Implementation of pre-captured videos for remote cytological evaluation of salivary gland lesions.

OBJECTIVE: The objective of this study was to examine the feasibility of implementing videos captured by static telecytological applications for remote cytological evaluation of fine needle aspiration specimens from salivary gland lesions. METHODS: The current study was carried out on 102 fine needle aspiration specimens from salivary gland lesions with histological confirmation (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23), retrospectively selected from the department's registry. Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. RESULTS: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of pre-captured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. CONCLUSIONS: Video production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary gland fine needle aspirations. Videos of salivary gland fine needle aspirations can be used for rapid and accurate diagnosis, by diminishing turn-around times and improving the quality indices of small cytology departments. They can also be used for archiving, teleconsultation, educational and second opinion purposes, improving the performance of the already existing static telecytology stations.

Remote cytological diagnosis of salivary gland lesions by means of precaptured videos.

OBJECTIVE: The objective of this study was to investigate the feasibility of implementing videos captured by static telecytological applications for remote cytological diagnosis of fine needle aspiration (FNA) specimens from salivary gland lesions. METHODS: The current study was performed on 102 specimens from patients referred to the Alpha Prolipsis Cytopathology Department for preoperative evaluation of salivary gland lesions. In all cases, surgical excision followed the initial cytological diagnosis. (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23). Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. RESULTS: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of precaptured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. CONCLUSIONS: Videos production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary glands FNAs. Videos of salivary glands FNAs can be used for accurate diagnosis, educational and second opinion purposes,. They can also be used for archiving, teleconsultation and educational purposes, improving the performance of the already existing static telecytology stations and small cytology departments' quality indices.

Two-Year Experience of the Implementation of the Milan for Reporting Salivary Gland Cytopathology at a Private Medical Laboratory.

This study aimed to present the 2-year experience of the implementation of the Milan System for Reporting Salivary Gland Cytopathology at Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. A totaI of 102 Fine Needle Aspirations (FNAs) performed since 2018 were included in the study. Reports were issued according to the Milan System for Reporting Salivary Gland Cytopathology. Aspirates were prepared with both conventional and liquid-based cytological methods and were evaluated by two or three Board-certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. All cases included in this study had histologic follow-up. The diagnostic accuracy of FNA for differentiating between benign and malignant disease according to MSRSGC classification was 93.3%, the specificity was 97.5% and the sensitivity was 82.2%. The positive and negative predictive values were 93.2 and 87.2%, respectively. Our results show that FNA is a valuable examination technique in the preoperative evaluation of salivary gland lesions. The integration of the 2018 Milan System for Reporting Salivary Gland Cytopathology is effective, with an overall accuracy around 95%.

The Implementation of Static Telecytology for Teleconsultation Purposes During Preoperative Evaluation of Thyroid Fine-Needle Aspiration Specimens.

Objective: The objective of this study was to investigate the impact of applying static telecytology for teleconsultation purposes during preoperative evaluation of challenging thyroid fine-needle aspiration specimens. Materials and Methods: The study was performed on 141 cytologically challenging specimens of 125 patients referred to Alpha Prolipsis Cytopathology Department. All cases were finally confirmed histologically. During the study, 10 characteristic images from each case were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists, with documented experience in the field of thyroid cytology. 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 based on digitized images and conventional slides. Telecytology is a prompt and valid method for acquisition of a second opinion diagnosis in challenging cases and can be integrated into daily workflow. The use of telecytology for teleconsultation purposes in the laboratory's daily workflow will further ensure the accuracy of preoperative cytological diagnoses and will contribute to cytopathologists continuous education and better understanding of the criteria applied in thyroid gland lesions cytomorphological diagnosis. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered based on digitized images among contributing cytopathologists. The overall interobserver agreement was very good with κ values of 0.73-0.88. Conclusions: The widespread availability of imaging technology and telecommunication enables instant access to global expert cytopathologists. Static telecytology can be used as an efficient method for acquisition of second opinion in challenging thyroid fine-needle aspiration specimens. It can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.

Implementation of pre-captured videos for remote diagnosis of cervical cytology specimens.

