Are sound abatement measures necessary in the cytology reading room? A study of auditory distraction.

OBJECTIVE: Listening to music and other auditory material during microscopy work is common practice among cytologists. While many cytologists would claim several benefits of such activity, research in other fields suggests that it might adversely affect diagnostic performance. Using a cross-modal distraction paradigm, the aim of the present study was to investigate the effect of auditory stimulation on the visual interpretation of cell images. METHODS: Following initial training, 34 participants undertook cell interpretation tests under four auditory conditions (liked music, disliked music, speech and silence) in a counterbalanced repeated-measures study. Error rate, area under the receiver operating characteristic curve, criterion and response time were measured for each condition. RESULTS: There was no significant effect of auditory stimulation on the accuracy or speed with which cell images were interpreted, mirroring the results of a previous visual distraction study. CONCLUSION: To the extent that the experiment reflects clinical practice, listening to music or other forms of auditory material whilst undertaking microscopy duties is unlikely to be a source of distraction in the cytopathology reading room. From a cognitive perspective, the results are consistent with the notion that high focal-task engagement may have blocked any attentional capture the sound may otherwise have produced.

Visual distraction in cytopathology: should we be concerned?

OBJECTIVE: Visual distraction in cytopathology has not been investigated previously as a source of diagnostic error, presumably because the viewing field of a conventional light microscope is considered to be large enough to minimise interference from peripheral visual stimuli. Virtual microscopy, which involves the examination of digitised images of pathology specimens on computer screens, is beginning to challenge the central role of light microscopy as a diagnostic tool in cytopathology. The relatively narrow visual angle offered by virtual microscopy makes it conceivable that users of these systems will be more vulnerable to visual interference. Using a variant of a visual distraction paradigm (the Eriksen flanker task), the aim of this study was to determine whether the accuracy and speed of the interpretation of cells on a central target screen are affected by images of cells and text displayed on neighbouring monitors under realistic reading room conditions. METHODS: Following a brief period of training, 31 cytology novices undertook four cell interpretation tests under different conditions of visual distraction. Error rates were measured under each condition. RESULTS: There was no effect of visual distraction on diagnostic accuracy. CONCLUSIONS: To the extent that the results from cytology novices extend to experienced practitioners, visual distraction is an unlikely source of error in virtual microscopy. Efficient visual selection and spatial attention, coupled with the high perceptual load of target images and the peripheral location of distractors, provide plausible explanations for the observed results.

Image analysis of hyperchromatic crowded cell groups in SurePath cervical cytology.

OBJECTIVE: The discrimination of hyperchromatic crowded cell groups (HCCGs) in cervical cytology is a difficult and error-prone interpretive task. While the classic features of dyskaryosis are of undoubted value, the contribution of size, shape and colour intensity of HCCGs is less certain. This study employed morphometric analysis to determine whether HCCG area, shape and colour intensity are useful in categorising them. METHODS: Seventy-five digital images from each of six categories of HCCG were subjected to image analysis. Ten variables relating to HCCG size, shape and colour intensity were assessed by discriminant function analysis. A further 28 cases were employed as a test set to determine the classification accuracy of the discriminant model. All samples were SurePath liquid-based cytology preparations. RESULTS: Nine of the 10 variables contributed significantly to the model (P<0.001) but no single variable had sufficient discriminative ability. Classification accuracy was highest for abnormal endocervical HCCGs and lowest for squamous metaplastic cells (64.0 vs. 17.3% correct classification rate). The accuracy of the model for distinguishing normal and abnormal HCCGs was 70.0%, which was significantly higher than chance (P<0.0001), but this reduced to 64.3% for the test cases, which was no better than chance (P>0.05). CONCLUSIONS: The area, shape and colour intensity of HCCGs, either alone or in combination, have little discriminative value. Practitioners and trainers should focus on the well-established features of dyskaryosis, such as chromatin pattern, nuclear membrane irregularities and group architecture. In terms of morphometric analysis, DNA ploidy and chromatin texture analysis may be more fruitful avenues of investigation.

