It is often difficult for cytologists to juggle their time between management responsibilities and onsite assessment of cytological samples. Their time would be better utilized if they could do both from their desk.  Agarwal et al looked into the possibility of remotely assessing digital cytology images — Telecytology — from fine-needle aspirations (FNAs) using the free FaceTime app and the Magnifi smartphone adapter attached to microscopes.  We’ve profiled before how FaceTime has been used in medicine for the last several years.

In this study, both endoscopic ultrasound-guided and computerized tomography (CT)-guided FNAs were evaluated in parallel with an onsite cytologist, retrospectively and prospectively. For the retrospective study, static, stored images were used, and resulted in 88% (22/25) agreement between remote and onsite assessments. In the prospective study, 86% (12/14) cases reached agreement. The average amount of time spent per diagnosis was similar at 10 seconds to 3 minutes for both remote and onsite evaluations.

Based on this telecytology study, real-time remote assessment of cytology images seems feasible with a high degree of concordance between assessments done onsite and remotely. However, some challenges remain:

  • Potential network connection issues
  • Focusing between different magnification objectives
  • Varying software versions leading to compatibility issues
  • Field-of-view fluctuations due to misalignment of camera on eyepiece
  • Occasional malfunctioning speakerphone function
  • No recording function on FaceTime using a smartphone

Telecytology has become increasingly common over the last few years. Cytologists are saving time while achieving clinical benefits, such as shorter overall procedure times, minimizing the number of passes, and allowing for immediate appropriate triage. Although static telecytology using pre-captured still-images is currently most common, the hybrid whole-slide imaging (WSI) method that allows for both 3D dynamic and still viewing of the images is much more powerful and appreciated. To make WSI possible, the institution must have the appropriate hardware and software to scan, store, transmit, and record image interpretations in a secure way. Furthermore, there must be a well-trained technician selecting the appropriate fields-of-view to image and enough financial resources to support this technology (e.g., a WSI device costs roughly $135,000).

Telecytology using FaceTime

Besides Magnifi and FaceTime, other combinations have been explored previously, such as one involving Gynocular and Skype.

It would be interesting to see a study comparing all existing smartphone-compatible camera adapters with different real-time video call apps to see which ones provide the best images, the most stable connections, and the most cost-effective results.