Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
J Am Soc Cytopathol. 2023 Nov-Dec;12(6):407-414. doi: 10.1016/j.jasc.2023.07.002. Epub 2023 Jul 26.
Rapid onsite evaluation (ROSE) decreases rates of inadequate fine-needle aspirations (FNAs). Telecytology allows pathologists to perform ROSE without being physically "on site", thereby saving cytopathologists' travel time and allowing them to perform ROSE for multiple institutions. Little research exists comparing telecytology to non-telecytology ROSE for FNA inadequacy rates.
Using previously obtained quality metrics, we compared inadequacy rates for lymph node and thyroid FNAs with and without ROSE and with non-telecytology ROSE compared with telecytology ROSE. Use of ROSE was determined by the proceduralist. Type of ROSE was location-based, as only certain locations at our institution have telecytology capabilities. Chi-squared testing was used to compare proportions of populations and P value was set to 0.05.
A total of 1168 lymph node and 1177 thyroid FNAs were included in our adequacy analysis. We found any ROSE decreased our inadequacy rate for both lymph node (20.4% to 12.7%, P = 0.002) and thyroid (34.7% to 4.8%, P = 7.4 × 10) FNAs. We found telecytology further decreased our inadequacy rate for lymph node (13.8% to 5.9%, P = 0.016), but not thyroid (3.3% to 5.0%, P = 0.34), FNAs.
At our institution, when using telecytology, slides are read in real time with the cytotechnologist and the proceduralist looking at slides together near the patient bedside, while the cytopathologist is on the phone looking at slides on the computer screen via Dameware. When non-telecytology ROSE is performed, the cytotechnologist evaluates a slide, brings it to the cytopathologist's office and then the cytopathologist calls the proceduralist to discuss the slide. We believe telecytology offers an opportunity for more inclusive communication thereby improving adequacy rates for more complex cases, like lymph nodes, without affecting adequacy rates for cases where assessment of adequacy is less complex, like thyroid. This research supports use of telecytology especially for complex cases.
快速现场评估（ROSE）可降低细针抽吸不足的发生率。远程细胞学允许病理学家在不“现场”的情况下进行 ROSE，从而节省细胞病理学家的旅行时间，并允许他们为多个机构进行 ROSE。关于远程细胞学与非远程 ROSE 对细针抽吸不足率的比较研究较少。
使用先前获得的质量指标，我们比较了有和没有 ROSE 的淋巴结和甲状腺细针抽吸的不充分率，以及非远程 ROSE 与远程 ROSE 的比较。ROSE 的使用由程序员决定。ROSE 的类型是基于位置的，因为我们机构只有某些位置具有远程细胞学功能。使用卡方检验比较人群比例，P 值设为 0.05。
共有 1168 例淋巴结和 1177 例甲状腺细针抽吸纳入我们的充分性分析。我们发现任何 ROSE 都降低了我们的淋巴结（20.4%降至 12.7%，P=0.002）和甲状腺（34.7%降至 4.8%，P=7.4×10）细针抽吸的不充分率。我们发现远程细胞学进一步降低了我们的淋巴结不充分率（13.8%降至 5.9%，P=0.016），但对甲状腺不充分率没有影响（3.3%降至 5.0%，P=0.34）。
在我们的机构中，当使用远程细胞学时，细胞技术人员和程序员实时在患者床边一起查看幻灯片，而细胞病理学家则通过 Dameware 在电话上查看计算机屏幕上的幻灯片。当进行非远程 ROSE 时，细胞技术人员评估一张幻灯片，将其带到细胞病理学家的办公室，然后细胞病理学家打电话给程序员讨论幻灯片。我们认为远程细胞学提供了更具包容性的沟通机会，从而提高了更复杂病例（如淋巴结）的充分性率，而不会影响评估充分性较简单的病例（如甲状腺）的充分性率。这项研究支持使用远程细胞学，特别是对于复杂病例。
