title: Cytologic evaluation of image-guided fine needle aspiration biopsies via robotic microscopy: A validation study.
abstract: BACKGROUND
  This study carried out was to assess the feasibility of using robotic microscopy (RM) for cytologic evaluation of direct smears from fine needle aspiration biopsy (FNAB).
  
  
  METHODS
  Three board-certified cytopathologists reviewed representative direct smears from 40 image-guided FNABs using RM and subsequently re-reviewed the same smears using conventional microscopy. Adequacy of the smears and cytologic diagnosis, as determined using the two approaches, were compared for each individual cytopathologist (intraobserver) and between the three cytopathologists (interobserver). The intraobserver and interobserver discrepancies were analyzed and discussed in a follow-up consensus conference.
  
  
  RESULTS
  FOR ASSESSMENT OF ADEQUACY, THERE WERE HIGH CONCORDANCE RATES (INTRAOBSERVER: 92.5-97.5%; interobserver: 90-92.5%), with a few discrepancies involving distinctions between suboptimal and satisfactory smears. Analysis of diagnostic interpretations showed correct classification of 92.5-95% (intraobserver) or 90-92.5% (interobserver) of benign and malignant cases combined, with the discrepancies being between benign and atypical cells in the benign group, and between suspicious and malignant in the malignant group. Within the malignant group, 94% of cases were accurately subclassified via RM. The quality of images viewed by using RM was rated adequate (fair or good) for 95% of the slides.
  
  
  CONCLUSIONS
  The results demonstrate that cytologic evaluation of direct smears from FNABs using RM is feasible. Problems encountered included the longer times needed to evaluate cases with thick, bloody smears and/or low numbers of diagnostic cells, and difficulties in recognizing neuroendocrine differentiation and mimics of hepatocellular carcinoma.
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA Yale University School of Medicine, New Haven, CT,USA.
authors.forename: Guoping
authors.initials: G
authors.lastname: Cai
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Teot
authors.forename: Walid E
authors.initials: WE
authors.lastname: Khalbuss
authors.forename: Jing
authors.initials: J
authors.lastname: Yu
authors.forename: Sara E
authors.initials: SE
authors.lastname: Monaco
authors.forename: Drazen M
authors.initials: DM
authors.lastname: Jukic
authors.forename: Anil V
authors.initials: AV
authors.lastname: Parwani
references.citation: Hum Pathol. 2001 Dec;32(12):1323-6
references.pmid: 11774164
references.citation: Histopathology. 2002 Aug;41(2):91-109
references.pmid: 12147086
references.citation: Mod Pathol. 2002 Nov;15(11):1197-204
references.pmid: 12429799
references.citation: Hum Pathol. 2006 Mar;37(3):322-31
references.pmid: 16613327
references.citation: Histopathology. 2007 Jan;50(2):266-73
references.pmid: 17222256
references.citation: Virchows Arch. 2002 Aug;441(2):159-64
references.pmid: 12189506
references.citation: Hum Pathol. 2007 Sep;38(9):1330-4
references.pmid: 17555793
references.citation: Acta Cytol. 2004 Nov-Dec;48(6):788-94
references.pmid: 15581163
references.citation: Hum Pathol. 2001 Dec;32(12):1318-22
references.pmid: 11774163
references.citation: Am J Clin Pathol. 2006 Aug;126(2):294-301
references.pmid: 16891206
references.citation: Hum Pathol. 2003 Oct;34(10):968-74
references.pmid: 14608529
references.citation: J Neuropathol Exp Neurol. 2007 Aug;66(8):750-9
references.pmid: 17882019
references.citation: Am J Clin Pathol. 2002 May;117(5):783-90
references.pmid: 12090429
references.citation: Hum Pathol. 2008 Apr;39(4):564-72
references.pmid: 18234276
references.citation: Hum Pathol. 2007 Dec;38(12):1764-71
references.pmid: 17707460
references.citation: Cancer. 2005 Aug 25;105(4):199-206
references.pmid: 15937917
references.citation: BMC Clin Pathol. 2006 Apr 27;6:4
references.pmid: 16643664
references.citation: Cancer. 2001 Oct 25;93(5):319-22
references.pmid: 11668466
references.citation: Telemed J. 1999 Winter;5(4):323-37
references.pmid: 10908448
references.citation: Hum Pathol. 2004 Nov;35(11):1303-14
references.pmid: 15668886
references.citation: Am J Clin Pathol. 2003 Mar;119(3):356-60
references.pmid: 12645336
references.citation: Diagn Cytopathol. 2003 Mar;28(3):147-52
references.pmid: 12619097
references.citation: J Pathol. 2004 Dec;204(5):613-8
references.pmid: 15470688
references.citation: Acta Cytol. 1998 Jan-Feb;42(1):148-64
references.pmid: 9479334
references.citation: Adv Anat Pathol. 2007 Sep;14(5):320-2
references.pmid: 17717431
references.citation: Cancer. 2007 Aug 25;111(4):203-9
references.pmid: 17580360
references.citation: Arch Pathol Lab Med. 2005 Apr;129(4):459-66
references.pmid: 15794667