Utility of Telecytopathology for Rapid Preliminary Diagnosis and Adequacy Assessment of Fine Needle Aspiration Biopsies
S Sanyal, ZU Khan, CT Steele, KK Khurana. SUNY Upstate Medical University, Syracuse, NY
Background: Telepathology, the practice of pathology at a distance, has been successfully tried for over two decades in various areas of pathology from medical education to diagnostic pathology, including consultation and frozen section diagnosis. However, the use of telepathology by cytopathologists has been limited to date. We present our institution's experience of using telecytology in rendering a preliminary diagnosis and adequacy assessment of Fine Needle Aspiration (FNA) procedures.
Design: A total of 39 cases were included in the study including a double blinded retrospective study of 15 cases and 24 cases performed prospectively. A telepathology system consisting of Olympus CX41 microscope and digital camera with NetCam software was used to transmit the images. The microscope was operated by different cytotechnologists and fellows who communicated with the viewing cytopathologists on a speaker phone. Comparison was made between preliminary diagnosis rendered by telepathology and the final diagnosis. Reasons for discrepancies were analyzed.
Results: The overall concordance rate between the preliminary and final diagnoses was 92.3%. The specimens were obtained from lymph nodes (14), thyroid (11), pancreas (7), bone (3), lungs (2) and head and neck (2). The final diagnoses were categorized as non-diagnostic in 3(7.7%), benign in 19(48.7%) and malignant in 17(43.6%) cases. Of the 15 cases selected for the retrospective study, 13(86.6%) showed concordance between the preliminary and final diagnoses. The two cases in which the diagnoses did not tally were both called 'atypical' initially. The final diagnosis was 'non small cell carcinoma' in one and 'benign ductal cells' in the other. In the first case, the diagnostic cells were not focused by the microscope operator. In the second case, reactive ductal cells were misinterpreted as atypical. There was only one diagnostic discrepancy in the 24 cases done prospectively with a concordance rate of 95.8%. This discrepant case was initially diagnosed as benign whereas the cell block showed metastatic renal cell carcinoma. Review of slides revealed misinterpretation of atypical malignant cells as being histiocytes.
Conclusions: Telecytopathology appears to be a reliable and effective method for rendering preliminary diagnosis and adequacy assessment during FNA procedures. It saves valuable time for the cytopathologists and makes real time consultation possible. Operator dependent mistakes can likely be overcome with further experience and training.
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 54, Monday Morning