title: Digital slide imaging in cervicovaginal cytology: a pilot study.
abstract: BACKGROUND
  Digital whole slide imaging is the anticipated future of anatomic pathology, where sign-out of glass slides will be replaced by scanned images. Whole slide imaging has been successfully used in surgical pathology, but its usefulness and clinical application have been limited in cytology for several reasons, including lack of availability of z-axis depth focusing and large file size. Recently, several systems have become available in the United States for whole slide imaging with z-axis technology.
  
  
  OBJECTIVE
  To determine the accuracy and efficiency of whole slide imaging, as compared with traditional glass slides, for use in cervicovaginal diagnostic cytology.
  
  
  METHODS
  Eleven cervicovaginal cytology cases (ThinPrep and SurePath) scanned at ×20, ×40, and ×40 z-stack magnifications using the BioImagene iScan Coreo Au 3.0 scanner were evaluated by 4 cytotechnologists and 3 pathologists in a blinded study. Different magnification scans were recorded as separate cases and presented in a randomized sequence. Corresponding glass slides were also reviewed. For each case, the diagnoses and total time to reach each diagnosis were recorded.
  
  
  RESULTS
  Diagnostic accuracy was higher and average time per case was lower with glass slides as compared with all digital images. Among the digital images, the ×40 or ×40 z-stack had the highest diagnostic accuracy and lowest interpretation time.
  
  
  CONCLUSIONS
  Whole slide imaging is a viable option for the purposes of teaching and consultations, and as a means of archiving cases. However, considering the large file size and total time to reach diagnosis on digital images, whole slide imaging is not yet ready for daily cervicovaginal diagnostic cytology screening use.
authors.affiliation: Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, TX 77030, USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Wright
authors.forename: Debora
authors.initials: D
authors.lastname: Smith
authors.forename: Bakula
authors.initials: B
authors.lastname: Dhurandhar
authors.forename: Todd
authors.initials: T
authors.lastname: Fairley
authors.forename: Miriam
authors.initials: M
authors.lastname: Scheiber-Pacht
authors.forename: Subhendu
authors.initials: S
authors.lastname: Chakraborty
authors.forename: Blythe K
authors.initials: BK
authors.lastname: Gorman
authors.forename: Dina
authors.initials: D
authors.lastname: Mody
authors.forename: Donna M
authors.initials: DM
authors.lastname: Coffey
mesh_terms: D002584:Cervix Uteri / Q000473:pathology*; D003581:Cytodiagnosis / Q000295:instrumentation / Q000379:methods*; D003952:Diagnostic Imaging / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D010338:Pathology, Clinical / Q000295:instrumentation / Q000379:methods; D010865:Pilot Projects; D019113:Telepathology / Q000295:instrumentation / Q000379:methods*; D014621:Vagina / Q000473:pathology*; D014626:Vaginal Smears