Making cytological diagnoses on digital images using the iPath network.
BACKGROUND
The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool.


OBJECTIVE
To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set.


METHODS
Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant.


RESULTS
For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93%, respectively; the overall accuracy was 88-90%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions.


CONCLUSIONS
Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.
Institute for Pathology, University Hospital Basel, Basel, Switzerland.
Peter
P
Dalquen
Spasenija
S
Savic Prince
Peter
P
Spieler
Dietmar
D
Kunze
Heinrich
H
Neumann
Serenella
S
Eppenberger-Castori
Heiner
H
Adams
Katharina
K
Glatz
Lukas
L
Bubendorf
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D034201:Computers, Handheld / Q000706:statistics & numerical data; D003581:Cytodiagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis* / Q000473:pathology; D007223:Infant; D008297:Male; D008679:Metaplasia / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000473:pathology; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000295:instrumentation* / Q000706:statistics & numerical data