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Agarwal A, Murray J, Sandhu SJ. Image-Guided Biopsies of Superficial and Deep Head and Neck and Skull-Base Lesions. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00008-0. [PMID: 37032175 DOI: 10.1016/j.coms.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Percutaneous image-guided biopsy has largely replaced open surgical biopsies for many head and neck (H&N) lesions, being very safe and minimally invasive. Although the radiologist plays the primary role in these cases, it requires a multidisciplinary approach. Depending upon numerous factors, these biopsies can be either fine-needle aspiration or core needle biopsy, using ultrasound for superficial lesions and computed tomography for deep neck lesions. The most crucial part of H&N biopsies is planning a trajectory to avoid injury to critical anatomic structures. This article outlines the standard biopsy approaches and key anatomical considerations for H&N procedures.
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Affiliation(s)
- Amit Agarwal
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - John Murray
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - S Johnny Sandhu
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Torous VF, Lopez SH, Xu C, Sweeney BJ, Pitman MB. Performance of Rapid On-Site Evaluation in Breast Fine-Needle Aspiration Biopsies: Identifying Areas of Diagnostic Challenge. Acta Cytol 2021; 66:1-13. [PMID: 34816801 DOI: 10.1159/000518579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is a well-established method for sampling breast lesions with high accuracy and positive predictive value. Despite its decline in recent years relative to the use of core needle biopsies, there are several advantages to FNA which include cost-effectiveness, low complication rate, and the ability to perform rapid on-site evaluation (ROSE). The aim of this study was to evaluate breast FNAs with ROSE to identify diagnostic challenges during ROSE. MATERIALS AND METHODS We identified all breast FNAs with ROSE performed at Massachusetts General Hospital from January 2014 to December 2019. From the electronic medical record, clinical, radiological, and follow-up pathology results were recorded. Comparison between the rapid and final cytological diagnosis was made. All discrepancies were documented with major discrepancy defined as a malignant rapid interpretation not confirmed on final diagnosis or a negative rapid interpretation upgraded to suspicious or positive on final diagnosis. RESULTS The study cohort consisted of 483 breast FNAs with ROSE. The rapid and final cytological interpretations showed good correlation, with only 6 (1.2%) major discrepancies. Problematic areas included low-grade, lobular, and fibroepithelial lesions with low cellularity being a contributory factor to misclassification. CONCLUSIONS FNA remains a highly accurate method for the evaluation of breast lesions with ROSE.
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Affiliation(s)
- Vanda F Torous
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christine Xu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda J Sweeney
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Martha B Pitman
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Sauter JL, Chen Y, Alex D, Balassanian R, Cuda J, Flanagan MB, Griffith CC, Illei P, Johnson DN, McGrath CM, Randolph ML, Reynolds JP, Spiczka AJ, van Zante A, VanderLaan PA. Results from the 2019 American Society of Cytopathology survey on rapid onsite evaluation (ROSE)-part 2: subjective views among the cytopathology community. J Am Soc Cytopathol 2020; 9:570-578. [PMID: 32861593 DOI: 10.1016/j.jasc.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aims to improve understanding of the cytopathology community's perspective regarding the value of rapid onsite evaluation (ROSE) in clinical practice. MATERIALS AND METHODS The American Society of Cytopathology membership was surveyed in 2019 to obtain subjective data on the cytopathology community's perceptions regarding ROSE. Comments were categorized by major themes and attitudes and analyzed by respondent's role in laboratory, practice size, and practice setting (Fisher's exact and χ2 tests). RESULTS A total of 541 responses were received from 255 cytopathologists/pathologists, 261 cytotechnologists, 19 trainees, and 6 others (as previously reported). Reasons for which cytopathology personnel provide this service aligned with their perceptions of why clinicians request ROSE. A minority of respondents, disproportionally from high volume centers, felt ROSE is unnecessary. Overall attitude regarding ROSE was generally positive. There were no significant differences in attitude regarding ROSE according to role in laboratory or practice size, but respondents from academic centers provided a significantly higher percentage of positive comments than those in private or community practice. Although survey respondents generally felt that ROSE is valuable to patient care, they also highlighted several challenges, including staffing, time commitment, and inadequate reimbursement. Implementation of telecytology was felt to potentially alleviate some of these challenges. CONCLUSIONS Survey results show that the cytology community views ROSE favorably, practices vary considerably, and there is a perceived need for improved reimbursement. Data from this study may be used to identify areas that warrant additional research to clarify the clinical value of ROSE.
