The Use of Static Telemedical Applications of Cytopathology for Proficiency Testing

The Use of Static Telemedical Applications of Cytopathology for Proficiency Testing

Stavros Archondakis (Department of Cytopathology, 401 Army Hospital, Athens, Greece)
Copyright: © 2013 |Pages: 7
DOI: 10.4018/ijrqeh.2013040104
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The purpose of this study was to examine the feasibility of developing an external quality control program for cytopathology labs wishing to be accredited according to ISO 15189:2007, by using low cost telemedical applications and solutions. One hundred twenty four fine-needle aspiration specimens from patients preoperatively aspirated under ultrasonographic guidance and on 104 pap smears with histological confirmation were retrospectively selected from the department’s registry. Three diagnostic categories of cytological reports were used. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for re-mote review by five independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor’s and reviewer’s diagnoses were collected, recorded and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered on the basis of digitized images and conventional slides.
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Proficiency testing (PT) is a process for checking actual laboratory performance usually by means of interlaboratory data comparisons (Woodhouse et al., 1999; Cramer et al., 1991). Results from proficiency testing are an indication of a laboratory’s competence and are an integral part of the assessment and accreditation process (Wood-house et al., 1999; Cramer et al., 1991). According to ISO 15189: 2007, all accredited laboratories must conduct proficiency tests in accordance with their normal patient testing and reporting procedures (Pantanowitz et al., 2009). The practice of diagnostic cytopathology performed on digital images is a novel process that can be used for obtaining expert opinions on difficult cases from remote laboratories (telecytology) (Archondakis et al., 2009). Telecytological diagnosis can be achieved either with the use of cytological pictures viewed in real time from the microscope (dynamic telecytological systems), or with the use of cytological pictures that are first captured in a digital format and then transmitted to distant observers (static telecytological systems) (Archondakis et al., 2009; Stamataki et al., 2008). As a result, many studies have focused on the possible role of telecytology as a tool of diagnosis and consultation in the everyday workflow (Archondakis et al., 2009).

Diagnostic concordance in telecytology is measured by diagnostic agreement and reproducibility (Stamataki et al., 2008; Pantanowitz et al., 2009). Agreement is the total or proportional number of cases in which the same diagnosis was issued between or within observers, including the part of the agreement that may be attributed to chance (Landis & Koch, 1977). Reproducibility, which is part of the agreement that cannot be explained purely by chance (Landis & Koch, 1977) is measured by the kappa statistic. Within the positive κ kappa values and in accordance with the study by Landis and Koch, the agreement was interpreted as follows: a range of 0.00– 0.20 indicated slight agreement, a range of 0.21–0.40 indicated fair agreement, a range of 0.41–0.60 indicated moderate agreement, a range of 0.61–0.80 indicated very good agreement, while a range of 0.61–0.80 indicated excellent agreement (Landis & Koch, 1977).

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