Ahmed Mohammed S, Klippel-Almaraz Dianna, Amin Sara E, Sura Gloria H, Kundu Uma Rani, Yu Wendong, Stewart Jogn M, Gan Qiong, Krishnamurthy Savitri
Department of Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
McGovern Medical School at UTHealth, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Cancer Cytopathol. 2025 Sep;133(9):e70046. doi: 10.1002/cncy.70046.
Rapid on-site evaluation (ROSE) of thyroid fine-needle aspiration biopsy (FNAB) improves diagnostic adequacy and facilitates ancillary molecular testing. In this prospective, multireader study, the authors evaluated the feasibility of using whole-slide images (WSIs) for ROSE to determine specimen adequacy and preliminary categorization (according to The Bethesda System for Reporting Thyroid Cytopathology [Bethesda]) of image-guided thyroid FNABs compared with conventional light-microscopic (LM) examination of the same specimens in a referral cancer center.
The authors evaluated 98 ultrasound-guided thyroid FNAB cases. Smears were stained with Papanicolaou and Diff-Quik and were scanned at ×20 magnification using a Leica Aperio CS2 scanner. Five cytopathologists evaluated specimen adequacy and Bethesda categorization using WSI followed by LM assessment after a 2-week washout. Intraobserver and interobserver agreements were calculated using Cohen and Fleiss kappa (κ) statistics. Scan time, interpretation time, and the need for ×40 magnification or z stacking were recorded.
In total, 463 slides were scanned, with mean scan time of 5.48 minutes. WSI quality was acceptable in most cases. Z stacking and ×40 magnification were requested in 23% and 14% of reviews, respectively. Intrareader agreement between WSI and LM examination was excellent (κ = 0.86-0.95). Inter-reader agreement was moderate for both WSI (κ = 0.48) and LM examination (κ = 0.56). Concordance was highest for Bethesda categories I and VI and lowest for categories III-V. Interpretation with WSI took significantly longer than with LM examination (p < .0001).
WSI is a feasible alternative to LM examination for ROSE of thyroid FNABs, with high intrareader agreement and comparable inter-reader agreement. The limited need for high magnification and z stacking supports its practical utility.
甲状腺细针穿刺活检（FNAB）的快速现场评估（ROSE）可提高诊断的充分性，并有助于辅助分子检测。在这项前瞻性多读者研究中，作者评估了在一家转诊癌症中心，使用全切片图像（WSIs）进行ROSE以确定图像引导下甲状腺FNAB标本的充分性和初步分类（根据甲状腺细胞病理学报告的贝塞斯达系统[贝塞斯达]），并与相同标本的传统光学显微镜（LM）检查进行比较的可行性。
作者评估了98例超声引导下的甲状腺FNAB病例。涂片用巴氏染色法和Diff-Quik染色，并使用徕卡Aperio CS2扫描仪以×20倍放大率进行扫描。五名细胞病理学家使用WSIs评估标本的充分性和贝塞斯达分类，然后在洗脱两周后进行LM评估。使用科恩和弗莱斯kappa（κ）统计量计算观察者内和观察者间的一致性。记录扫描时间、解读时间以及对×40倍放大或z轴堆叠的需求。
总共扫描了463张玻片，平均扫描时间为5.48分钟。在大多数情况下，WSI质量是可以接受的。分别有23%和14%的评估需要z轴堆叠和×40倍放大。WSI和LM检查之间的读者内一致性非常好（κ = 0.86 - 0.95）。WSI（κ = 0.48）和LM检查（κ = 0.56）的读者间一致性均为中等。贝塞斯达分类I和VI的一致性最高，分类III - V的一致性最低。使用WSI进行解读比使用LM检查花费的时间显著更长（p <.0001）。
对于甲状腺FNAB的ROSE，WSI是LM检查的一种可行替代方法，具有较高的读者内一致性和相当的读者间一致性。对高倍放大和z轴堆叠的需求有限支持了其实际应用价值。
