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

Abstract

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.

Rapid On-site Evaluation (ROSE) for Fine Needle Aspiration of Thyroid: Is It Helpful?

“…Multiple studies around the world has demonstrated beneficial effect of this strategy in decreasing the rate of inadequate specimen with US-FNA at multiple sites, including thyroid [7,[9][10][11][12]. Some even suggested using tele-cytopathology to overcome the shortage of onsite cytopathologist at some sites [13]. However, this comes with the price of prolonging the procedure time and increasing the cost, with some studies suggesting no overall benefit [14,15].…”

Recommendations for pathologic practice using digital pathology: consensus report of the Korean Society of Pathologists

“…1) Cytology slides: In most cases with cell smears, liquid-based cytology, or blood smears, the results are similar to those from microscopic diagnoses made using glass slides with appropriate focus stacking (Z-stacking) during scanning and sufficient validation [52]. However, the optimal focus stacking method must be carefully selected for certain sample types (e.g., samples with many 3-dimensional structures, such as thyroid gland fine-needle aspirates [53]), staining conditions, and smear conditions. Excessive focus stacking and the acquisition of higher-magnification images (60 × 100 × or higher) could lead to over-scaling of the WSI files, which could negatively affect the operation of the entire system [6].…”

“…When diagnoses are made using portable terminals such as a tablet PC, the use of a relatively small screen is a major concern. The results of a recent study suggest that diagnosis using portable terminals should be limited to special cases that require relatively low accuracy but rapid reporting of results, such as frozen section tests [1,53,65]. These terminals are generally not reliable for routine diagnostic work.…”

The impact of the COVID‐19 pandemic on cytopathology practice

“…Although partly attributed to patient selection, the absence of in‐person intradepartmental consensus meetings can partially explain these results. As previously reported, there is a tendency to have a lower threshold for applying indeterminate diagnostic categories when using virtual platforms for diagnosis 10 . However, virtual platforms have enjoyed a boost during the pandemic, not only for diagnosis but also for educational purposes, allowing residents’ training to continue 5 .…”