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Cancer Cytopathol. 2018 Sep;126(9):767-772. doi: 10.1002/cncy.22026. Epub 2018 Sep 19.

Use of a low-cost telecytopathology method for remote assessment of thyroid FNAs.

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Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil.
Department of Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil.
Department of Collective Health, Santa Casa Medical School, Sao Paulo, Brazil.
Department of Radiology, Santa Casa Medical School, Sao Paulo, Brazil.



Rapid on-site evaluation is a great tool for optimizing the adequacy and quality of cytologic samples. The objective of the current study was to analyze a low-cost telecytopathology method for the remote assessment of thyroid fine-needle aspiration biopsies (FNABs), with comparison of the primarily rendered adequacy and diagnosis with the final conventional analysis.


Material collected from thyroid FNABs was immediately smeared onto glass slides and stained with Diff-Quik. A conventional microscope attached to a smart device was operated on-site by either a medical student or a pathology resident for Wi-Fi transmission of the images by Skype. The cytopathologist would remotely guide the screening of the slides, zooming in and out of areas of interest. Remote assessment included an analysis of material adequacy and a preliminary diagnosis. The quality of the transmission and the number of slides also were recorded. After a washout period of 3 weeks, final diagnosis and adequacy were assigned by conventional microscopy.


The final agreement rate for adequacy between remote and conventional analysis was 90.5%. For diagnosis, the final agreement rate was 83.3%. The diagnosis agreement rate varied, depending on the quality of transmission: there was 88% agreement when the quality was excellent, 77.8% agreement when it was good, and 62.5% agreement when it was poor.


Low-cost telecytopathology is an efficient method for the remote assessment of thyroid FNAB adequacy and diagnosis. The wide use of such technology in low-resource or remote centers may have a positive impact on the number of adequate or satisfactory samples, optimizing the management of patients who have thyroid nodules.


cytology; fine-needle aspiration; telecytopathology; thyroid; thyroid nodule


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