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Affiliation(s)
- Jennifer L Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Deepu Alex
- Department of Pathology and Laboratory Medicine, British Columbia Cancer Agency, Vancouver, Canada
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Jackie Cuda
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melina B Flanagan
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, Morgantown, West Virginia
| | - Christopher C Griffith
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Peter Illei
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Daniel N Johnson
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cindy M McGrath
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center and Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Melissa L Randolph
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amy J Spiczka
- American Society for Clinical Pathology, Chicago, Illinois
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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Yao K, Li Z. Review of different platforms to perform rapid onsite evaluation via telecytology. Cytopathology 2020; 31:379-384. [PMID: 32506692 DOI: 10.1111/cyt.12871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022]
Abstract
There is increased utilisation of cytopathology to provide a rapid onsite evaluation (ROSE) of fine needle aspiration and touch preparations of small biopsies. A well-executed ROSE procedure can significantly impact the diagnostic quality and appropriate specimen triage of procured biopsy materials. To accommodate the demand for ROSE, telecytology has been increasingly implemented to facilitate ROSE occurring remotely. Telecytology can be categorised based on camera systems including eyepiece system, camera port system and robotic microscope/whole slide image scanner system. Image sharing methods include static images, broadcast only live video streaming, teleconferencing and whole slide image management system. In this review, we will discuss the advantages and disadvantages of each of these systems and deployment considerations.
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Affiliation(s)
- Keluo Yao
- Department of Pathology, University of California, San Francisco, California, USA
| | - Zaibo Li
- Deparment of Pathology, The Ohio State Unversity, Columbus, Ohio, USA
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Fetzer R, Duey M, Pena V, Wanzer D, Kirkpatrick J, Chau D, Sarode VR. Role of cytotechnologists in rapid onsite adequacy assessment of cytology materials for diagnostic workup and specimen allocation for ancillary testing using a standardized protocol. J Am Soc Cytopathol 2020; 9:67-75. [PMID: 31543473 DOI: 10.1016/j.jasc.2019.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/23/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Data on the performance of cytotechnologists in assessing specimen adequacy of needle core biopsies (NCB) is scant and their role in specimen triaging for ancillary studies have not been well established. MATERIALS AND METHODS We retrospectively analyzed rapid onsite evaluation (ROSE) performed exclusively by cytotechnologists on 248 NCB and fine-needle aspiration (FNA) specimens. Overall adequacy and accuracy rates were determined by comparing to final diagnosis. We also reviewed the process of specimen allocation for ancillary testing to determine whether specimens were appropriately triaged at the time of ROSE. RESULTS Of the 248 cases, 222 (89.5%) were touch imprint and 26 (10.5%) were FNA smears. The overall adequacy rate was 73.4% (182 of 248). Concordance for "adequate" interpretation by ROSE with unequivocal malignant or benign diagnoses on final interpretation was 95.6%. The sensitivity, specificity, and accuracy of ROSE for a final "positive for malignancy" were 89.2% (95% CI 83.04% to 93.69%), 43.24% (95% CI 31.77% to 55.28%), and 73.87% (95% CI 67.57% to 55.28%), respectively. Cases with "positive for malignancy" on final diagnosis were "adequate" by ROSE in 89.1% (132 of 148) and "inadequate" in 10.8% (16 of 148), P < 0.0001. Ancillary tests were performed in 168 of 248 (67.7%); the majority were immunohistochemical stains for determining tumor subtype. Predictive biomarkers were performed successfully in 100% of metastatic breast cancers. CONCLUSIONS Cytotechnologists performed at a high level of competency in providing ROSE and allocating specimens for ancillary testing, which were performed successfully in the majority of cases. Implementation of a standardized protocol for tissue management/prioritization is of paramount importance to maximize tissue preservation and minimize wastage.
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Affiliation(s)
- Russel Fetzer
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Michelle Duey
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Valerie Pena
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Dana Wanzer
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - James Kirkpatrick
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Donnie Chau
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas
| | - Venetia R Sarode
- Department of Pathology, Clements University Hospital, UT Southwestern Medical Center, Dallas, Texas.
