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Dynamic telecytopathology of on site rapid cytology diagnoses for pancreatic carcinoma.

Kim B, Chhieng DC, Crowe DR, Jhala D, Jhala N, Winokur T, Eloubeidi MA, Eltoum IE - Cytojournal (2006)

Bottom Line: Kappa statistics, K, was as follows: telecytopathology versus onsite diagnosis K, 95% CI = 0.65, 0.41-0.88, for telecytopathology versus final K, 95% CI = 0.61, 0.37-0.85 and for onsite diagnosis versus final K, 95% CI = 0.79, 0.61-0.98.There is no significant difference in agreement between onsite and telecytopathology diagnoses.Kappa values for telecytopathology were less than onsite evaluation when compared to the final diagnosis; however, the difference was not statistically significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Scripps Green Hospital/Clinic, Department of Pathology, La Jolla, California, USA. kim.burton@scrippshealth.org

ABSTRACT

Background: Diagnosis of pancreatic lesions can be accurately performed by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) with onsite cytopathologists to assess specimen adequacy and to determine a preliminary diagnosis. Considerable time is needed to perform on-site assessments. This takes away work time of cytopathologists and prohibits them from serving remote locations. It is therefore logical to ask if real-time telecytopathology could be used to assess specimen adequacy and if telecytopathology diagnosis has the same level of agreement to the final diagnosis as that of onsite evaluation. In this study, we compare agreement between cytodiagnoses rendered using telecytopathology with onsite and final interpretations.

Method: 40 Diff-Quik-stained EUS-FNA were re-evaluated retrospectively (patient ages 31-62, 19:21 male:female, 15 non-malignant lesions, 25 malignant lesions as classified by final diagnosis). Each previously assessed by a cytopathologist and finally reviewed by the same or different cytopathologist. Blinded to the final diagnosis, a resident pathologist re-screened all slides for each case, selected a slide and marked the diagnostic cells most representative of the lesion. Blinded to the diagnosis, one cytopathologist assessed the marked cells through a real time remotely operated telecytopathology system (MedMicroscopy). Diagnosis and time spent were recorded. Kappa statistic was used to compare agreements between telecytopathology vs. original onsite vs. final diagnoses.

Results: Time spent for prescreening ranged from 1 to 5 minutes (mean 2.6 +/- 1.3 minutes) and time spent for telecytopathology diagnosis ranged from 2-20 minutes (mean 7.5 +/- 4.5 minutes). Kappa statistics, K, was as follows: telecytopathology versus onsite diagnosis K, 95% CI = 0.65, 0.41-0.88, for telecytopathology versus final K, 95% CI = 0.61, 0.37-0.85 and for onsite diagnosis versus final K, 95% CI = 0.79, 0.61-0.98. There is no significant difference in agreement between onsite and telecytopathology diagnoses. Kappa values for telecytopathology were less than onsite evaluation when compared to the final diagnosis; however, the difference was not statistically significant.

Conclusion: This retrospective study demonstrates the potential use of telecytopathology as a valid substitute for onsite evaluation of pancreatic carcinoma by EUS-FNA.

No MeSH data available.


Related in: MedlinePlus

Pre-screened Region. Figure 2 shows further magnification of the initial whole slide scan at a pre-screened  location marked with two black ink dots.
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Figure 2: Pre-screened Region. Figure 2 shows further magnification of the initial whole slide scan at a pre-screened location marked with two black ink dots.

Mentions: MedMicro System (Trestle Corporation of Irvine, CA) was used for our dynamic telepathology hardware and software. This system consists of remotely operated robotics at the stage, objective, and focus levels incorporated into an Olympus BX41 microscope. This robotic system is connected to a standard PC computer (requirements: Pentium III 450 MHz, Windows 2000, 128 MB RAM, 50 MB of free Hard Drive space, 1280 × 1024 Display). At an offsite location in the cytopathologist office, remote operation was performed through a standard PC computer(requirements: Pentium 200 MMX, Windows 98/NT/2000/ME, 32 MB RAM, 10 MB of free Hard Drive space, 1024 × 768 Display) through Internet Protocol (IP). The included MedMicro Viewer software also allows full navigation of the slide, including control of objective, focus, and illumination. This system enables transfer of 24-bit images to be interpreted in a dynamic fashion in real-time (see figures 1, 2, 3).


