Implementation of Telecytology in Georgia

Background

It is well known, that telecytology may be static (store and forward), dynamic (real-time), or hybrid. Store and forward telecytology is a less efficient method but there have been isolated reports of a concordance of as high as 95-100% between glass slide and telecytology diagnosis (Rocha et al, 2009; Raab et al, 1996). It has limitations because of the disjointed nature of the images, and the diagnostic errors incurred with this method have been attributed to inappropriate field selection by the submitting cytologist. Dynamic telecytology using fully motorized robotic systems, through cost-prohibitive, has revolutionized the field, and a concordance rate of 99-100% has been reported between telecytology and light microscopy diagnosis. The fully motorized robotic systems are a cost-prohibitive for Georgia, but they are used very routinely in other locations, especially in countries with middle and high incomes. Hybrid systems use virtual slides (so called whole slide images – WSI) and in various studies the diagnostic efficacy was shown. The 'virtual slides' are entirely digitalized glass slides at a very high resolution and can be viewed by multiple cytologists and without any loss of resolution.

The applications of telecytology, like those of telemedicine can be classified into four major groups: primary opinion (first diagnosis on a case), second opinion (expert opinion about a case), third opinion (expert group opinion/discussion about a case) and distance learning. The most frequently use case of telecytology is the second opinion. In remote and rural areas where because of economic reasons, one cannot afford to have a competent cytologist, telecytology is considered to be a boon. eLearning in cytology has also gained acceptance. Telecytology has been used for research applications, distance education, remote consultations with astounding success (Coleman, 2009; Rocha et al, 2009; Weinstein et al, 2009).