Reply to Why is digital pathology in cytopathology lagging behind surgical pathology?

Abstract

We thank Simone Van Es for her comments on our article.1 She delightfully points out that the cytopathology community should embrace whole-slide imaging (WSI). Indeed, many of the current WSI challenges in cytology (eg, screening and focusing) may be overcome with newer technology or adapting the workflow. However, what if we took it one step further and explored modifying cytology specimens so that they were much better suited for WSI? A prime historical example of when this was undertaken is the introduction of liquid-based cytology (LBC) to automate the Papanicolaou test and use image analysis. The transition from conventional Pap tests to LBC Pap tests was contentious at first, but has since proven its worth and has accordingly largely been adopted as the standard of care in cytology practice today. Similar progressive efforts have been proposed by Tawfik et al, who demonstrated that cell block preparations of Pap tests in lieu of LBC preparations can help to overcome the current limitations of WSI for gynecologic cytology.2, 3 In our experience at the University of Pittsburgh Medical Center, we have found that for nongynecologic cases submitted for telecytology consultation, using cell block preparations only, is feasible and sufficient to provide a meaningful second opinion interpretation in the majority of cases. As Van Es indicates, perhaps we need to “think outside the box” in cytology to adopt and leverage emerging WSI technology. No specific funding was disclosed. Liron Pantanowitz has acted as a paid consultant for Hamamatsu for work performed outside of the current study. Matthew G. Hanna, MD Liron Pantanowitz, MD Department of Pathology University of Pittsburgh Medical Center Pittsburgh, Pennsylvania