The Potential of Telecytology of Cell Block Preparations from Pap Smear Samples "TelePAPology"
K Amin, P Hernandez-Rios, M Davis, F Fan, J Wilson, O Tawfik. Kansas University Medical Center, Kansas City, KS; MAWD Pathology, North Kansas City, MO
Background: Background Digital images are being used for telecytology, automated screening of Pap smears, training and education, as well as, proficiency testing. However, to date, the impact of the digital imaging on routine day to day cytology remains far from perfect. Cell block (CB) preparations from the discarded/residual conventional and liquid based GYN samples have been shown to be feasible, valid and of diagnostic value. Furthermore CBs could be used for detection of HPV DNA by both immunohistochmistry and in-situ hybridization, thus eliminating the need of separate testing. The aim of this study is to evaluate the feasibility of CB using imaging technology to overcome current limitations with digitizing cytologic specimens. Our goal is to present this novel approach as a model for widespread adoption to achieve accurate diagnosis, provide high quality preparations, consistent results and timely reports.
Design: H&E stained CB specimens prepared from residual samples of Pap smears were used. Cellient automated CB system from Hologic (Marlborough, MA) was used to prepare CBs. 31 cases consisting of 11 atypical squamous cells of undermined significance (ASCUS), 12 low grade squamous intraepithelial lesion (LGSIL) and 8 high grade squamous intraepithelial lesion (HGSIL) have been evaluated thus far. Slides were scanned using the Aperio digital imaging system (Vista, CA). They were reviewed manually and digitally by pathologists and cytotechnologists. Correlations were performed between digital and manual CB reads and routineThin prep reads for sensitivity and specificity.
Results: CBs contained optimal amount of material from all cases for meaningful evaluation. There was 100% concordance between manual and digital reads of CBs for both pathologists and cytotechnologists. Compared to thin prep reads, 9 of 11 ASCUS cases were reclassified as LGSIL using CBs and 2 cases of LGSIL were upgraded to HGSIL. Time required for digitally scanning CB slides varied from 2-3 minutes. Average time spent reviewing slides was similar to conventional method (2-5 min).
Conclusions: Digital evaluation of CB prepared from pap samples is a feasible method for widespread adoption to achieve high quality specimen preparations, consistent, reliable and timely diagnosis that can potentially reduce the biopsy load significantly especially in a resource-poor settings. It has the potential to revolutionize the screening for cervical cancer.
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 76, Tuesday Morning