Objective: Cervical cancer is one of the most common malignancies worldwide, yet it is preventable by population screening. In a previous study, we confirmed the feasibility of utilizing whole slide imaging (WSI) of cell block (CB) preparations to overcome the limitations of digitizing cytologic samples. In this study, we evaluated the accuracy of WSI in identifying various organisms and nonneoplastic findings. Study Design: A total of 335 WS images from Pap CB preparations were analyzed using the Aperio system. The test performance characteristics of ThinPrep (TP) and WSI samples were compared for adequacy, for the presence of bacterial vaginosis (BV), fungi, Trichomonas vaginalis (TV) and herpes simplex virus (HSV) and for nonneoplastic findings. Results: The WSI samples contained optimal material from all preparations. BV was diagnosed in 33 WSI versus 36 TP samples. Budding yeasts and/or pseudohyphal forms were noted in 18 WSI versus 19 TP samples. TV organisms (10 of 11 samples) and 1 HSV case were accurately identified in the WSI and TP samples. Squamous metaplasia, keratosis and reactive/reparative and inflammatory changes were easily identified by WSI. Conclusions: The concept of WSI from Pap CB preparations is potentially feasible for adoption. Digital remote web-based technology eliminates the need for an individual on site, saving time and resources.

1.
Dee FR: Virtual microscopy in pathology education. Hum Pathol 2009;40:1112-1121.
2.
Wilbur DC, Madi K, Colvin RB, Duncan LM, Faquin WC, Ferry JA, Frosch MP, Houser SL, Kradin RL, Lauwers GY, Louis DN, Mark EJ, Mino-Kenudson M, Misdraji J, Nielsen GP, Pitman MB, Rosenberg AE, Smith RN, Sohani AR, Stone JR, Tambouret RH, Wu CL, Young RH, Zembowicz A, Klietmann W: Whole-slide imaging digital pathology as a platform for teleconsultation: a pilot study using paired subspecialist correlations. Arch Pathol Lab Med 2009;133:1949-1953.
3.
Hedvat CV: Digital microscopy past, present, and future. Arch Pathol Lab Med 2010;134:1666-1670.
4.
Jara-Lazaro AR, Thamboo TP, Teh M: Digital pathology: exploring its applications in diagnostic surgical practice. Pathol 2010;42:512-518.
5.
Pantanowitz L: Digital images and the future of digital pathology. J Pathol Inform 2010;1:15.
6.
Bauer TW, Schoenfield L, Slaw RJ, Yerian L, Sun Z, Henricks WH: Validation of whole slide imaging for primary diagnosis in surgical pathology. Arch Pathol Lab Med 2013;137:518-524.
7.
Campbell WS, Foster KW, Hinrichs SH: Application of whole slide image markup and annotation for pathologist knowledge capture. J Pathol Inform 2013;4:2-8.
8.
Pantanowitz L, Hornish M, Goulart RA: The impact of digital imaging in the field of cytopathology. Cytojournal 2009;6:6.
9.
Kalbuss WE, Pantanowitz L, Parwani AV: Digital imaging in cytopathology. Pathol Res Inst 2011;2011:264683.
10.
O'Brien MJ, Takahashi M, Brugal G, Christen H, Gahm T, Goodell RM, Karakitsos P, Knesel EA Jr, Kobler T, Kyrkou KA, Labbe S, Long EL, Mango LJ, McGoogan E, Oberholzer M, Reith A, Winkler C: Digital imagery/telecytology: International Academy of Cytology Task Force summary. Diagnostic Cytology towards the 21st Century: an international expert conference and tutorial. Acta Cytol 1998;42:148-164.
11.
Alli PM, Ollayos CW, Thompson LD, Kapadia I, Butler DR, Williams BH, Rosenthal DL, O'Leary TJ: Telecytology: intraobserver and interobserver reproducibility in the diagnosis of cervical-vaginal smears. Hum Pathol 2001;32:1318-1322.
12.
Lee ES, Kim IS, Choi JS, Yeom BW, Kim HK, Han JH, Lee MS, Leong AS: Accuracy and reproducibility of telecytology diagnosis of cervical smears: a tool for quality assurance programs. Am J Clin Pathol 2003;199:356-360.
