Use of telecytology for the immediate assessment of CT guided and endoscopic FNA cytology: diagnostic accuracy, advantages, and pitfalls.

Telecytology (TC) can assist cytopathologists in efficiently providing immediate evaluation for fine needle aspirations (FNAs) performed at remote locations. Our aim was to evaluate the accuracy and feasibility of TC for immediate assessments of FNAs. Phase I: Diff-Quik and Pap stained smears from two retrospective sets of 20 pilot cases each (n = 40) were included for TC assessments. For the first set, diagnoses were rendered by four pathologists and for the second set, in addition, four cytotechnologists also participated. Diagnostic concordance with the final diagnosis was assessed. Phase IIA: These were followed by real time assessments (RTA) of 56 TC FNAs and diagnostic concordance was compared to that of 100 conventional in-person immediate assessments (Phase IIB). Phase I: 79/80 (98.8%) diagnoses (20 cases × 4 pathologists) from the first set were accurate. On the second set, 160 diagnoses were rendered on Pap stained slides and 160 on Diff-Quik stained slides. The accuracy rate was 95% (76/80) for malignant diagnoses and 96.2% (77/80) for benign diagnoses on Pap stain. Diff-Quik stains were more difficult to interpret than Pap stains and accuracy rates for them were lower. Endoscopic bronchial ultrasound guided (EBUS) FNAs of paratracheal nodes were more difficult to interpret. Phase IIA and B: 95% (53/56) RTAs by TC were concordant with the final diagnoses compared with 97% (97/100) for in-person assessments. TC is a useful aid and yields concordance rates comparable to in-person assessments. Individual practices should perform pilot studies to understand the pitfalls and limitations before employing telecytology.