Digital slide imaging in cervicovaginal cytology: a pilot study

Area of Science:

• Anatomic Pathology
• Cytopathology
• Digital Imaging

Background:

• Digital whole slide imaging (WSI) is emerging in anatomic pathology, replacing traditional glass slides.
• WSI in cytology has faced challenges like lack of z-axis depth focusing and large file sizes.
• New WSI systems with z-axis technology are now available.

Purpose of the Study:

• To compare the accuracy and efficiency of WSI versus traditional glass slides for cervicovaginal diagnostic cytology.
• To evaluate the impact of different WSI magnifications and z-stacking on diagnostic performance.

Main Methods:

• Eleven cervicovaginal cytology cases (ThinPrep, SurePath) were scanned using BioImagene iScan Coreo Au 3.0 at ×20, ×40, and ×40 z-stack magnifications.
• Four cytotechnologists and three pathologists conducted a blinded review of digital images and glass slides.
• Diagnostic accuracy and interpretation time were recorded for each case and magnification.

Main Results:

• Glass slides yielded higher diagnostic accuracy and lower average interpretation time per case compared to all digital WSI formats.
• Among digital images, ×40 magnification with z-stacking demonstrated the highest diagnostic accuracy and shortest interpretation time.
• Despite improvements, digital interpretation time remained longer than with glass slides.

Conclusions:

• Whole slide imaging is a viable tool for cytology education, consultations, and case archiving.
• Current WSI technology, due to file size and interpretation time, is not yet suitable for routine daily cervicovaginal diagnostic cytology screening.
• Further advancements in WSI technology are needed to overcome limitations for primary diagnostic use.