Khurana Kamal K, Kovalovsky Andra, Masrani Deepa
Department of Pathology, State University of New York, 750 East Adams Street, Syracuse, New York.
J Pathol Inform. 2012;3:36. doi: 10.4103/2153-3539.101803. Epub 2012 Sep 28.
In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA) specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA) of axillary lymph nodes in a remote breast care center.
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 the preliminary diagnosis was compared with the final diagnosis, retrospectively.
A total of 39 female patients (mean age: 50.5 years) seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 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. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases.
This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate compared with the final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.
近年来，病理学数字方法的进展促使远程细胞学用于细针穿刺（FNA）标本的即时评估。然而，需要针对基于器官和身体部位的研究，探讨远程细胞学用于FNA即时评估的情况，以评估其缺陷和局限性。我们介绍了在一个偏远乳腺护理中心使用远程细胞学对腋窝淋巴结超声引导下FNA（USG-FNA）进行现场评估的经验。
使用连接到奥林巴斯CX41显微镜的奥林巴斯数码相机获取Diff-Quik染色细胞学涂片的实时图像，由细胞技术人员通过以太网将图像传输给病理学家，病理学家在通过Vocera系统与现场细胞技术人员沟通的同时做出初步诊断。回顾性地将初步诊断的准确性与最终诊断进行比较。
乳腺护理中心共39例女性患者（平均年龄：50.5岁）接受了44个腋窝淋巴结的USG-FNA。初步诊断为良性、可疑/恶性和不满意的分别占41%、52%和7%。最初诊断为良性的23例病例中，只有1例在最终细胞学诊断时重新分类为可疑。最初细胞学检查为可疑/恶性的18例病例中，17例最终细胞学诊断为恶性。1例可疑病例在最终细胞学诊断时重新分类为良性。所有不满意病例最终细胞学解释仍不充分。细胞块中存在额外材料和解释错误是差异的主要原因，占这两例差异病例。
这项回顾性研究表明，在偏远乳腺护理中心，对患者腋窝淋巴结USG-FNA进行现场远程细胞学评估与最终细胞学评估相比具有高度准确性。它使病理学家能够更有效地利用时间，并使在偏远地点进行现场评估成为可能。
