Internet-Based Gynecologic Telecytology With Remote Automated Image Selection: Results of a First-Phase Developmental Trial

| June 5, 2008

American Journal of Clinical Pathology 
Volume 129, Number 5 / May 2008 

John H. Eichhorn A1 A2, Leigh Buckner A3, Sally Beth Buckner A4, David P. Beech A1, Kimberly A. Harris A5, Douglas J. McClure A5, Barbara A. Crothers A3, David C. Wilbur A1 A2

A1 Cytopathology Division, Massachusetts General Hospital
A2 Department of Pathology, Harvard Medical School
A3 Cytopathology Service, Walter Reed Army Medical Center, Washington, DC
A4  National Naval Medical Center, Bethesda, MD
A5 Departments of Pathology, Partners Health Care, Boston


A retrospective set of 191 gynecologic cytology slides with reference interpretations was run on an automated screening device that selects fields of view (FOVs) based on a hierarchical probability of abnormality being present. An interface was developed between the device and a remote server using customized image review software. FOVs were reviewed by 3 cytotechnologists and 3 cytopathologists, and binary triage (unsatisfactory for evaluation/negative for intraepithelial lesion or malignancy [NILM] vs "abnormal" [neither unsatisfactory nor NILM]) and specific interpretations were done. No morphologic training before FOV review was provided.

Three or more reviewers agreed on the correct categorization of NILM/unsatisfactory in 89% (85/96) and abnormal in 83% (79/95). Three or more reviewers triaged cases to abnormal as follows: atypical squamous cells of uncertain significance, 83% (5/6); atypical squamous cells, cannot exclude high-grade lesion, 100% (3/3); low-grade squamous intraepithelial lesion (SIL), 83% (52/63); high-grade SIL, 94% (17/18); and atypical glandular cells, 40% (2/5).

This procedure may have comparable sensitivity and specificity and possibly could provide effective initial triage to further evaluation. A review of individual cases suggests that further accuracy can be achieved with additional training and experience.

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