OBJECTIVE: The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology. METHODS: The study was performed on representative short videos captured from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; adenocarcinoma, 2) that were sent via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on the overall digital video quality. Contributors' and reviewers' diagnoses were collected, recorded, and statistically evaluated. RESULTS: Statistical evaluation detected no significant difference in diagnostic accuracy between cytological diagnoses based on short videos versus conventional slides. The overall interobserver agreement ranged from substantial to almost perfect with κ values of 0.74-0.91. CONCLUSIONS: Short videos produced by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into the daily workflow. Short pre-captured videos of cervical smears can be used for rapid and accurate diagnosis, diminishing turnaround times and improving small cytology departments' quality indices. They can also be used for archiving, teleconsultation, and second opinion purposes, improving the performance of already existing static telecytology stations.

The Use of Static Telecytology for Quality Assessment Purposes in the Evaluation of Cervical Smears Prepared by Means of Liquid-Based Cytology.

Objective: The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology. Materials and Methods: The study was performed on representative digital cytological images from a total of 808 cervical smears (benign, 270; atypical squamous cells of undetermined significance, 184; low-grade squamous intraepithelial lesion, 124; high-grade squamous intraepithelial lesion, 174; squamous cell carcinoma, 52; and adenocarcinoma, 4) that were transferred through file transfer protocol to password-protected accounts for remote review by three 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. Their reports were recorded and classified. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of digitized images and conventional slides. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97. Conclusions: Static telecytology can be used as an alternative method for the cytological diagnosis of cervical smears, particularly in quality assurance programs. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.

Tracheal pseudo-tumor caused by herpes simplex virus.

BACKGROUND: Herpes simplex virus (HSV) has been shown to cause respiratory tract infections mostly in severely immunocompromised patients. Endobronchial tumor-like lesions have been described very rarely as HSV pulmonary manifestations in critically ill patients or in immunosuppressed individuals. CASE PRESENTATION: This case study describes a 75-yr-old male who presented with persistent hoarseness. Fiberoptic bronchoscopy showed marked mucosal thickening protruding in mid and distal trachea causing stenosis. Biopsy specimens demonstrated cytopathological changes consistent with HSV type 1 and 2 infection. CONCLUSIONS: To the best of the authors' knowledge, this is the first reported case of HSV presenting as an endotracheal tumor in an immunocompetent person.

Solitary gastric metastasis from primary lung adenocarcinoma: a rare site of extra-thoracic metastatic disease.

Lung cancer metastasizing to gastrointestinal (GI)-tract is a rare event. Gastric metastasis is usually asymptomatic but when mucosal in location it may cause symptoms as demonstrated in the current case. This report describes a 60-year old male who was admitted for evaluation of a left upper lobe lung mass with associated bilateral nodular opacities and mediastinal lymphadenopathy. After thorough work-up the diagnosis of advanced lung adenocarcinoma was made. During hospitalization period and prior to starting chemotherapy, he exhibited upper gastrointentinal bleeding. Esophagogastroduodenoscopy revealed an ulcerative lesion in the gastric corpus representing metastasis of the primary lung carcinoma that ensued from immunohistochemical analysis. Clinical, pathological and therapeutic aspects of this uncommon site of extrathoracic metastatic disease are discussed, emphasizing the importance of the immunohistochemistry in the differential diagnosis of lung carcinomas whether primary or secondary to the lung.

Thyroid gland metastasis from small cell lung cancer: an unusual site of metastatic spread.

Metastasis to the thyroid gland is uncommon compared with the frequency of primary thyroid tumors. The primary sites of metastatic thyroid tumors usually include the breast, lung, kidney and stomach. Among lung cancer types metastasizing to the thyroid, adenocarcinomas are the commonest followed by squamous and large cell carcinomas. Small cell lung carcinoma has not been frequently reported to cause thyroid metastatic deposits. Herein, we describe a patient with small cell lung cancer who developed metastatic lesions to the thyroid and brain simultaneously. Thyroid ultrasonography-guided fine-needle aspiration cytology (US-FNAC) and particularlyimmunocytochemistry documented metastasis from primary lung cancer. Clinical, cytopathological and therapeutic aspects of this unusual site of extrathoracic metastatic disease are discussed laying special emphasis on the paramount importance of the immunocytochemistry in distinguishing primary thyroid tumors from thyroid metastasis due to lung cancer.