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Kuzan TY, Canbey Goret C. Comparison of Number of Passes and Cytopathological Specimen Adequacy for Thyroid Fine-Needle Aspiration Biopsy in the Absence of an On-Site Pathologist. Eur Thyroid J 2020; 9:49-54. [PMID: 32071902 PMCID: PMC7024850 DOI: 10.1159/000504094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/11/2019] [Indexed: 01/21/2023] Open
Abstract
AIM Ultrasound-guided fine-needle aspiration biopsy (FNAB) is a reliable, minimally invasive diagnostic method with high sensitivity and specificity in the evaluation of thyroid nodules. Our aim in this retrospective study was to determine if there was a difference in the adequacy ratio based on the number of needle passes in the thyroid FNABs in the absence of rapid on-site evaluation (ROSE) by the pathologist and to determine the optimal needle pass number for FNAB. METHODS Between November 2018 and February 2019, thyroid FNABs of 121 (99 female, 22 male) patients were evaluated retrospectively. Samples for each biopsy were numbered according to the order of retrieval, and 4 pairs of slides were prepared by the radiologist without on-site microscopic evaluation. Cytological results were determined according to the Bethesda classification. RESULTS The rate of adequacy in the first, second, third, and fourth passes were 76.0, 82.6, 77.7, and 71.2%, respectively. No statistically significant difference was found between these four groups in terms of adequacy (p = 0.21). The adequacy rates of the 1st, 1st+2nd, 1st+2nd+3rd, and cumulative evaluation of all four biopsies were 76.0, 87.6, 90.1, and 91.7%, respectively (p = 0.001). A statistically significant difference was found in the comparison of the 1st biopsy and the cumulative 1st+2nd biopsy in terms of adequacy rates (p = 0.019). However, there was no statistically significant difference between the cumulative 1st+2nd biopsy and the cumulative 1st+2nd+3rd biopsy in terms of adequacy rates (p = 0.54). CONCLUSIONS In cases where ROSE cannot be performed, we recommend a minimum of 2 and a maximum of 3 needle entries for FNAB adequacy with the right technique and preparation.
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Affiliation(s)
- Taha Yusuf Kuzan
- Department of Radiology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
- *Taha Yusuf Kuzan, MD, Department of Radiology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, TR–34785 Sancaktepe, Istanbul (Turkey), E-Mail ,
| | - Ceren Canbey Goret
- Department of Surgical Pathology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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Lin O, Rudomina D, Feratovic R, Sirintrapun SJ. Rapid on-site evaluation using telecytology: A major cancer center experience. Diagn Cytopathol 2019; 47:15-19. [PMID: 29575752 PMCID: PMC8059101 DOI: 10.1002/dc.23925] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Rapid on-site evaluation (ROSE) with cytology preparations plays a critical role in minimally invasive procedures. The time spent by a pathologist performing ROSE is unpredictable and could be used for more cost-effective activities. The solution encountered by several institutions to address this issue is the use of telecytology (TC). This study analyzes the experience of using telecytology for ROSE in a major cancer center over a period of over 2 years. METHODS A retrospective analysis of all remote TC evaluations for adequacy on fine needle aspiration (FNA) and touch preparations (TP) of core biopsies (CB) performed at a major cancer center was performed. The preliminary adequacy assessment was then compared to the adequacy assessment at final diagnosis. RESULTS A total of 12 949 adequacy assessments were analyzed. The most common sites biopsied in our institution were lymph node, lung, and liver. There were 7725 adequacy assessments for CB (59.7%), while adequacy assessment for FNA specimens represented 40.3% (n = 5224) of the total number of specimens evaluated by ROSE. Perfect concordance between initial adequacy assessment and the adequacy assessment at final cytologic diagnosis was 93% (12 049/12 949). The final diagnosis adequacy upgrade rate was 6.7% (n = 863), and the adequacy downgrade (a specimen considered adequate on-site that was determined to be nondiagnostic on final examination) was 0.3% (n = 37). CONCLUSIONS TC can be easily implemented with the current technologies available. It is cost-effective and allows for better patient care with a more efficient use of the pathologist's time and laboratory resources.
