Telecytology for Rapid Preliminary Diagnosis of Ultrasound-Guided Fine Needle Aspiration of Axillary Lymph Nodes in Patients with Prior History of Breast Carcinoma
Andra Kovalovsky, Deepa Masrani, Kamal K Khurana. SUNY Upstate Medical University, Syracuse, NY
Background: In the recent years, the advances in digital methods in pathology have resulted in use of telecytology in the immediate assessment of fine needle aspiration specimens. However, there is a need for organ based and body site specific studies on use of telecytology for immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with use of telecytology for on-site evaluation of ultrasound guided fine needle aspiration USG-FNA of axillary lymph nodes.
Design: Real time images of Diff Quik stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of preliminary diagnosis was compared with final diagnosis, retrospectively. Kappa statistic was used to compare agreements between telecytology preliminary diagnoses versus final diagnoses.
Results: A total of 19 female patients (mean age 50.5 yr.) with prior history of breast carcinoma underwent USG-FNA of 23 axillary nodes. Preliminary diagnoses of benign, suspicious/ malignant and unsatisfactory were 35%, 52%, and 13% respectively. Only one of the 8 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Eleven of 12 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation.There was excellent agreement between telecytology and final cytologic evaluation (Kappa value 87%). Presence of additional material on Pap stained slide and cell block was the main reason for discrepancy, accounting for the two discrepant cases.
Conclusions: This retrospective study demonstrates that on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients with prior history of breast carcinoma is highly accurate compared with final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 231, Tuesday Afternoon