Ren Fei, Li Huange, Yang Wentao, Chen Ying, Zheng Yuwei, Zhang Hao, Zhou Shuling, Ping Bo, Shi Peng, Wan Xiaochun, Wang Yanli
Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Diagn Cytopathol. 2025 Jan;53(1):18-26. doi: 10.1002/dc.25401. Epub 2024 Aug 29.
Whole-slide imaging (WSI) is a promising tool in pathology. However, the use of WSI in cytopathology has lagged behind that in histology. We aimed to evaluate the utility of WSI for the intraoperative touch imprint cytological diagnosis of axillary sentinel lymph nodes (SLNs) in breast cancer patients.
Glass slides from touch imprint cytology of 480 axillary SLNs were scanned using two different WSI scanners. The intra- and interobserver concordance, accuracy, possible reasons for misdiagnosis, scanning time, and review time for three cytopathologists were compared between WSI and light microscopy (LM).
A total of 4320 diagnoses were obtained. There was substantial to strong intraobserver concordance when comparing reads among paired LM slides and WSI digital slides (κ coefficient ranged from 0.63 to 0.88, and concordance rates ranged from 94.58% to 98.33%). Substantial to strong interobserver agreement was also observed among the three cytopathologists (κ coefficient ranged from 0.67 to 0.85, and concordance rates ranged from 95.42% to 97.92%). The accuracy of LM was slightly higher (average of 98.06%) than that of WSI (averages of 96.81% and 97.78%). The majority of misdiagnoses were false negative diagnoses due to the following top three causes: few cancer cells, confusing cancer cells with histiocytes, and confusing cancer cells with lymphocytes.
This study is the first to address the feasibility of WSI in touch imprint cytology. The use of WSI for intraoperative touch imprint cytological diagnosis of SLNs is a practical option when experienced staff are not available on-site.
全切片成像（WSI）在病理学中是一种很有前景的工具。然而，WSI在细胞病理学中的应用落后于组织学。我们旨在评估WSI在乳腺癌患者腋窝前哨淋巴结（SLN）术中触摸印片细胞学诊断中的效用。
使用两种不同的WSI扫描仪对480个腋窝SLN的触摸印片细胞学玻璃切片进行扫描。比较了WSI和光学显微镜（LM）下三位细胞病理学家的观察者内和观察者间一致性、准确性、误诊的可能原因、扫描时间和复查时间。
共获得4320个诊断结果。比较配对的LM切片和WSI数字切片之间的读数时，观察者内一致性从中度到高度（κ系数范围为0.63至0.88，一致性率范围为94.58%至98.33%）。三位细胞病理学家之间也观察到了从中度到高度的观察者间一致性（κ系数范围为0.67至0.85，一致性率范围为95.42%至97.92%）。LM的准确性略高于WSI（分别为98.06%、96.81%和97.78%）。大多数误诊是由于以下三大原因导致的假阴性诊断：癌细胞数量少、癌细胞与组织细胞混淆、癌细胞与淋巴细胞混淆。
本研究首次探讨了WSI在触摸印片细胞学中的可行性。当现场没有经验丰富的工作人员时，使用WSI进行SLN术中触摸印片细胞学诊断是一种切实可行的选择。
