Telecytologic Diagnosis of Breast Fine Needle Aspiration Biopsies

Objective: In this study, the efficiency of telemedical consulting with regard to fine needle aspirates from space-occupying lesions (SOLs) of the liver is investigated for the first time. Study Design: The study includes fine needle aspirations from 62 patients, 33 with hepatocellular carcinoma (HCC) and 29 with non-hepatic tumors. Using the Internet-based iPath system, the initial pathologist submitted 1-8 images from smears and cell block sections. One consultant assessed the cytological and another one the histological images. Both made their diagnoses independent of each other. A final diagnosis was made by immunochemistry of cell block sections. The cytological images were analyzed retrospectively for the occurrence of the most typical HCC indicators. The number of these indicators was related to the initial diagnoses of the three pathologists, and possible reasons for diagnostic errors were analyzed based on this analysis. Results: The accuracy of the preliminary telemedical diagnoses regarding HCC was 82.0% for the cytological images and 87.7% for the histological images. Most of the false diagnoses occurred in tumors with unusual cytological and histological patterns. Conclusions: Telemedical consulting is a valuable tool to obtain a second opinion. However, for improvement of the diagnosis of HCC, supplementary immunochemical tests are necessary.

Section: Discussionsupporting

confidence: 73%

“…But it must be kept in mind that the diagnoses made by the three pathologists are mostly ‘hedged diagnoses' [5,31], i.e. they made their diagnoses with caution, e.g.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Telecytological Diagnosis of Space-Occupying Lesions of the Liver

Mostafa

Dalquen

et al. 2014

“…It has been shown with specimens of pleural effusions [27], FNAs of the breast [41] and gynecological smears [9] that interobserver variability was not significantly lower whether the participant pathologists made their diagnoses on digital images or the original glass slides of the same cases. One could assume that using virtual slides instead of still images might improve the diagnostic accuracy and interrater concordance.…”

Section: Discussionmentioning

confidence: 99%

Making Cytological Diagnoses on Digital Images Using the iPath Network

Dalquen¹,

Prince²,

Spieler

et al. 2014

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/.

“…In the remaining 16%, the images were deemed insufficient for a definitive diagnosis, with 1 case representing a false-negative result in an invasive lobular carcinoma. Briscoe et al [29] reported that observer experience was important in breast fine-needle aspiration static-image telecytology. In their study, the pathologist having the most experience had the highest level of concordance and ‘diagnostic confidence’.…”

Section: Telediagnosis/teleconsultationmentioning

confidence: 99%

Digital Cytology: Current State of the Art and Prospects for the Future

Wilbur¹

2011

The growth of digital methods in pathology is accelerating. Digital images can be used for a variety of applications in cytology, including rapid interpretations, primary diagnosis and second opinions, continuing education and proficiency testing. All of these functions can be performed using small static digital images, real-time dynamic digital microscopy, or whole-slide images. This review will discuss the general principles of digital pathology, its methods and applications to cytologic specimens. As cytologic specimens have unique features compared to histopathology specimens, the key differences will be discussed. Technical and administrative issues in digital pathology applications and the outlook for the future of the field will be presented.