title: Whole-Slide Imaging of Pap Cellblock Preparations Is a Potentially Valid Screening Method.
abstract: OBJECTIVE
  To date, the impact of digital imaging on routine cytology remains far from perfect. Cellblock (CB) preparations from Pap samples have been shown to be diagnostically valuable. We evaluated the validity of utilizing whole-slide imaging (WSI) prepared from Pap CBs as a screening tool.
  
  
  METHODS
  A total of 1,110 CB slides prepared from residual Pap samples were analyzed - 563 normal, 282 atypical squamous cells of undetermined significance (ASCUS), 12 atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion, 188 low-grade squamous intraepithelial lesions (LSIL), 36 high-grade squamous intraepithelial lesions (HSIL), 25 atypical glandular cells of undetermined significance, 1 adenocarcinoma in situ, 2 invasive adenocarcinomas, and 1 squamous cell carcinoma. Virtual slides were obtained using the Aperio system. Test performance characteristics of liquid-based samples and WSI from CB samples were compared.
  
  
  RESULTS
  Average sensitivity and specificity of the five WSI reviewers was 58.3 and 85.1% for ASCUS, respectively, 54.1 and 93.9% for LSIL, and 51.8 and 98.8% for HSIL. Overall WSI sensitivity and specificity for detecting lesions was 82.1 and 86.2%, respectively. Agreement (kappa values) between WSI reviewers was 0.56 for ASCUS, 0.69 for LSIL, 0.67 for HSIL, and 0.74 for negative samples.
  
  
  CONCLUSIONS
  WSI of CB preparations is a feasible method to achieve high-quality specimen preparations. It is as sensitive as liquid-based methods and appears to be highly specific for the detection of LSIL and HSIL.
authors.affiliation: Department of Pathology and Laboratory Medicine, Kansas University Medical Center, Kansas City, Kans., USA.
authors.forename: Ossama
authors.initials: O
authors.lastname: Tawfik
authors.forename: Marilyn
authors.initials: M
authors.lastname: Davis
authors.forename: Susan
authors.initials: S
authors.lastname: Dillon
authors.forename: Laila
authors.initials: L
authors.lastname: Tawfik
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Diaz
authors.forename: Khalid
authors.initials: K
authors.lastname: Amin
authors.forename: Fang
authors.initials: F
authors.lastname: Fan
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065309:Atypical Squamous Cells of the Cervix; D057205:Automation, Laboratory; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D002584:Cervix Uteri / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008875:Middle Aged; D060787:Neoplasm Grading; D015588:Observer Variation; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*