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Affiliation(s)
- Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Dorota Rudomina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Rusmir Feratovic
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - S Joseph Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
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Wang XY, Mahajan H, Dickinson N, Cox C, Byth K, Bayly A, Cahill MA, Pathmanathan N. Fine needle aspiration biopsy cytology of phyllodes tumour and fibroadenoma: A cytomorphological study of 104 cases. Diagn Cytopathol 2018; 46:927-935. [DOI: 10.1002/dc.24021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/01/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Xue Yu Wang
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Hema Mahajan
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Nicole Dickinson
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Carol Cox
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Karen Byth
- Research and Education Network; Westmead Hospital, Western Sydney Local Health District; Westmead New South Wales Australia
| | - Angela Bayly
- Department of Cytology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
- Department of Tissue Pathology and Diagnostic Oncology; ICPMR, Westmead Hospital; Westmead New South Wales Australia
| | - Michael A. Cahill
- School of Biomedical Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - Nirmala Pathmanathan
- Westmead breast cancer institute; Westmead Hospital, Western Sydney Local Health District; Westmead New South Wales Australia
- University of Sydney; Western Clinical School; Westmead New South Wales Australia
- Douglass Hanly Moir Pathology; Macquarie Park New South Wales Australia
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Selhi PK, Tyagi R, Bansal P, Kaur H, Sood N. Hepatic fine-needle aspiration cytology: The role of rapid on-site evaluation in the assessment of hepatic lesions. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:442-447. [PMID: 30249559 DOI: 10.5152/tjg.2018.17466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Radiologically guided fine-needle aspiration cytology (FNAC) of internal organs is not cost-effective. Rapid on-site evaluation (ROSE) of smears by a cytopathologist can improve the diagnostic yield of FNACs and save time and money by reducing the need for repeat procedure/biopsy. To determine the role of ROSE in the diagnostic outcome of hepatic lesions by comparative analysis of FNAC with and without ROSE by a cytopathologist. MATERIALS AND METHODS Hepatic FNACs were retrospectively analyzed over two separate time periods from January 2011 to June 2013 and from January 2015 to July 2016. Smears from 2015-2016 were subjected to ROSE by a cytopathologist after staining with toluidine blue for 1 min to assess adequacy of the material. Final report was given after hematoxylin and eosin, May Grünwald Giemsa, and Papanicolaou staining were performed. Chi-square test (non-parametric) was used to determine if there was a statistically significant increase in the diagnostic yield with ROSE. RESULTS During 2011-2013, of the 160 radiologically guided FNACs for hepatic lesions, 22 were non-diagnostic, whereas during 2015-2016, of 142 radiologically guided hepatic FNACs, only six were non-diagnostic. With the application of ROSE, there was a statistically significant increase in the diagnostic yield of hepatic FNACs from 86.25% to 95.8% (p=0.015). CONCLUSION ROSE performed by a cytopathologist using toluidine blue can increase the diagnostic yield of hepatic FNACs and reduce the cost of healthcare by eliminating the need for a repeat procedure.
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Affiliation(s)
- Pavneet Kaur Selhi
- Department of Pathology, Dayanand Medical College and Hospital, Punjab, India
| | - Ruchita Tyagi
- Department of Pathology, Dayanand Medical College and Hospital, Punjab, India
| | - Priya Bansal
- Department of Community Medicine, Dayanand Medical College and Hospital, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Punjab, India
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Pearson L, Factor RE, White SK, Walker BS, Layfield LJ, Schmidt RL. Rapid On-Site Evaluation of Fine-Needle Aspiration by Non-Cytopathologists: A Systematic Review and Meta-Analysis of Diagnostic Accuracy Studies for Adequacy Assessment. Acta Cytol 2018; 62:244-252. [PMID: 29874653 DOI: 10.1159/000489550] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Rapid on-site evaluation (ROSE) has been shown to improve adequacy rates and reduce needle passes. ROSE is often performed by cytopathologists who have limited availability and may be costlier than alternatives. Several recent studies examined the use of alternative evaluators (AEs) for ROSE. A summary of this information could help inform guidelines regarding the use of AEs. The objective was to assess the accuracy of AEs compared to cytopathologists in assessing the adequacy of specimens during ROSE. STUDY DESIGN This was a systematic review and meta-analysis. Reporting and study quality were assessed using the STARD guidelines and QUADAS-2. All steps were performed independently by two evaluators. Summary estimates were obtained using the hierarchal method in Stata v14. Heterogeneity was evaluated using Higgins' I2 statistic. RESULTS The systematic review identified 13 studies that were included in the meta-analysis. Summary estimates of sensitivity and specificity for AEs were 97% (95% CI: 92-99%) and 83% (95% CI: 68-92%). There was wide variation in accuracy statistics between studies (I2 = 0.99). CONCLUSIONS AEs sometimes have accuracy that is close to cytopathologists. However, there is wide variability between studies, so it is not possible to provide a broad guideline regarding the use of AEs.
