Multi-Layer Virtual Slide Scanning System with Multi-Focus Image Fusion for Cytopathology and Image Diagnosis

Abstract

SUMMARY Objective: The virtual slides are high-magnification whole digital images of histopathological tissue sections. The existing virtual slide system, which is optimized for scanning flat and smooth plane slides such as histopathological paraffin-embedded tissue sections, but is unsuitable for scanning irregular plane slides such as cytological smear slides. This study aims to develop a virtual slide system suitable for cytopathology slide scanning and to evaluate the effectiveness of multi-focus image fusion (MF) in cytopathological diagnosis. Study Design: We developed a multi-layer virtual slide scanning system with MF technology. Tumors for this study were collected from 21 patients diagnosed with primary breast cancer. After surgical extraction, smear slide for cytopathological diagnosis were manufactured by the conventional stamp method, fine needle aspiration method (FNA), and tissue washing method. The stamp slides were fixed in 95% ethanol. FNA and tissue washing samples were fixed in CytoRich RED Preservative Fluid, a liquid-based cytopathology (LBC). These slides were stained with Papanicolaou stain, and scanned by virtual slide system. To evaluate the suitability of MF technology in cytopathological diagnosis, we compared single focus (SF) virtual slide with MF virtual slide. Cytopathological evaluation was carried out by 5 pathologists and cytotechnologists. Results: The virtual slide system with MF provided better results than the conventional SF virtual slide system with regard to viewing inside cell clusters and image file size. Liquid-based cytology was more suitable than the stamp method for virtual slides with MF. Conclusion: The virtual slide system with MF is a useful technique for the digitization in cytopathology, and this technology could be applied