title: Diagnostic digital cytopathology: Are we ready yet?
abstract: BACKGROUND
  The cytology literature relating to diagnostic accuracy using whole slide imaging is scarce. We studied the diagnostic concordance between glass and digital slides among diagnosticians with different profiles to assess the readiness of adopting digital cytology in routine practice.
  
  
  METHODS
  This cohort consisted of 22 de-identified previously screened and diagnosed cases, including non-gynecological and gynecological slides using standard preparations. Glass slides were digitalized using Aperio ScanScope XT (×20 and ×40). Cytopathologists with (3) and without (3) digital experience, cytotechnologists (4) and senior pathology residents (2) diagnosed the digital slides independently first and recorded the results. Glass slides were read and recorded separately 1-3 days later. Accuracy of diagnosis, time to diagnosis and diagnostician's profile were analyzed.
  
  
  RESULTS
  Among 22 case pairs and four study groups, correct diagnosis (93% vs. 86%) was established using glass versus digital slides. Both methods more (>95%) accurately diagnosed positive cases than negatives. Cytopathologists with no digital experience were the most accurate in digital diagnosis, even the senior members. Cytotechnologists had the fastest diagnosis time (3 min/digital vs. 1.7 min/glass), but not the best accuracy. Digital time was 1.5 min longer than glass-slide time/per case for cytopathologists and cytotechnologists. Senior pathology residents were slower and less accurate with both methods. Cytopathologists with digital experience ranked 2(nd) fastest in time, yet last in accuracy for digital slides.
  
  
  CONCLUSIONS
  There was good overall diagnostic agreement between the digital whole-slide images and glass slides. Although glass slide diagnosis was more accurate and faster, the results of technologists and pathologists with no digital cytology experience suggest that solid diagnostic ability is a strong indicator for readiness of digital adoption.
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Jarret C
authors.initials: JC
authors.lastname: House
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA ; Department of Anatomic Pathology, Cytology Division, Tampa, FL, USA.
authors.forename: Evita B
authors.initials: EB
authors.lastname: Henderson-Jackson
authors.affiliation: Analytic Microscopy Core, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Johnson
authors.affiliation: Analytic Microscopy Core, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Lloyd
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA ; Department of Anatomic Pathology, Cytology Division, Tampa, FL, USA.
authors.forename: Jasreman
authors.initials: J
authors.lastname: Dhillon
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Nazeel
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA ; Department of Anatomic Pathology, Cytology Division, Tampa, FL, USA.
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Hakam
authors.affiliation: Cytology Division, Shadyside Hospital, University of Pittsburgh, PA, USA.
authors.forename: Walid E
authors.initials: WE
authors.lastname: Khalbuss
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA ; Department of Anatomic Pathology, Cytology Division, Tampa, FL, USA.
authors.forename: Marino E
authors.initials: ME
authors.lastname: Leon
authors.affiliation: Department of Pathology, Cytology Division, Yale University, New Haven, CT, USA.
authors.forename: David
authors.initials: D
authors.lastname: Chhieng
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA ; Department of Anatomic Pathology, Cytology Division, Tampa, FL, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Centeno
authors.affiliation: Department of Pathology and Cell Biology, University of South Florida College of Medicine, Tampa, FL, USA ; Analytic Microscopy Core, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Bui
keywords: Digital diagnostic cytopathology; virtual microscopy; whole slide imaging