Telecytology: A Tool for Quality Assessment and Improvement in the Evaluation of Thyroid Fine-Needle Aspiration Specimens

The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of thyroid fine-needle aspiration specimens prepared by the ThinPrep (R) technique (Cytyc Co., Boxborough, MA). The study was performed on 252 adequate specimens of 157 patients referred to the Cytopathology Department of University Hospital Attikon for preoperative evaluation of thyroid nodules. In all cases, surgical excision followed the initial cytological diagnosis. Three diagnostic categories of cytological reports were used. All cases were confirmed by histological diagnosis of surgical specimens. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for remote review by four independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered on the basis of digitized images and conventional slides. Telecytology is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. The use of liquid-based cytology ensures that additional material is preserved for ancillary studies (if necessary) and that a sufficient number of replicate microscope slides can be produced. The use of telecytology in the daily workflow will ensure the reproducibility of cytological diagnoses and make feasible the production of digital educational material. Besides diagnostic accuracy, the implementation of a diagnostic telecytology system requires consideration of numerous financial, legal, professional, and ethical issues.