Accuracy and perceptions of virtual microscopy compared with glass slide microscopy in cervical cytology.

OBJECTIVE: To evaluate virtual microscopy in terms of diagnostic performance and acceptability among practising cytologists. METHODS: Twenty-four experienced cytologists were recruited to examine 20 SurePath® cervical cytology slides by virtual microscopy. Diagnostic accuracy was compared with glass slide microscopy using an unbiased crossover experimental design. Responses were allocated a score of one for a correct identification of normal or abnormal (borderline/atypical changes in squamous or glandular cells or worse) and a score of zero for an incorrect response (a normal slide reported as abnormal or vice versa). Perceptions of virtual microscopy were assessed by questionnaire analysis. RESULTS: Participants yielded a total of 285 responses for the virtual slide set and 300 for the glass slide set. The approximate time to screen a virtual slide was 18 minutes, compared with 8 minutes or less for a glass slide. Overall there was no significant difference between virtual microscopy and glass slide microscopy in terms of diagnostic accuracy (P = 0.22). Virtual microscopy under-performed when images were captured over a narrow focal range (P = 0.01). Diagnostic accuracy of virtual microscopy equalled that of glass slide microscopy when participants were able to focus through the full thickness of the slide images (P = 0.07). The most common difficulties experienced by participants with virtual microscopy were freezing of the computer screen during image download, slow response of the computer during slide movement and, in some instances, 'fuzzy' images. Cytologists have a strong preference for glass slides over virtual microscopy despite the overall equal diagnostic performance of the two viewing modalities. CONCLUSIONS: Diagnostic accuracy of virtual microscopy can equal that of glass slide microscopy. However, without good computer network connections, wide focal range and software that permits effortless navigation across virtual slides, cytologists are unlikely to be convinced of the utility of this technology for cytology screening and diagnosis.

Survey of medical training in cytopathology carried out by the journal Cytopathology.

This report of the Editorial Advisory Board of Cytopathology gives the results of a survey of medical practitioners in cytopathology, which aimed to find out their views on the current situation in undergraduate and postgraduate training in their institutions and countries. The results show that training in cytopathology and histopathology are largely carried out at postgraduate level and tend to be organized nationally rather than locally. Histopathology was regarded as essential for training in cytopathology by 89.5% of respondents and was mandatory according to 83.1%. Mandatory cytopathology sections of histopathology were reported by 67.3% and specific examinations in cytopathology by 55.4%. The main deficiencies in training were due to its variability; there were insufficient numbers of pathologists interested in cytology and a consequent lack of training to a high level of competence. Pathologists without specific training in cytopathology signed out cytology reports according to 54.7% of responses, more often in centres where training was 3-6 months or less duration. Although 92.2% of respondents thought that specialist cytology should not be reported by pathologists without experience in general cytopathology, that practice was reported by 30.9%, more often in centres with small workloads. The survey report recommends that 6-12 months should be dedicated to cytopathology during histopathology training, with optional additional training for those wanting to carry out independent practice in cytopathology. Formal accreditation should be mandatory for independent practice in cytopathology. When necessary, temporary placements to centres of good practice should be available for trainees intending to practise independently in cytopathology. There should be adequate numbers of pathologists trained in cytopathology to a high level of competence; some of their time could be released by training cytotechnologists and trainee pathologists to prescreen cytology slides and assess adequacy of fine-needle aspiration samples when immediate diagnosis was not required. The survey demonstrated a clear need for European and international guidelines for training in cytopathology.

What can cytologists learn from 25 years of investigations in visual search?

This review aims to provide an insight into the nature and mechanisms of the visual screening of cytological preparations and to discuss the implications for current practice. Visual perception in cytology is under-researched and deserves further investigation. Fundamental issues to be addressed include the mechanisms of visual scanning of cytological preparations and the factors affecting search performance. Answers to these questions will have wide reaching impact on issues such as liquid-based technology, automated screening, training, quality assurance, recruitment and selection of staff, and medico-legal problems.