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Affiliation(s)
- Lauren Pearson
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Rachel E Factor
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Sandra K White
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Brandon S Walker
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
| | - Lester J Layfield
- Department of Pathology and Laboratory Medicine, University of Missouri, Columbia, Missouri, USA
| | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, Utah, USA
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Tharian B, Krall K, Zhu X, George N, Chambers M, Varadarajulu S, Hebert-Magee S. Endosonographer-driven dynamic telecytopathology of pancreatic lesions-a pilot study. J Am Soc Cytopathol 2018; 7:86-91. [PMID: 31043257 DOI: 10.1016/j.jasc.2017.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Telecytopathology for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been shown to be an alternative to rapid on-site evaluation (ROSE). Gastroenterologists (endosonographers) performing EUS-FNA can be trained to evaluate a specimen for adequacy. This study examined the ability of an endosonographer with focused cytopathologic training to assess the adequacy of pancreatic FNA specimens and transmit diagnostic images to a remotely located cytopathologist as compared to an experienced cytotechnologist. MATERIALS AND METHODS This was a retrospective study of consecutive pancreatic lesions sampled by EUS-FNA reviewed by an endosonographer and a cytotechnologist. The participants were assessed based on their ability to (1) determine adequacy, (2) locate and transmit representative cell groups, (3) provide a preliminary diagnosis, and (4) provide concordance with actual diagnosis. RESULTS 105 consecutive cases of EUS-FNA of the pancreas were analyzed, including: adenocarcinoma (n = 39), cyst (n = 17), neuroendocrine neoplasia (n = 7), pancreatitis (n = 14), benign pancreas (n = 9), other neoplasms (n = 6), suspicious/atypical (n = 3), and nondiagnostic (n = 10). The cytotechnologist demonstrated superiority in accuracy 92.7% versus 70% (P = 0.003) and subcategorization 95.0% versus 76% (P = 0.007). There was no difference in "broad" categorization (benign/malignant) between the endosonographer and cytotechnologist, 98% and 98.2% (P = 0.946), respectively. Also, there was no difference with regard to adequacy assessment (P = 0.29). A steady learning curve for the endosonographer was demonstrated in their cytologic assessment (P = 0.041). The endosonographer was shown to be able to remotely transmit diagnostic images to a pathologist. CONCLUSION An endosonographer with limited training can examine for specimen adequacy, transmit images, and demonstrate representative cell groups. Larger studies are required though preliminary results are encouraging.
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Affiliation(s)
- Benjamin Tharian
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida; University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas.
| | - Konrad Krall
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida
| | - Xiang Zhu
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida
| | - Nayana George
- University of Arkansas for Medical Sciences (UAMS), Little Rock, Arkansas
| | - Michael Chambers
- University of Central Florida College of Medicine, Orlando, Florida
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida
| | - Shantel Hebert-Magee
- Center for Interventional Endoscopy (CIE), Florida Hospital, Orlando, Florida; Center for Diagnostic Pathology, Florida Hospital, Orlando, Florida
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Affiliation(s)
- Oscar Lin
- Memorial Sloan Kettering Cancer Center, Department of Pathology, 1275 York Avenue, New York, NY 10065
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13
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Borhani AA, Monaco SE. Chapter 7 Image-Guided Fine-Needle Aspiration and Core Needle Biopsy of Neck Lymph Nodes: Techniques, Pearls, and Pitfalls. Semin Ultrasound CT MR 2017; 38:531-541. [DOI: 10.1053/j.sult.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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VandenBussche CJ, Adams C, Ali SZ, Olson MT. Cytotechnologist Performance for Screening Hürthle Cell Atypia in Indeterminate Thyroid Fine-Needle Aspirates. Acta Cytol 2015; 59:377-83. [PMID: 26606302 DOI: 10.1159/000441939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We have previously shown that specimens diagnosed as containing Hürthle cells have a 12% chance of being malignant if they are classified as atypia of undetermined significance (AUS-HC). The identification of Hürthle cells by cytotechnologists (CTs) during screening can improve cytopathologist efficiency and may prevent diagnostic errors due to the oversights of focal findings. Here, we examine the performance of our institutional CTs when screening for Hürthle cell atypia in thyroid fine-needle aspiration (FNA) specimens. STUDY DESIGN Information on 8,814 thyroid cytopathology specimens was retrieved for a 10-year period. Specimens were screened by 1 of 11 CTs. A subsample of cases was categorized either as AUS-HC or suspicious for Hürthle cell neoplasm. RESULTS AUS-HC screening diagnoses were more likely to be downgraded to benign but less likely to be upgraded compared to AUS diagnoses with nuclear or microfollicular atypia. AUS-HC represents almost all papillary thyroid carcinoma (PTC) screening diagnoses downgraded to the AUS category, which suggests that even low levels of Hürthle cell atypia can result in PTC being included in the differential diagnosis. CONCLUSION Overall, there are few major discrepancies between CT and pathologist diagnoses for specimens containing Hürthle cell atypia.
