Telecytopathology for Rapid On-Site Evaluation (ROSE) Adequacy in Fine-Needle Aspiration of Pancreatic and Lung Lesions during COVID19 Pandemic

ABSTRACT

Background: Telecytopathology (TCP) has a variety of different applications in clinical practice and is becoming more widely utilized especially during COVID pandemic. More recently, TCP use has been increasingly applied to the rapid on-site evaluation (ROSE) at our institution with immediate assessment by viewing cytologic smears remotely over web conferencing platform (zoom). As part of our quality control evaluation, we retrospectively investigated ROSE adequacy in two of the busiest FNA procedures at our institute (pancreas and lung) via TCP. Design: The study includes retrospective review of 151 of pancreatic lesions and 242 lung lesions over a two-year period. The air dried Diff-Quick slides were evaluated on site for adequacy by the cytopathology fellow/ cytotechnologist and cytopathologists via TCP at the same time. The ROSE adequacy diagnosis is recorded and transcribed to the preliminary report. We reviewed the adequacy and preliminary ROSE assessment and compared it to the final diagnosis as the gold standard. The non-diagnostic rate and discrepancy rate between initial and final diagnosis were calculated. Results: A total of 393 adequacy assessments of pancreas (151, 38%) and lung (242, 62%) were analyzed. Overall, 114 (75%) pancreatic cases and 199 (82%) lung lesions had adequate diagnosis at the time of the ROSE, while 37 (25%) of pancreatic cases and 43 (18%) of lung cases had non-adequate ROSE read specimens. Concordance between initial assessment of diagnosis and the final cytological diagnosis was identified in 94% (142 out of 151) of pancreatic cases and 93.4% (226 out of 242) of lung cases. Of the discordant cases, the final diagnosis was upgraded to adenocarcinoma in 7/9 pancreatic lesions and either SCC, adenocarcinoma or atypia in 5/16 lung lesions. The final diagnosis was downgraded to benign category in 2/9 pancreatic lesions and 11/16 lung lesions. Conclusions: Telecytopathology ROSE evaluation of pancreatic and lung lesions may have several advantages over in-person ROSE, including providing a suitable alternative technology, mitigating disease transmission during the COVID19 pandemic, while maximizing resources to allow more efficient use of the pathologist's time, thereby improving efficiency, eliminating downtime, and answering the increasing demand for on-site adequacy evaluation.