Working toward consensus among professionals in the identification of classical cervical cytomorphological characteristics in whole slide images

Abstract

Introduction:Cervical cancer is one of the most common causes of death in women worldwide.[1] The introduction of cervical cytology in screening programs is an effective way for early detection and treatment of cervical precancerous lesions. Conventional screening of cervical cytology slides is still considered the current “gold standard” for the assessment of proficiency in becoming a cytotechnician, but diagnosis using digital whole slide images (WSI) may offer many advantages.Materials and Methods:In this study, we have used a selection of WSI from thin-layer specimens of the most common cervical infections and (pre) neoplastic lesions, and hypothesized that weekly WSI based case-meetings would help to obtain optimal acceptance of the new digital workflow in daily pathology practice. A questionnaire, before and after the test period was used to study the effect of our approach.Results:The participants clearly had to go through a learning curve to get accustomed to viewing WSI. In the beginning, there was a little self-confidence in recognizing classical cervical cytomorphological features in the WSI, and there were complaints about the speed of viewing and insufficient Z-resolution for cell groups. Adjusting the Z-stack settings resulted in better three-dimensional information due to better focusing options. Weekly meetings appeared to be instrumental in the implementation process, as participants had to select and present WSI from thematic cases themselves, and thereby, got used to viewing WSI. Some WSI were replaced by better ones until a final set of 45 representatives WSI remained. Eventually, the consensus was reached among all participants that cytomorphological features in WSI from thin-layers cervical specimens could comparably be appreciated in WSI as by conventional microscopy. The selection of 45 WSI was now used to create a digital WSI based reference atlas to support further studies.Conclusion:We have obtained consensus between professionals that WSI from cervical cytology can be used to identify cytomorphological features, necessary for diagnosis. In addition, we observed that active participation of professionals had a positive effect on the overall acceptance of WSI and was important in the change management.

Being fully digital: perspective of a Dutch academic pathology laboratory

“…Furthermore, we are currently exploring ways of integrating in‐house‐developed deep‐learning algorithms and Visiopharm image‐processing algorithms for routine diagnostic work in order to determine how effective they would be in practice. Finally, we have started working on the implementation of Z‐scanning for cytology . When Z‐stacks appear to be necessary, this will have consequences for our scanning and storage workflow.…”

“…Finally, we have started working on the implementation of Zscanning for cytology. 22,23 When Z-stacks appear to be necessary, this will have consequences for our scanning and storage workflow.…”

Digital cytology: A short review of technical and methodological approaches and applications

“…In a recent study, Bongaerts et al found that in cervical LBC, the observers found a distance of 2 μm between the z‐dimension layers and seven levels more acceptable than a 1 μm distance. Earlier, Mori et al in a complex study based on cells dimensions determined that “layers of 1.5 μm thickness each with a total of 10 to 15 layers resulting in 15 to 20 μm scan is suitable for most cytology slides”.…”

Dermatopathology – the link between ancillary techniques and clinical lesions

“…Despite meticulous scanning of a sample, certain features such as granules, small inclusion bodies and small pathogens are not necessarily obvious on scanned slides (personal observation). In such instances, the pathologist needs to go back to the actual glass slide or request reimaging of the glass slide by alternative modalities, such as Z‐stack images …”

“…In such instances, the pathologist needs to go back to the actual glass slide or request reimaging of the glass slide by alternative modalities, such as Z-stack images. 6…”