13.
Eichhorn JH, Brauns TA, Gelfand JA, Crothers BA, Wilbur DC: A novel automated screening and interpretation process for cervical cytology using the Internet transmission of low-resolution images: a feasibility study. Cancer 2005;105:199-206.
14.
Wright AM, Smith D, Dhurandhar B, Fairley T, Scheiber-Pacht M, Chakraborty S, Gorman BK, Mody D, Coffey DM: Digital slide imaging in cervicovaginal cytology: a pilot study. Arch Pathol Lab Med 2013;137:615-624.
15.
Prayaga AK, Loya AC, Rao IS: Telecytology: are we ready? J Telemed Telecare 2006;12:319-320.
16.
Yeoh GP, Chan KW: Cell block preparation on residual ThinPrep sample. Diagn Cytopathol 1999;21:427-431.
17.
Richard K, Dziura B, Hornish A: Cell block preparation as a diagnostic technique complementary to fluid-based monolayer cervicovaginal specimens. Acta Cytol 1999;43:69-73.
18.
Diaz-Rosario LA, Kabawat SE: Cell block preparation by inverted filter sedimentation is useful in the differential diagnosis of atypical glandular cells of undetermined significance in ThinPrep specimens. Cancer 2000;90:265-272.
19.
Keyhani-Rofagha S, Vesey-Shecket M: Diagnostic value, feasibility, and validity of preparing cell blocks from fluid-based gynecologic cytology specimens. Cancer 2002;96:204-209.
20.
Gupta S, Hadler K, Khan VA, Sodhani P: Cell block as an adjunct to conventional Papanicolaou smear for diagnosis of cervical cancer in resource-limited settings. Cytopathology 2007;18:309-315.
21.
Fetsch PA, Simir A, Brosky K, Abati A: Comparison of the 3 commonly used cytologic preparations in effusion immunocytochemistry. Diagn Cytopathol 2001;26:61-66.
22.
Afify A, Yu C, Hejazi N, Howell L: The diagnostic utility of cell blocks prepared from residual SurePath Pap material for detection of human papillomavirus. Appl Immunohistochem Mol Morphol 2009;17:108-114.
23.
Amin K, Hernandez-Rios P, Davis M, Fan F, Wilson J, Tawfik O: The potential of telecytology of cell block from Pap smear samples ‘TelePAPology'. Mod Pathol 2010;23(suppl 1):86A.
24.
Andraws N, Davis M, Dillon S, Fan F, Tawfik O: TelePAPology versus liquid-based ThinPrep cervical cytology: a comparative study evaluating human papillomavirus testing by Hybrid Capture-2 and in-situ hybridization. Cytojournal 2011;8:16.
25.
Pham T, Winters C, Davis M, Fan F, Tawfik O: TelePAPology vs. liquid-based cervical cytology: A comparative study evaluating p16 immunohistochemistry and HPV testing by Hybrid Cpature-2 and in-situ hybridization. Mod Pathol 2013;26(suppl 1):100A.
26.
Hutchinson ML, Isenstein LM, Goodman A, Hurley AA, Douglass KL, Mui KK, Patten FW, Zahniser DJ: Homogeneous sampling accounts for the increased diagnostic accuracy using the ThinPrep Processor. Am J Clin Pathol 1994;101:215-219.
27.
Lee KR, Ashfaq R, Birdson GG, Corkill ME, McIntosh KM, Inhorn SL: Comparison of conventional Papanicolaou smears and a fluid-based, thin layer system for cervical screening. Obstet Gynecol 1997;90:278-284.
28.
Linder J, Zahniser D: ThinPrep Papanicolaou testing to reduce false-negative cervical cytology. Arch Pathol Lab Med 1998;122:139-144.
29.
Limaye A, Connor AJ, Huang X, Luff R: Comparative analysis of conventional Papanicolaou tests and a fluid-based thin-layer method. Arch Pathol Lab Med 2003;127:200-204.
30.
Davey E, Barratt A, Irwig L, et al: Effect of study design and quality on unsatisfactory rates, cytology classifications, and accuracy in liquid-based versus conventional cervical cytology: a systematic review. Lancet 2006;367:122-132.
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