Integrating cytology into routine digital pathology workflow: a 5-year journey

Despite recent advances in digital imaging, the adoption of digital cytology is challenging due to technical limitations. This study describes our 5-year institutional experience with the implementation of digital cytology. The routine cytology workflow included conventional two-step screening by cytotechnologists, followed by sign out by pathologists. We introduced sign out of cytologic cases using a microscopic digital imaging platform operated by cytotechnologists, which allowed for remote review of slides by cytopathologists via video streaming. We also provided cytologic correlation to support the virtual slide-based sign out of histopathological specimens and for a weekly pathology-radiology conference. In addition, positive cytology cases were archived for integration into the laboratory information system and for prospective computational pathology studies. We also summarized lessons learned over the years and outlined our vision for future developments. This unique experience may serve as a role model for other institutions.