Digitally Assisted Review of PAP Smear Cellblock Preparations "Telepapology" Is a Valid Screening/Diagnostic Method.
Khalid Amin, Marilyn Davis, Susan Dillon, Marsha Danley, Francisco Diaz, Laila Tawfik, Pablo Hernandez-Rios, Jeff Wilson, Fang Fan, Rashna Madan, Ossama Tawfik. Kansas University Med Ctr, Kansas City; MAWD Pathology Group, Kansas City, MO
Background: The Pap test is a useful method for the detection of precancerous and cancerous lesions of the cervix. To date, the impact of digital imaging on routine day to day cytology remains far from perfect. Cellblock (CB) preparations from discarded/residual conventional and liquid based GYN samples have been shown to be of diagnostic value. In a pilot study, we have demonstrated the feasibility of utilizing imaging technology to overcome current limitations by digitizing cytologic specimens from CB preparations. Our goal is to develop a web-based diagnostic process in which virtual slides of CBs (TelePAP) could be analyzed remotely, as a model for widespread adoption. Our objective is to compare test performance characteristics of ThinPrep (TP) and TelePAP samples.
Design: The Cellient system from Hologic (Marlborough, MA) was used to prepare CBs. 335 H&E stained CB slides prepared from residual TP samples, including 233 normal, 44 ASCUS, 44 LSIL and 14 HSIL cases, were analyzed. TelePAP slides were obtained using the Aperio digital imaging system (Vista, CA). They were reviewed by 3 cytopathologists and 2 cytotechnologists. Test performance characteristics of TP and TelePAP samples were compared for sensitivity and specificity.
Results: CBs contained optimal amount of material from all cases for meaningful evaluation. The average sensitivity and specificity of the 5 reviewers for the TelePAP method was 81.6% and 87.8%, respectively, for negative cases, 55.1% and 87% for ASCUS cases, 52.0% and 92% for LSIL cases and 49.4% and 98.8% for HSIL cases. Agreement between TelePAP reviewers and TP diagnosis was as follows: Kappa 0.49, 0.61, 0.75, 0.76 and 0.81. Agreement between the 5 TelePAP reviewers for each diagnosis was kappa 0.66. Compared to TP diagnosis, a significant number of ASCUS cases were reclassified as either normal or LSIL using TelePAP method and fewer numbers of LSIL cases were either up or down graded. 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: TelePAPology is a feasible method for widespread adoption to achieve high quality specimen preparations. It is as sensitive as TP method and appears to be highly specific for detection of LSIL and HSIL lesions. This method has the potential to revolutionize screening for cervical cancer. It is suitable for routine cytology, in situ and immunohistochemistry testing for HPV and other prognostic markers.
Monday, February 28, 2011 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 62, Monday Morning