow that make the use of digital pathology more challenging than surgical pathology.…”

Section: Introductionmentioning

confidence: 99%

Advantage of Z‐stacking for teleconsultation between the USA and Colombia

Mosquera-Zamudio

Hanna

Parra‐Medina

et al. 2018

Diagnostic Cytopathology

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Introduction There is an emerging need for telecytology in Colombia as the demand for cytopathology has increased. However, due to economic and technological constraints telecytology services are limited. Our aim was to evaluate the diagnostic feasibility of using whole slide imaging with and without Z‐stacking for telecytology in Colombia, South America. Methods Archival glass slides from 17 fine needle aspiration smears were digitized employing whole slide imaging (WSI) (Nanozoomer 2.0 HT, Hamamatsu) in one Z‐plane at 40x, and panoramic digital imaging (Panoptiq system, ViewsIQ) combining low‐magnification digital maps with embedded 40x Z‐stacks of representative regions of interest. Fourteen Colombian pathologists reviewed both sets of digital images. Diagnostic concordance, time to diagnosis, image quality (scale 1–10), usefulness of Z‐stacking, and technical difficulties were recorded. Results Image quality scored by pathologists was on average 8.3 for WSI and 8.7 for panoramic images with Z‐stacks (P = .03). However, diagnostic concordance was not impacted by image quality ranking. In the majority of cases (72.4%) pathologists deemed Z‐stacking to be diagnostically helpful. Technical issues related to Z‐stack video performance constituted only a minor proportion of technical problems reported. Slow downloads and crashing of files while viewing were mostly experienced with larger WSI files. Conclusion This study demonstrated that international telecytology for diagnostic purposes is feasible. Panoramic images had to be acquired manually, but were of suitable diagnostic quality and generated smaller image files associated with fewer technical errors. Z‐stacking proved to be useful in the majority of cases and is thus recommended for telecytology.

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“…Whole-slide-Image (WSI) is a procedure that permits the digitalization of samples of pathological purpose to obtain high-resolution images. Due to the various applications of this technology, it has become a key factor for the innovation of digital pathology [1], unleashing in the construction of different microscopes based on this approach [2][3][4][5][6][7][8][9][10][11]. Unfortunately, there are limitations for the implementations of WSI for clinical use, among them is its high cost due to the use of specialized software, hardware, and maintenance .…”

Section: Introductionmentioning

confidence: 99%

An Overlapping and Integral Blurry Evaluation Method to Optimize Tissues Scanning from Microscope

et al. 2018

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Virtual microscopes are devices that employ an automated XYZ mechanism to scan a sample, leading to the obtention of a series of small pictures that, when merged, compose a high-quality representation of the specimen. Due to the assembly tolerances, these devices may suffer from zones out of focus, reducing the quality of the final image. To solve this problem, researchers employ evaluation methods to calculate the blurriness of the image, and when an out of focus picture is located, performs the process of autofocus. Because of the variation on the types of samples, especially in pathology, the existing evaluation methods may fail to deliver a proper blur detection. This article proposes an optimized algorithm for the detection of the blurriness while conducting the sample scan in real time, ensuring that every scanned picture will be in focus. For this purpose, the algorithm relies on two functions, the comparison of the overlapping zones of two consecutive images, and the multivariate linear regression of a series of focus functions. The algorithm proved to be a reliable tool when applied in different pathology samples.

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

Cited by 33 publications

References 35 publications

The Role of Telecytology in the Primary Diagnosis of Thyroid Fine-Needle Aspiration Specimens

The Role of Telecytology in the Primary Diagnosis of Thyroid Fine-Needle Aspiration Specimens

Advantage of Z‐stacking for teleconsultation between the USA and Colombia

An Overlapping and Integral Blurry Evaluation Method to Optimize Tissues Scanning from Microscope

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