Comparison of Remote-Controlled Microscopy, Telecytology and In-Person Methods for Rapid On-Site Evaluation

Summary: Introduction: As cytotechnologists are becoming increasingly difficult to hire, additional solutions for providing rapid on-site evaluation (ROSE) are needed. Commercially-available remote-controlled microscopy systems (RCMs) can utilize personnel without cytopathology interpretive expertise on-site, with a pathologist or cytotechnologist operating the microscope remotely. Comparison of results of RCM-provided ROSE with conventional in-person and telecytology ROSE methods in practice is needed. Materials and Methods: Results of ROSE procedures from 67 consecutive cases performed 11/3/23 to 4/26/24 via a validated Mikroscan L5 RCM system (Mikroscan, Carlsbad, CA) by a remote cytopathologist were reviewed. During the same time interval, results from an equal number of consecutive in-person pathologist-performed ROSE procedures and consecutive cytotechnologist/cytopathologist-performed telecytology ROSE procedures using an Apple iPhone 11 and FaceTime were reviewed and compared to RCM for accuracy of adequacy assessment and concordance with final diagnosis. Cases in which malignant cells were only present in the core biopsy/cell block rather than the touch preparations were excluded from analysis (n=2). Results: Discrepancies were defined as a two-step or more diagnostic category difference between ROSE diagnosis and final diagnosis. Using this definition, the discrepancy rate was similar for in-person (3/67, 4.5%), telecytology (3/67, 4.5%), and RCM-provided ROSE (4/67, 6.0%). The adequacy accuracy rate (concordance between adequacy assessment for ROSE versus final diagnosis) was also similar for in-person (65/67, 97.0%), telecytology (63/67, 94.0%) and RCM methods (64/67, 95.5%). Results are summarized in Table 1. Conclusions: RCM-provided ROSE was noted to have similar rates of concordance with final diagnosis and accuracy of adequacy assessment to in-person and telecytology methods. Given the challenges many have in hiring cytotechnologists, remote methods like RCM could prove necessary to continue providing ROSE in ever-growing medical centers.