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Schmidt RL, Walker BS, Cohen MB. When Is Rapid On-Site Evaluation Cost-Effective for Fine-Needle Aspiration Biopsy? PLoS One 2015; 10:e0135466. [PMID: 26317785 PMCID: PMC4552737 DOI: 10.1371/journal.pone.0135466] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/22/2015] [Indexed: 02/07/2023] Open
Abstract
Background Rapid on-site evaluation (ROSE) can improve adequacy rates of fine-needle aspiration biopsy (FNAB) but increases operational costs. The performance of ROSE relative to fixed sampling depends on many factors. It is not clear when ROSE is less costly than sampling with a fixed number of needle passes. The objective of this study was to determine the conditions under which ROSE is less costly than fixed sampling. Methods Cost comparison of sampling with and without ROSE using mathematical modeling. Models were based on a societal perspective and used a mechanistic, micro-costing approach. Sampling policies (ROSE, fixed) were compared using the difference in total expected costs per case. Scenarios were based on procedure complexity (palpation-guided or image-guided), adequacy rates (low, high) and sampling protocols (stopping criteria for ROSE and fixed sampling). One-way, probabilistic, and scenario-based sensitivity analysis was performed to determine which variables had the greatest influence on the cost difference. Results ROSE is favored relative to fixed sampling under the following conditions: (1) the cytologist is accurate, (2) the total variable cost ($/hr) is low, (3) fixed costs ($/procedure) are high, (4) the setup time is long, (5) the time between needle passes for ROSE is low, (6) when the per-pass adequacy rate is low, and (7) ROSE stops after observing one adequate sample. The model is most sensitive to variation in the fixed cost, the per-pass adequacy rate, and the time per needle pass with ROSE. Conclusions Mathematical modeling can be used to predict the difference in cost between sampling with and without ROSE.
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Affiliation(s)
- Robert L. Schmidt
- Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah, United States of America
- * E-mail:
| | | | - Michael B. Cohen
- Department of Pathology, University of Utah School of Medicine and ARUP Laboratories, Salt Lake City, Utah, United States of America
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Marotti JD, Rao KP, Brister KJ, Gutmann EJ, Tsapakos MJ, Sheiman R, Wang HH, VanderLaan PA. Cytologic rapid on-site evaluation of transthoracic computed tomography-guided lung needle biopsies: who should perform ROSE? A cross-institutional analysis of procedural and diagnostic outcomes. J Am Soc Cytopathol 2015; 4:160-169. [PMID: 31051697 DOI: 10.1016/j.jasc.2015.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Cytologic rapid on-site evaluation (ROSE) during minimally invasive biopsy procedures is an increasingly important service provided by cytopathology to increase diagnostic yield and appropriately triage cellular material. Although ROSE can be performed by cytopathologists, cytotechnologists, or cytopathology fellows, few studies have directly compared both procedural and diagnostic outcome measures among different ROSE personnel. MATERIALS AND METHODS We evaluated all transthoracic computed tomography (CT)-guided lung biopsies in which ROSE was performed during a 1-year period at 2 academic institutions with similar patient populations and procedural methods: Dartmouth-Hitchcock Medical Center (DHMC) (where ROSE is performed by cytopathologists) and the Beth Israel Deaconess Medical Center (BIDMC) (where ROSE is rendered by either cytotechnologists or cytopathology fellows). RESULTS A total of 273 CT-guided transthoracic lung biopsies (190 DHMC, 83 BIDMC) were analyzed. There was no major difference in procedure time with respect to ROSE personnel. The repeat procedure rate for nondiagnostic biopsies was similar at DHMC (cytopathologists) and BIDMC (cytotechnologists or cytology fellows) (2.1% versus 2.3%, P = 1.0). Adequacy rates for cytopathologists, cytotechnologists, and cytopathology fellows were comparable (P = 0.23). ROSE assessments by cytopathologists were more concordant with the final diagnosis (87%) than those by cytotechnologists (82%) or cytopathology fellows (79%); this difference was not statistically significant (P = 0.28). CONCLUSIONS ROSE procedural and diagnostic outcomes for transthoracic CT-guided lung biopsies were similar among cytopathologists, cytotechnologists, and cytopathology fellows.
