On-Site Adequacy Assessment and Preliminary Diagnosis of Fine-Needle Aspiration Specimen by Telecytopathology
J Carlo-Demovich, CC Massey, JE Madory, PM Houser, R Recavarren, AM Medina, DN Lewin, J Yang. Medical University of South Carolina, Charleston, SC
Background: On-site evaluation of fine-needle aspiration (FNA) specimens by a pathologist is essential to obtain adequate samples and provide a preliminary cytologic diagnosis. However, distance from the pathology laboratory and multiple locations for FNAs makes pathologist on-site evaluation difficult. This study will summarize our experience of on-site evaluation through telecytopathology.
Design: Cytology smears were prepared by cytotechnologists and cytopathology fellows on-site. Dynamic images were captured and processed with Nikon Telepathology L2 System and transmitted via Ethernet, which was accessible from any computer with internet access. A pathologist interpreted the cytology images on a computer screen, communicated with on-site operators over telephone, and provided adequacy assessment and preliminary diagnosis. Rate of sample adequacy and accuracy of preliminary diagnosis through telecytopathology were compared with those obtained by conventional on-site method prior to the use of telecytopathology.
Results: Evaluation of 119 cases via telecytopathology and 144 consecutive cases with conventional pathologist on-site evaluation were compared. The specimen sites were similar in these two groups, included assessment of pancreas, lymph node, liver, stomach, duodenum, bile duct, esophagus, adrenal gland, and rectal sites. Rate of sample adequacy in the telecytopathology group and conventional group was 91.4% and 94.5%, respectively. The preliminary diagnoses of unsatisfactory, adequate (without specific diagnosis), negative/benign, atypical, spindle cell or neuroendocrine neoplasm, suspicious, and positive for malignancy were 8.6%, 21.0%, 17.6%, 12.6%, 5.9%, 5.0% , 29.4% in telecytopathology group and 5.6%, 32.6%, 22.2%, 9.7%, 2.1%, 6.3%, 22.2% in conventional group. The discrepancy between the preliminary and final diagnosis was 6.7% and 4.9%, respectively for telecytopathology and conventional groups. The major difficulty in telecytopathology was to distinguish reactive lymphocytes from neuroendocrine neoplasm of pancreas.
Conclusions: The study demonstrated that on-site evaluation of FNA specimens via telecytopathology provided similar results in assuring sample adequacy and preliminary diagnosis accuracy when compared with the conventional method. Telecytopathology allows pathologists use their time more efficiently and makes on-site evaluations at multiple and/or remote locations possible.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 70, Wednesday Afternoon