title: Cytodiagnosis through use of a z-axis video by volunteer observers: a promising tool for external quality assessment.
abstract: OBJECTIVE
  This study examined whether cytological diagnosis through the use of a video, which shows the changing depth of focus in the microscopic field, described as a z-axis video, is useful compared with a still image.
  
  
  METHODS
  From 17 cytology preparations of fine needle aspiration of the breast, we made six z-axis videos per case. A frame exhibiting the characteristic features was then extracted from each video and saved as a representative still image. One hundred and twenty-eight volunteer cytotechnologists were randomly divided into two groups of video observers and still image observers. The participants were asked to make a diagnosis of benign, indeterminate, suspicious or malignant without having any clinical information other than the age of the patient. Diagnoses were categorized as 'recommended' or 'unacceptable' according to degree of correlation with histology.
  
  
  RESULTS
  The number of definitive diagnoses of 'benign' or 'malignant' were increased in video observers, and indeterminate or suspicious categories were decreased (P = 0.013). The distribution of diagnostic categories in three of the 17 cases was significantly different; the distribution in the remaining cases was similar between the two groups. The z-axis video observers may have selected the definite diagnoses with confidence because they observed valuable microscopic findings by 'focusing through observation'. The average number of 'recommended' diagnoses by individual observers was significantly higher in the video observer group than in the still image observer group (P = 0.016). In contrast, the average number of 'unacceptable' diagnoses was significantly lower (P = 0.019).
  
  
  CONCLUSIONS
  A z-axis video is easy to obtain and is therefore expected to become a powerful diagnostic modality for the external quality assessment of clinical cytology and even in the field of primary cytodiagnosis.
authors.affiliation: Division of Pathology, Hokkaido Cancer Center, Kikusui 4-2, Shiroishi-ku, Sapporo, Japan. yamasiro@sap-cc.go.jp
authors.forename: K
authors.initials: K
authors.lastname: Yamashiro
authors.forename: M
authors.initials: M
authors.lastname: Tagami
authors.forename: K
authors.initials: K
authors.lastname: Azuma
authors.forename: A
authors.initials: A
authors.lastname: Nakamura
authors.forename: O
authors.initials: O
authors.lastname: Kato
authors.forename: K
authors.initials: K
authors.lastname: Taira
authors.forename: M
authors.initials: M
authors.lastname: Azuma
authors.forename: H
authors.initials: H
authors.lastname: Takeda
authors.forename: H
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods; D001940:Breast / Q000473:pathology*; D003581:Cytodiagnosis / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods* / Q000592:standards; D018715:Microscopy, Video / Q000379:methods* / Q000592:standards; D011786:Quality Control; D012015:Reference Standards; D015203:Reproducibility of Results