Osteoblastoma of the rib: A rare benign tumor with an unusual location.

INTRODUCTION: Osteoblastoma is a rare benign bone tumor commonly located at spine and long bones. However, rib involvement has been reported less frequently. PRESENTATION OF CASE: In this report, we describe a young adult male presenting with left posterolateral chest wall pain. Chest computed tomography showed a calcified tumor in the left third posterior segment of the rib. Radical mass resection was performed and histopathology confirmed a benign osteoblastoma. At last follow-up, 10 months postoperatively, the patient has eventually relieved of the unbearable chest pain. Imaging evaluation revealed no evidence of recurrent tumor. DISCUSSION: Osteoblastoma is an uncommon primary bone tumor accounting for only 1% of all bone tumors. Ribs are involved in less than 5% of patients. The disease has usually good prognosis with a tendency for local destruction and recurrence. CONCLUSION: Radical surgery remains the treatment of choice to prevent recurrences and to provide a definite diagnosis differentiating it from osteoblastoma-like osteosarcoma.

Mixed squamous and large-cell carcinoma of the lung: a case study and literature review.

Lung tumors with combined histological pattern are seldom seen exhibiting a more aggressive clinicopathological picture than tumors with a single histology. Herein, we present a 58-year-old male with mixed squamous and large-cell lung carcinoma. The patient was initially diagnosed through fluoroscopy-guided transbronchial lung biopsy with large-cell lung carcinoma of the left upper lobe. He received neo-adjuvant chemotherapy and then underwent left upper lobectomy. Postoperative pathological diagnosis was combined squamous and large-cell neuroendocrine carcinoma. Two months after surgery, restaging revealed brain metastatic deposits. Local radiotherapy was promptly applied with relatively good response and the patient is under observation eight months after diagnosis. A brief review of the current literature is also included with special emphasis on the clinicopathologic aspects and prognosis of lung tumors with mixed histology.

Assessment of static telecytological diagnoses' reproducibility in cervical smears prepared by means of liquid-based cytology.

OBJECTIVE: This study evaluated the accuracy and reproducibility of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology. MATERIALS AND METHODS: Representative digital cytological images from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; and adenocarcinoma, 2) were uploaded to the CytoTrainer e-learning telecytology platform (developed in the Department of Cytopathology, "ATTIKON" University General Hospital, Athens, Greece) with specific password-protected accounts and were reviewed remotely by four independent board-certified cytopathologists (checking round). Their reports were recorded and classified. After 12 and 24 months, the same representative digital images were transferred in random order to the same cytopathologists and were reviewed again (first and second review rounds, respectively). The cytopathologists' first and second round diagnoses were recorded and compared with their initial ones. RESULTS: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy among checking and review diagnoses. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97, whereas intraobserver agreement ranged from almost perfect to perfect with κ values of 0.76-1 in all diagnostic rounds. CONCLUSIONS: Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices. Diagnoses made by using static telecytological systems can be as reliable as those made by using conventional microscopy, under the conditions that representative images are taken and that standard cytological diagnostic criteria are applied. Telecytology can be used as an alternative method for the cytologic diagnosis of cervical smears, particularly in quality assurance programs.

Could serum visfatin be a potential biomarker for postmenopausal breast cancer?

