远程细胞学诊断用于即时评估细针吸取标本。

Telecytopathology for immediate evaluation of fine-needle aspiration specimens.

机构信息

Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

出版信息

Cancer Cytopathol. 2010 Jun 25;118(3):119-26. doi: 10.1002/cncy.20074.

DOI:10.1002/cncy.20074

PMID:20544707

Abstract

BACKGROUND

On-site evaluation of fine-needle aspiration (FNA) specimens by a pathologist is essential to obtain adequate samples and provide a preliminary diagnosis. Distance from the laboratory can make this difficult. The authors present their experience with on-site evaluation using telecytopathology.

METHODS

Dynamic images of cytology smears were captured and processed with a Nikon digital camera system for microscopy and transmitted via Ethernet. A pathologist accessed the real-time images on a computer and interpreted them while communicating with on-site operators over the telephone. Sample adequacy and accuracy of preliminary diagnosis were compared with those obtained by regular on-site evaluation.

RESULTS

A total of 429 telecytopathology cases and 363 conventional on-site cases were compared. Specimens were mainly from the pancreas, gastrointestinal tract, liver, and lymph nodes. Adequacy rate was 94.0% for telecytopathology and 97.7% for conventional cases. Preliminary diagnoses of unsatisfactory, adequate (defer), negative/benign, atypical, neoplasm, suspicious, and positive for malignancy were 6.3%, 13.5%, 14.9%, 17.9%, 7.2%, 8.6%, and 31.5% for telecytopathology and 3.9%, 30.6%, 21.5%, 9.6%, 5.0%, 5.2%, and 24.2% for conventional cases. Preliminary and final diagnoses were discrepant in 7 (1.8%) of 371 telecytopathology cases, and in 8 (3.1%) of 252 conventional cases. Difficulty was encountered in some cases in distinguishing pancreatic endocrine neoplasm from lymphoid proliferations, and low grade pancreatic tumors from chronic pancreatitis via telecytopathology.

CONCLUSIONS

On-site evaluation of FNA specimens via telecytopathology assures sample adequacy and accurate preliminary diagnosis compared with the conventional method. It allows pathologists to use their time more efficiently and makes on-site evaluations at remote locations possible.

摘要

背景

病理学家现场评估细针抽吸（FNA）标本对于获得足够的样本并提供初步诊断至关重要。但是距离实验室较远会使这变得困难。作者介绍了他们使用远程细胞学进行现场评估的经验。

方法

使用尼康数码相机系统获取细胞学涂片的动态图像进行显微镜检查，并通过以太网传输。病理学家在计算机上访问实时图像，并在通过电话与现场操作人员进行通信的同时对其进行解释。比较了远程细胞学和常规现场评估的样本充足率和初步诊断的准确性。

结果

共比较了 429 例远程细胞学和 363 例常规现场病例。标本主要来自胰腺、胃肠道、肝脏和淋巴结。远程细胞学的充足率为 94.0%，常规现场的为 97.7%。远程细胞学的初步诊断结果为不满意、充足（延迟）、阴性/良性、非典型、肿瘤、可疑和恶性阳性的分别为 6.3%、13.5%、14.9%、17.9%、7.2%、8.6%和 31.5%，常规现场的分别为 3.9%、30.6%、21.5%、9.6%、5.0%、5.2%和 24.2%。在 371 例远程细胞学病例中有 7 例（1.8%）和 252 例常规现场病例中有 8 例（3.1%）的初步和最终诊断存在差异。通过远程细胞学，在某些情况下难以区分胰腺内分泌肿瘤和淋巴组织增生，以及低级别胰腺肿瘤和慢性胰腺炎。