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Affiliation(s)
- Jonathan D Marotti
- Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Kavitha P Rao
- Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Kathriel J Brister
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Edward J Gutmann
- Department of Pathology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire; Department of Pathology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Michael J Tsapakos
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Radiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Robert Sheiman
- Department of Radiology, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Helen H Wang
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pathology, Harvard Medical School, Boston, Massachusetts
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Bharathidasan M, Thirumurugan R, William BJ, George RS, Arunprasad A, Kannan TA, Viramuthu S. Xylazine-ketamine immobilization and propofol anesthesia for surgical excision of sebaceous adenoma in a jaguar (Panthera onca). Vet World 2014. [DOI: 10.14202/vetworld.2014.986-990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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VandenBussche CJ, Olson MT, Adams C, Ali SZ. Cytotechnologist performance for screening microfollicular atypia in indeterminate thyroid fine-needle aspirates. Acta Cytol 2014; 58:432-8. [PMID: 25341367 DOI: 10.1159/000367882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/25/2014] [Indexed: 01/25/2023]
Abstract
INTRODUCTION We previously identified a high level of accuracy among our cytotechnologists (CTs) for identifying nuclear atypia in thyroid fine-needle aspiration (FNA) specimens. Herewith, we present our CT performance at screening for microfollicular atypia. METHODS 8,814 thyroid FNA specimens were identified in our archives, all screened by 1 of 11 CTs and signed out by a cytopathologist. A subsample of cases was categorized either as atypia of uncertain significance (AUS) with microfollicular proliferation (AUS-F) or suspicious for a follicular neoplasm (SFN). RESULTS The agreement rate was low between CTs and cytopathologists for SFN and AUS-F. Only 55.8% of SFN screening diagnoses were upheld; 27.9% were downgraded to AUS, 10.4% were downgraded to benign, and 5% were upgraded. Of AUS-F screening diagnoses, 35.5% were upheld, 33.7% were downgraded to benign, and 20.2% were upgraded to SFN. Among all cases, two-step discrepancies were uncommon. CONCLUSION Most disagreements were one-category discrepancies between AUS-F and SFN. The evaluation of microfollicular atypia is challenging given that certain follicular lesions cannot be definitively diagnosed on cytology, a high level of subjectivity is involved in the interpretation of such lesions, and the presence of nuclear or Hurthle cell atypia may complicate the diagnosis.
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Rooper LM, Ali SZ, Olson MT. A minimum fluid volume of 75 mL is needed to ensure adequacy in a pleural effusion: a retrospective analysis of 2540 cases. Cancer Cytopathol 2014; 122:657-65. [PMID: 25060164 DOI: 10.1002/cncy.21452] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND No consensus exists regarding minimum fluid volume for adequacy of benign pleural effusion specimens. Although any volume is acceptable if cytologic findings are malignant, the distinction between the absence of disease and false-negativity is not straightforward in low-volume specimens. Recent literature has offered conflicting results regarding what minimum volume is necessary. Moreover, no studies to date have evaluated this issue across a large series of specimens with a wide distribution of volumes. The objective of the current study was to determine the minimum volume of pleural fluid necessary for optimal cytopathological diagnosis. METHODS The authors identified 2540 pleural fluid specimens received between January 2000 and December 2009 and retrospectively reviewed their diagnoses and characteristics. Because of the large range of volumes (1 mL-6500 mL), the cases were binned into 9 groups of roughly equivalent sample sizes. The malignancy fractions (percentage of cases with malignant diagnoses) were compared for each group. RESULTS The current study specimens had a median volume of 200 mL and an overall malignancy fraction of 20.1%. The malignancy fraction increased from 10.1% (95% confidence interval, 8.1%-12.1%) for volumes < 5 mL to 23.3% (95% confidence interval, 20.0%-25.8%) for volumes between 50 mL and 75 mL (P = .009). Specimens with volumes ≥ 75 mL had malignancy fractions independent of volume. In addition, ratios of benign or malignant diagnoses versus nondiagnostic and atypical results continued to increase with volume. CONCLUSIONS A fluid volume of ≥ 75 mL is required to eliminate the influence of specimen size on diagnostic adequacy. Although larger volumes do not appear to impact malignancy fraction, they do correlate with decreased nondiagnostic and atypical results.
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Affiliation(s)
- Lisa M Rooper
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Collins BT. Everything's Coming Up R.O.S.E.s. J Am Soc Cytopathol 2014; 3:57-59. [PMID: 31051701 DOI: 10.1016/j.jasc.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Brian T Collins
- Section Head, Cytopathology, Department of Pathology and Immunology, Division of Anatomic and Molecular Pathology, Washington University in St. Louis, St. Louis, Missouri.
