Pinco Jeffery, Goulart Robert A, Otis Christopher N, Garb Jane, Pantanowitz Liron
Departments of Pathology, Tufts University School of Medicine, Springfield, MA 01199, USA.
Arch Pathol Lab Med. 2009 Jan;133(1):57-61. doi: 10.5858/133.1.57.
Digital images have become an important component of cytology practice. They are used in telecytology, automated screening, educational material, and Web sites and have potential for use in proficiency testing. However, there has been no formal evaluation to date to determine if digital image manipulation (intentional or unintentional) can affect their interpretation.
To investigate whether alteration of digital cytology images affects diagnosis.
Acquired digital images of ThinPrep Papanicolaou test slides were manipulated (rotated 90 degrees and brightness, contrast, red-green-blue color, and luminosity adjusted) using Photoshop. A test composed of these altered images, along with their original (unaltered) image and exact duplicates was given to 22 cytologists (13 cytotechnologists, 8 cytopathologists, and 1 fellow). All images were rated as negative, atypical (atypical squamous cells of undetermined significance), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or positive for cancer. Weighted kappa and heterogeneity chi(2) statistics were used to measure levels of agreement and assess concordance between groups.
The level of agreement for identical duplicate images was excellent (kappa = 0.81), compared with the poor agreement for manipulated image pairs (kappa = 0.21), a statistically significant difference (P < .001). For all altered image types agreement was poor. There was no significant difference between cytotechnologists and cytopathologists in level of agreement (P = .56).
Manipulation of a Papanicolaou test digital image, irrespective of the specific category of cytologic material photographed, significantly affects its interpretation by both cytotechnologists and cytopathologists. This suggests that care needs to be taken when digital cytology images are used, to specifically ensure that their alteration does not affect diagnosis.
数字图像已成为细胞学实践的重要组成部分。它们用于远程细胞学、自动筛查、教育材料和网站，并且在能力验证方面具有应用潜力。然而，迄今为止尚未进行正式评估以确定数字图像操纵（有意或无意）是否会影响其解读。
研究数字细胞学图像的改变是否会影响诊断。
使用Photoshop对ThinPrep巴氏染色测试玻片的采集数字图像进行处理（旋转90度并调整亮度、对比度、红-绿-蓝颜色和亮度）。由这些改变后的图像、其原始（未改变）图像和精确复制品组成的测试被提供给22位细胞学家（13位细胞技术专家、8位细胞病理学家和1位研究员）。所有图像被评为阴性、非典型（意义不明确的非典型鳞状细胞）、低级别鳞状上皮内病变、高级别鳞状上皮内病变或癌症阳性。使用加权kappa和异质性卡方统计量来测量一致性水平并评估组间的一致性。
相同复制品图像的一致性水平极佳（kappa = 0.81），相比之下，处理后图像对的一致性较差（kappa = 0.21），差异具有统计学意义（P < .001）。对于所有改变后的图像类型，一致性都很差。细胞技术专家和细胞病理学家在一致性水平上没有显著差异（P = .56）。
无论所拍摄的细胞学材料的具体类别如何，对巴氏染色测试数字图像的处理都会显著影响细胞技术专家和细胞病理学家对其的解读。这表明在使用数字细胞学图像时需要谨慎，特别要确保其改变不会影响诊断。
