The Use of Telecytopathology (TeleCyP) in Real Time On-Site Evaluation of Fine Needle Aspiration Specimens.
Abha Goyal, Zubair W Baloch, Prabodh K Gupta. Hospital of the University of Pennsylvania, Philadelphia
Background: Telepathology can be challenging to implement as a diagnostic modality in the field of cytopathology; because precise cytopathologic interpretation requires examination of the finest cellular details. Numerous studies have demonstrated that both static and dynamic TeleCyP are useful in providing diagnostic services at remote sites by assessing specimen adequacy, thereby allowing a more effective use of cytopathologist's time. In this study, we have evaluated whether real-time TeleCyP can prove advantageous for on-site assessment in a busy fine needle aspiration (FNA) practice such as at our institution.
Design: A cohort of already diagnosed 38 pancreatic FNAs performed by endoscopic-ultrasound (EUS) was selected to validate the effectiveness of TeleCyP in providing on-site adequacy assessment and interpretation. A cytopathology fellow was responsible for driving the Diff-Quik® stained slides (1 to 2 per case) on the microscope equipped with triple chip high-speed digital video camera (Optronics, Coleta, California) and selecting the fields of interest. Two cytopathologists who were blinded to the final cytopathologic diagnosis, independently examined the images on a personal computer employing “Axis Video Management Software” (Lund, Sweden) in real time. At the same time the cytopathologist was in constant communication with the cytopathology fellow to inquire regarding the pertinent clinical details of the case and pinpoint the fields/cells that needed to be examined on high power.
Results: The average time spent for the TeleCyP on-site diagnosis was 49.2 seconds (range 15 to 165 seconds). An average of 1.6 medium-power fields (10X and 20X) and 1.5 high-power fields (40X) were examined; average time spent in low power field (5X) scanning was 28.4 seconds. There was complete agreement between the TeleCyP on-site and final cytopathology diagnoses in 38 cases (16 adenocarcinomas, 7 mucinous cystic neoplasms, 6 neuroendocrine neoplasms, 5 non-neoplastic conditions and 1 solid pseudopapillary tumor). The discrepancy was noted in only 3(3/38 8%) benign cases which were interpreted as tumor/suspicious for tumor on TeleCyP.
Conclusions: This validation study shows that real-time TeleCyP can be successfully employed for on-site evaluation in a busy FNA service setting. Evaluation of additional cases from other organ systems will be required before we incorporate the routine use of TeleCyP in our practice.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 60, Tuesday Morning