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Olson MT, Novak A, Boonyaarunnate T, Shahid H, Kirby J, Ali SZ. Cytotechnologist-attended on-site evaluation of adequacy for fine-needle aspiration of bone and soft tissue neoplasms. J Am Soc Cytopathol 2014; 3:60-66. [PMID: 31051702 DOI: 10.1016/j.jasc.2013.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION On-site evaluation of adequacy (OSEA) is commonly used to increase the adequacy rate of fine-needle aspiration (FNA) procedures. OSEA is increasingly necessary with the widespread use of image-guided procedures, which are expensive to perform and repeat. The increased demand for OSEA has prompted an increasing reliance on cytotechnologists for OSEA in many practices, including ours. However, the performance of cytotechnologists has not been compared with that of cytopathologists for OSEA in FNA of bone and soft tissue tumors. MATERIALS AND METHODS We retrospectively analyzed 10 years of data in which both cytotechnologists and cytopathologists performed OSEA for 632 bone and soft tissue tumor FNA. We calculated adequacy and accuracy statistics in conjunction with other variables including imaging modality, biopsy site, accompanying core biopsy, tissue type, final diagnosis, and number of smears. RESULTS Of the 632 bone and soft tissue tumor FNA procedures, OSEA was performed in 223 (35.3%) by cytotechnologists and in 409 (64.7%) by cytopathologists. There was no difference in the adequacy downgrade rate for cytotechnologists versus cytopathologists during this study period (4.5 versus 2.4%, P = 0.23). The adequacy rates for procedures in which OSEA was performed by cytotechnologists and cytopathologists did not differ significantly (78.9 versus 84.1%, P = 0.13). CONCLUSIONS Cytotechnologists and cytopathologists are comparably accurate in OSEA of bone and soft tissue neoplasms.
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Affiliation(s)
- Matthew T Olson
- Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anna Novak
- Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Thiraphon Boonyaarunnate
- Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Hinna Shahid
- Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John Kirby
- Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins School of Medicine, Baltimore, Maryland.
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Dudas R, VandenBussche C, Baras A, Ali SZ, Olson MT. Inexpensive telecytology solutions that use the Raspberry Pi and the iPhone. J Am Soc Cytopathol 2014; 3:49-55. [PMID: 31051730 DOI: 10.1016/j.jasc.2013.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/05/2013] [Accepted: 09/06/2013] [Indexed: 06/09/2023]
Abstract
INTRODUCTION There is currently substantial interest in dynamic telecytology-the presentation of microscopic findings by live video feed to a cytopathologist at a remote location. However, the initial costs of a telecytology system can be high. We present several low-cost alternatives along with their performance characteristics. MATERIALS AND METHODS We tested 3 low-cost telecytology systems: a Raspberry Pi with a webcam, an iPhone 4S with FaceTime, and an iPhone 4S with a live streaming app. Costs, resolution capacities, and latency periods for image transmission were determined. RESULTS At $85.55, the Raspberry Pi system is the least expensive telecytology solution described to date. When the cost per megapixel of resolution is considered, the cost of a Raspberry Pi system is 120× less than the most expensive commercially available option and about 7-fold less than the iPhone-based alternatives. Latency periods were substantially lower for the iPhone systems: 2.5 ± 1 seconds for FaceTime and 2.8 ± 0.3 seconds for iPhone live streaming versus 6.6 ± 0.6 seconds for the Raspberry Pi system at comparable frame rates. CONCLUSIONS This proof-of-principle study demonstrates that inexpensive telecytology systems are able to stream live video feeds of cytology slides from a microscope to a remote location at useable resolutions.
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Affiliation(s)
- Radu Dudas
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alex Baras
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T Olson
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ahmed A, Novak AB, Farhat Sheerin A, Boonyaarunnate T, Ali SZ, Olson MT. Accuracy of cytotechnologist evaluation of specimen adequacy and screening interpretation of malignancy in fine-needle aspiration of the liver. Acta Cytol 2014; 58:367-72. [PMID: 25115188 DOI: 10.1159/000364853] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/09/2014] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the performance of cytotechnologists in assessing the adequacy and accuracy of the preliminary diagnosis for fine-needle aspirates of the liver. STUDY DESIGN We retrospectively analyzed 10 years of data and found 589 cases of ultrasound-guided fine-needle aspiration (FNA) of the liver with on-site evaluation of adequacy (OSEA). All the OSEA were performed by the cytopathologist because OSEA of liver FNA is not performed by cytotechnologists at our institution at present. After OSEA, the material was seen by cytotechnologists who rendered an adequacy assessment and preliminary diagnosis. We calculated the adequacy and accuracy statistics and compared the performance of the cytotechnologists with the OSEA and final interpretation. RESULTS There was no statistically significant difference in adequacy downgrade rate for cytotechnologist versus cytopathologist assessment during the study period (5 vs. 3%, p = 0.06). A total agreement of 88% was noted in overall diagnosis with 97% agreement in malignant cases. CONCLUSION Cytotechnologists assess the adequacy of liver FNA accurately and there is therefore potential for them to perform OSEA for liver FNA.
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Affiliation(s)
- Aadil Ahmed
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Md., USA
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