Digital Cytology

Cervical cancer is one of the most common causes of death in women worldwide (Organisation). The introduction of cervical cytology in screening programs is an effective way for early detection and treatment of cervical precancerous lesions. Conventional screening of cervical cytology slides is still considered the current “gold standard“ for the assessment of proficiency in becoming a cytotechnician, but diagnosis using digital whole slide images (WSI) may offer many advantages. In this study we have established a digital WSI based reference atlas of the most common cervical infections and (pre)neoplastic lesions, and hypothesized that weekly WSI based case-meetings would help to obtain optimal acceptance of the new digital workflow in our daily pathology practice. A questionnaire before and after the test period was used to study the effect of our approach.

The participants clearly had to go through a learning curve to get accustomed to viewing WSI. In the beginning, there was little self-confidence in recognizing classical cervical cytomorphological features in the WSI, and there were complaints about the speed of viewing and insufficient z-resolution for cell groups. Adjusting the z-stack settings resulted in better 3-Dimensional information due to better focusing options, and weekly meetings appeared to be instrumental in the implementation process, as participants had to select and present WSI from thematic cases themselves and thereby got used to viewing WSI. Some WSI were replaced by better ones until a final set of 45 representative WSI remained. Eventually, as evident from the questionnaire, participants agreed that cytomorphological features in WSI from thin layers cervical slides could comparably be appreciated in WSI as by conventional microscopy.

In conclusion, we have obtained confirmation and acceptance by professionals that WSI from cervical cytology can be used to identify cytomorphological features, necessary for diagnosis. In addition we have demonstrated that active participation of professionals had a positive effect during a period of change management.

WSI can equally to Conventional Light Microscopy (CLM) be used in primary diagnosics of cervical cytological thin-layer slides

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