6th ESACP Congress, Heidelberg, April 7-11, 1999

A124
IS TODAY'S TELEPATHOLOGY EQUIPMENT ALSO APPROPRIATE FOR TELECYTOLOGY? - A PILOT STUDY WITH PAP SMEARS
Schwarzmann P, Schenck U, Binder B

Inst.Physikalische Elektronik, Stuttgart, Germany

Diagnosis in telepathology with robotic microscopes has proven in many fieldtests to achieve similar results as the conventional inspection under the microscope. This is due to the advanced status of todays telepathology equipment with remotely controllable microscopes allowing a comfortable inspection of histological specimens. In telecytology the situation unfortunately differs from that in histology. In cytology very often the complete slide must be inspected with high magnification (10x to 40x) to evaluate details in cell structures, whereas in histology mostly only selected areas are of interest, additionally mostly only low magnifications (1,25x to 5x) with big fields of view are applied. PAP smear screening with telemicroscopy for instance would require about 4.000 fields of view. Assuming image transmission via 8 ISDN channels about 100 min. are necessary to transmit all fields of a slide! Such intervals are inacceptable. Ways out of this dilemma are the restriction to slides with only few cells or to make a preselection of areas of the slide assumed to contain diagnostically important material. This leads to the well known situation of a prescreening scenario, where the expert has not to inspect all areas or slides. In a pilot study with 104 well diagnosed PAP smears of different degrees of malignancy, suspicious areas in the slides were selected, and only these areas have been investigated by the remote senior cytotechnician. In the results of the study 3 slides were diagnosed false positive (incl. 2 IIID) and 9 false negative (incl. 5 IIID). Accompanying findings like bacteria etc. were reported in 73 slides in correspondence to the conventional report and in 33 cases with deviations. In conclusion can be stated, that telecytology achieves acceptable results if the amount of data on a slide is handled appropriately.