OBJECTIVE: Previous studies have shown that visfatin is significantly elevated in patients with gastric carcinoma and postmenopausal breast cancer (PBC). We thus explored whether serum visfatin could be used as a potential diagnostic and prognostic tool for PBC, taking into account clinicopathological features, serum tumor markers, anthropometric and metabolic parameters. METHODS: Serum visfatin, tumor marker CA 15-3, carcinoembryonic antigen, metabolic and anthropometric parameters were determined in 103 postmenopausal women with pathologically confirmed, incident invasive breast cancer, 103 controls matched on age and time of diagnosis, and 51 patients with benign breast lesions (BBL). RESULTS: Mean serum visfatin was significantly higher in cases than in controls and patients with BBL (p<0.001). In cases, visfatin was significantly associated with CA 15-3 (p=0.03), hormone-receptor status (p<0.001), lymph node invasion (p=0.06) but not with metabolic and anthropometric variables (p>0.05). Multivariable regression analysis revealed that absence of estrogen and progesterone receptors (ER-PR-) was the strongest significant determinant of serum visfatin (p<0.001) in cases adjusting for demographic, metabolic and clinicopathological features. Based upon receiver operator characteristic analysis, serum visfatin outperformed CA 15-3 only in discriminating between PBC cases with early cancer stage than those with late stage, and in differentiating particularly patients with ER-PR- breast tumors. CONCLUSION: Further prospective and longitudinal studies are needed to determine whether serum visfatin could be used as a prognostic tool in the armamentarium of PBC monitoring and management in conjunction with other biomarkers.

Study on the reproducibility of thyroid lesions telecytology diagnoses based upon digitized images.

The objective of this study is to evaluate the reproducibility and usefulness of telecytology diagnoses proffered on the basis of digitized images from fine-needle aspiration specimens prepared by means of liquid-based cytology. Representative digital cytological images from a total of 270 thyroid fine-needle aspiration specimens were transferred via file transfer protocol to specific password-protected accounts and were remotely reviewed by five independent board-certified cytopathologists (initial round). Their reports were recorded and classified. After 6 and 12 months, the same representative digital images were transferred in random order to the same cytopathologists and were reviewed again (first and second review rounds). The cytopathologists' first and second round diagnoses were recorded and compared with their initial ones. Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy among initial and review diagnoses. The overall interobserver agreement was almost perfect with κ values of 0.869-0.939, whereas intraobserver agreement ranged from almost perfect to perfect with κ values of 0.967-1 in all diagnostic rounds. Digitized cytological images transmission and remote evaluation allows reproducible diagnosis of thyroid gland lesions. Diagnoses made by using static telecytology systems can be equally reliable to those made by using conventional microscopy, provided that representative images are utilized and that the standard cytological diagnostic criteria are applied.

Telecytology: a tool for quality assessment and improvement in the evaluation of thyroid fine-needle aspiration specimens.

The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of thyroid fine-needle aspiration specimens prepared by the ThinPrep(R) technique (Cytyc Co., Boxborough, MA). The study was performed on 252 adequate specimens of 157 patients referred to the Cytopathology Department of University Hospital "Attikon" for preoperative evaluation of thyroid nodules. In all cases, surgical excision followed the initial cytological diagnosis. Three diagnostic categories of cytological reports were used. All cases were confirmed by histological diagnosis of surgical specimens. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for remote review by four 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. Telecytology is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. The use of liquid-based cytology ensures that additional material is preserved for ancillary studies (if necessary) and that a sufficient number of replicate microscope slides can be produced. The use of telecytology in the daily workflow will ensure the reproducibility of cytological diagnoses and make feasible the production of digital educational material. Besides diagnostic accuracy, the implementation of a diagnostic telecytology system requires consideration of numerous financial, legal, professional, and ethical issues.

Oncocytoma of the lacrimal gland diagnosed initially by fine-needle aspiration cytology.

Oncocytomas are benign tumors that infrequently involve ocular adnexa. We describe a case of oncocytoma of the lacrimal gland which was initially diagnosed by fine-needle aspiration cytology. An 83-year-old patient presented to the cytology laboratory with a peripunctal mass in the right eye. The tumor was aspirated. The cytoplasm of the tumor cells was rich in eosinophilic granules. The initial cytological diagnosis was oncocytoma. The tumor was then completely excised and the histological diagnosis confirmed the initial cytological one. Oncocytoma is a rare entity which must be considered in differential diagnosis of a peripunctal mass in elderly patients. The literature was reviewed confirming the rarity of such a presentation and the novelty of this case. Cytological criteria of malignancy are not yet established.