Assessing the Use of Telecytology for Rapid On-Site Evaluation (TC-ROSE) of Thyroid Fine Needle Aspirations: An Endocrinology Clinic Experience

Summary: Introduction: Telecytology (TC) improves rapid on-site evaluation (ROSE) of thyroid fine needle aspirations (FNA) through online communication platforms, enabling remote preliminary diagnoses by pathologists. Hence, expediting specimen triaging for enhanced diagnostic efficiency. Given the implications for laboratory quality improvement, we report our experience using TC-ROSE in our off-site endocrinology clinic's thyroid FNA procedures. Materials and Methods: We conducted a retrospective review of thyroid FNA cases with TC-ROSE from 02/25/2021-05/17/2023. The cytotechnologist prepares the Diff-Quik stained slides and shows the case to the pathologist using our TC-ROSE set-up which includes a microscope-camera system (Views-IQ, Vancouver, BC), secure network and Zoom. The pathologist relays the adequacy status and decides the appropriate triage. We compared the adequacy and preliminary TC-ROSE results to the final diagnosis. The non-diagnostic rate and discrepancy rate between preliminary and final diagnosis were then calculated. Results: A total of 569 cases were analyzed, with 92% (521) receiving adequate diagnosis during TC-ROSE. 68.7% (391) received preliminary diagnoses, while 22.8% (130) were adequate, but no prelim was given. The non-diagnostic rate was 8%, with 100% concordance between preliminary and final diagnoses for malignant-IV, 99.7% for suspicious-V, and 90.8% for AUS/FLUS-III. Discordant cases included 1.5% (6) benign-II preliminarily with AUS/FLUS-III as final and 3.6% (14) AUS/FLUS-III preliminary with benign-II as final. Only one case diagnosed as benign-II was later found malignant due to sampling issue, i.e., (slides from the pass containing malignant cells were not stained during ROSE). This resulted in refining the protocol (at least one smear per pass stained for TC-ROSE). These findings are summarized in Table 1. Conclusions: In our study, TC-ROSE of thyroid FNA showed an overall high concordance with adequacy in preliminary vs final diagnosis. TC-ROSE also offers added benefits of streamlining patient care and optimizing pathologist resources. With ongoing modifications and additional studies, its accuracy and efficiency can be further enhanced.