title: Assessment of static telecytological diagnoses' reproducibility in cervical smears prepared by means of liquid-based cytology.
abstract: 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.
  
  
  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.
authors.affiliation: Department of Cytopathology, 401 General Army Hospital, Athens, Greece.
authors.forename: Thomas
authors.initials: T
authors.lastname: Tsilalis
authors.forename: Stavros
authors.initials: S
authors.lastname: Archondakis
authors.forename: Christos
authors.initials: C
authors.lastname: Meristoudis
authors.forename: Niki
authors.initials: N
authors.lastname: Margari
authors.forename: Abraham
authors.initials: A
authors.lastname: Pouliakis
authors.forename: Lazaros
authors.initials: L
authors.lastname: Skagias
authors.forename: Ioannis
authors.initials: I
authors.lastname: Panayiotides
authors.forename: Petros
authors.initials: P
authors.lastname: Karakitsos
mesh_terms: D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006115:Greece; D006801:Humans; D007091:Image Processing, Computer-Assisted; D015588:Observer Variation; D012680:Sensitivity and Specificity; D019113:Telepathology / Q000592:standards*; D014626:Vaginal Smears / Q000379:methods*