Making Cytological Diagnoses on Digital Images Using the iPath Network

Abstract

Background: The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool. Aim: To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set. Method: Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant. Results: For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93%, respectively; the overall accuracy was 88-90%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benignlesions. Conclusion: Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.

International telecytology: Current applications and future potential

“…The majority of international telecytology studies reported overall concordance rates above 80%, with a range of 71%‐93% (Table ). This is comparable to the concordances rates published from other studies comparing diagnoses made by digital still images to reference glass slides, which vary from 80% to 95% . Reported concordance and accuracy rates for dynamic telecytology are higher, at 95%‐97% concordance and 99% accuracy, perhaps owing to better selection of diagnostic materials up front by viewing the entire slide in real‐time.…”

“…International telepathology consultation services with digital whole slide image capabilities have been established at several academic medical centers, including the University of Pittsburgh Medical Center (UPMC), the University of California at Los Angeles (UCLA), and the University of Utah through Associated Regional and University Pathologists (ARUP) Laboratories (Dr. Rosai Surgical Pathology Consultative Services) . Other platforms for international telepathology consultation include the iPath network, MECEMS (the Medical Electronic Consultation Expert system), and the Virtual International Pathology Institute (VIPI) . Despite the range of international telepathology consultation services available, very few studies on international telecytology in clinical practice using WSI have been published.…”

“…Most of the international telecytology studies reported here used digital still cameras (usually Nikon brand) attached to microscopes. Methods for transferring images from the referring pathologists to the consulting pathologists varied, including: (1) attaching images to an email, (2) uploading images to a website for online review through a digital portal or shared weblink, or (3) file transfer protocol to a custom server network, from which the digital telecytology images could be reviewed, and (4) using a smartphone application to transfer images from smartphone to smartphone . In all the studies, clinical history and other pertinent data were made available in some fashion along with the digital images, and on several platforms consulting pathologists could leave comments for other reviewers prior to finalizing the diagnosis.…”

“…It is important to keep in mind, however, that a static telecytology consultation cannot replace examination of the entire specimen, and thus is not suitable for a primary diagnosis, but rather for a second opinion. Lastly, diagnostic difficulty was faced with all sample types due to lack of immunocytochemical and/or molecular or other ancillary testing …”

The Impact of Prospective Telemedicine Implementation in the Management of Childhood Acute Lymphoblastic Leukemia in Recife, Brazil

“…20 The iPath platform provides expert pathologic review for colleagues in developing countries. 21 In addition, the SickKids-Caribbean Initiative 22 is a regional program sponsored by the Hospital for Sick Children in Toronto, Canada, to build capacity in six Caribbean countries to improve the outcomes of children with cancers and blood disorders. Other projects to improve care for specific underserved areas within the U.S. include the Pacific Island Health Care Project, 23 which provides expert care to the indigenous people of the U.S.-associated Pacific Islands, and the Kansas University Center for Telemedicine & Telehealth, 24 which provides clinical and educational support for several underserved areas in Kansas.…”