Dynamic telecytopathology of on site rapid cytology diagnoses for pancreatic carcinoma.

Kim B, Chhieng DC, Crowe DR, Jhala D, Jhala N, Winokur T, Eloubeidi MA, Eltoum IE - Cytojournal (2006)

Pre-screened Region. Figure 2 shows further magnification of the initial whole slide scan at a pre-screened  location marked with two black ink dots.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1713251&req=5

Figure 2: Pre-screened Region. Figure 2 shows further magnification of the initial whole slide scan at a pre-screened location marked with two black ink dots.
Mentions: MedMicro System (Trestle Corporation of Irvine, CA) was used for our dynamic telepathology hardware and software. This system consists of remotely operated robotics at the stage, objective, and focus levels incorporated into an Olympus BX41 microscope. This robotic system is connected to a standard PC computer (requirements: Pentium III 450 MHz, Windows 2000, 128 MB RAM, 50 MB of free Hard Drive space, 1280 × 1024 Display). At an offsite location in the cytopathologist office, remote operation was performed through a standard PC computer(requirements: Pentium 200 MMX, Windows 98/NT/2000/ME, 32 MB RAM, 10 MB of free Hard Drive space, 1024 × 768 Display) through Internet Protocol (IP). The included MedMicro Viewer software also allows full navigation of the slide, including control of objective, focus, and illumination. This system enables transfer of 24-bit images to be interpreted in a dynamic fashion in real-time (see figures 1, 2, 3).

Bottom Line: Kappa statistics, K, was as follows: telecytopathology versus onsite diagnosis K, 95% CI = 0.65, 0.41-0.88, for telecytopathology versus final K, 95% CI = 0.61, 0.37-0.85 and for onsite diagnosis versus final K, 95% CI = 0.79, 0.61-0.98.There is no significant difference in agreement between onsite and telecytopathology diagnoses.Kappa values for telecytopathology were less than onsite evaluation when compared to the final diagnosis; however, the difference was not statistically significant.

View Article: PubMed Central - HTML - PubMed

Affiliation: Scripps Green Hospital/Clinic, Department of Pathology, La Jolla, California, USA. kim.burton@scrippshealth.org

ABSTRACT

Background: Diagnosis of pancreatic lesions can be accurately performed by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) with onsite cytopathologists to assess specimen adequacy and to determine a preliminary diagnosis. Considerable time is needed to perform on-site assessments. This takes away work time of cytopathologists and prohibits them from serving remote locations. It is therefore logical to ask if real-time telecytopathology could be used to assess specimen adequacy and if telecytopathology diagnosis has the same level of agreement to the final diagnosis as that of onsite evaluation. In this study, we compare agreement between cytodiagnoses rendered using telecytopathology with onsite and final interpretations.

Method: 40 Diff-Quik-stained EUS-FNA were re-evaluated retrospectively (patient ages 31-62, 19:21 male:female, 15 non-malignant lesions, 25 malignant lesions as classified by final diagnosis). Each previously assessed by a cytopathologist and finally reviewed by the same or different cytopathologist. Blinded to the final diagnosis, a resident pathologist re-screened all slides for each case, selected a slide and marked the diagnostic cells most representative of the lesion. Blinded to the diagnosis, one cytopathologist assessed the marked cells through a real time remotely operated telecytopathology system (MedMicroscopy). Diagnosis and time spent were recorded. Kappa statistic was used to compare agreements between telecytopathology vs. original onsite vs. final diagnoses.

Results: Time spent for prescreening ranged from 1 to 5 minutes (mean 2.6 +/- 1.3 minutes) and time spent for telecytopathology diagnosis ranged from 2-20 minutes (mean 7.5 +/- 4.5 minutes). Kappa statistics, K, was as follows: telecytopathology versus onsite diagnosis K, 95% CI = 0.65, 0.41-0.88, for telecytopathology versus final K, 95% CI = 0.61, 0.37-0.85 and for onsite diagnosis versus final K, 95% CI = 0.79, 0.61-0.98. There is no significant difference in agreement between onsite and telecytopathology diagnoses. Kappa values for telecytopathology were less than onsite evaluation when compared to the final diagnosis; however, the difference was not statistically significant.

Conclusion: This retrospective study demonstrates the potential use of telecytopathology as a valid substitute for onsite evaluation of pancreatic carcinoma by EUS-FNA.

No MeSH data available.


Related in: MedlinePlus