Pitfalls of Rapid Onsite Evaluation (ROSE) Using Dynamic Telecytology

s S15 was to assess the pitfalls of rapid onsite evaluation with the use of dynamic telecytology. Materials and Methods: Diff Quick stained slides from 30 consecutive computed tomographyor endoscopyguided fine needle aspiration (FNA) cases that had required ROSE, were retrospectively evaluated via telecytology. Original diagnoses were kept blind to both, the operator (the cytotechnologist), and the remote consultant (cytopathologist). The same sets of cases were independently reviewed by two separate cytopathologists blinded to each other’s telecytology diagnostic impression. Cytotechnologist projected all cases and remote pathologist had the ability to request additional screening, better focus, higher power, etc, before making the final interpretation. Results: The specimen sites, original and telecytology diagnoses (Cytopathologist1 and Cytopathologist2) are listed in Table 1 and 2. Of the 30 cases (11 male, 19 female; age 14 93 years) evaluated by telecytology, lymph node EBUS FNA was the most common specimen. The diagnostic concordance rate was 95%. Two cases with discordant diagnosis are listed in Table 2. One was a mediastinal lymph node that was called small cell carcinoma (Cytopathologist1). The second was a paratracheal lymph node interpreted as non-small cell carcinoma (Cytopathologist2). Both cases had been originally diagnosed as reactive lymph nodes. Slides and telecytology pictures were reviewed after telecytology, with the aim to understand the reasons for the telecytology discrepancy. Table 1 Specimen sites Site Number of cases Lymph node (EBUS:16, US: 1) 17 Pancreas (CT: 6, EUS:2) 8 Lung (CT) 1 Omentum (CT) 1 Kidney (CT) 1 Liver (CT) 1 Bone (CT) 1 Total of cases 30 Table 2 Specimen, Diagnoses and Discrepancies Site Procedure Original Telecytology Telecytology Discrepancy diagnosis Diagnosis Cytopathologist1 Diagnosis Cytopathologist2 reason LN paratracheal EBUS Reactive Reactive Non-small cell carcinoma Reactive atypia of bronchial cells LN subcarinal EBUS Inadequate Non diagnostic Non diagnostic LN subcarinal EBUS Inadequate Non diagnostic Non diagnostic LN, R4 EBUS Granuloma Granuloma Granuloma LN, R4 EBUS Granuloma Granuloma Granuloma LN paratracheal EBUS Granuloma Granuloma Granuloma LN mediastinal EBUS Small cell carcinoma Reactive Small cell carcinoma Lymphocytes with crush artifact LN, R4 EBUS Small cell carcinoma Small cell carcinoma Small cell carcinoma LN mediastinal EBUS Reactive Reactive Reactive LN paratracheal EBUS Adenocarcinoma Adenocarcinoma Adenocarcinoma LN paratracheal EBUS Adenocarcinoma Adenocarcinoma Adenocarcinoma LN mediastinal EBUS Small cell carcinoma Small cell carcinoma Small cell carcinoma LN paratracheal EBUS Inadequate Inadequate Inadequate LN hilar EBUS Small cell carcinoma Small cell carcinoma Small cell carcinoma LN subcarinal EBUS Squamous cell ca Squamous cell ca Squamous cell ca LN hilar EBUS Granuloma Granuloma Granuloma LN right neck US Lymphoma Lymphoma Lymphoma Pancreas CT Pancreatic endocrine neoplasm Pancreatic endocrine neoplasm Pancreatic endocrine neoplasm Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas EUS Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas EUS Adenocarcinoma Adenocarcinoma Adenocarcinoma Bone CT Metastatic Adenocarcinoma Metastatic Adenocarcinoma Metastatic Adenocarcinoma Omentum CT Endometroid Adenocarcinoma Endometroid Adenocarcinoma Endometroid Adenocarcinoma Lung CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Liver CT Metastatic Adenocarcinoma Metastatic Adenocarcinoma Metastatic Adenocarcinoma Left kidney CT Renal Cell Carcinoma Renal Cell Carcinoma Renal Cell Carcinoma EBUS Z Endoscopic bronchial ultrasound; EUS Z Endoscopic ultrasound; USZ Ultrasound; CT Z Computed tomography; LNZ Lymph node. Conclusions: The pitfalls of rapid onsite evaluation by telecytology are similar to those found in conventional evaluation. EBUSFNAs of paratracheal nodes are more challenging. Reactive atypia of bronchial cells may be misinterpreted as adenocarcinoma when comparison with rest of the slide is suboptimal due to delayed projection of the frames screened, rendering a false-positive result. Also we need to be aware of the distinction between benign lymphocytes with crush artifact and small cell carcinoma.