Study on the Reproducibility of Thyroid Lesions Telecytology Diagnoses Based Upon Digitized Images John Georgoulakis, M.D., Ph.D., 1 Stavros Archondakis, M.D., 2 Ioannis Panayiotides, M.D., Ph.D., 3 Dionisis Anninos, M.D., 1 Lazaros Skagias, M.D., 2 * Magdalini Stamataki, M.D., 1 George Peros, M.D., Ph.D., 4 and Petros Karakitsos, M.D., Ph.D. 1 The objective of this study is to evaluate the reproducibility and usefulness of telecytology diagnoses proffered on the basis of digitized images from fine-needle aspiration specimens prepared by means of liquid-based cytology. Representative digital cytological images from a total of 270 thyroid fine-needle aspiration specimens were transferred via file transfer protocol to specific password-protected accounts and were remotely reviewed by five independent board-certified cyto- pathologists (initial round). Their reports were recorded and classified. After 6 and 12 months, the same representative digital images were transferred in random order to the same cytopatho- logists and were reviewed again (first and second review rounds). The cytopathologists’ first and second round diagnoses were recorded and compared with their initial ones. Statistical evaluation of cytological diagnoses detected no sig- nificant difference in diagnostic accuracy among initial and review diagnoses. The overall interobserver agreement was almost perfect with j values of 0.869–0.939, whereas intraob- server agreement ranged from almost perfect to perfect with j values of 0.967–1 in all diagnostic rounds. Digitized cytological images transmission and remote evalua- tion allows reproducible diagnosis of thyroid gland lesions. Diagnoses made by using static telecytology systems can be equally reliable to those made by using conventional micros- copy, provided that representative images are utilized and that the standard cytological diagnostic criteria are applied. Diagn. Cytopathol. 2011;39:495–499. ' 2010 Wiley-Liss, Inc. Key Words: fine-needle aspiration; thyroid; liquid-based cytol- ogy; telecytology; reproducibility; interobserver agreement; intraobserver agreement Telecytology diagnosis reproducibility is a sine qua non for its further implementation in the everyday laboratory workflow. It provides immediate access to a second opin- ion and improves specialty consultation opportunities. 1,2 Telecytology also enables a high quality of medical edu- cation and proficiency testing. 3 Telecytology diagnosis can be achieved either with the use of cytological pictures viewed in real time from the microscope (dynamic telecytology systems), or with the use of cytological pictures first captured in a digital for- mat and subsequently transmitted to distant observers (static telecytology systems). 2,4,5 Static telecytology systems diagnostic reliability is a sine qua non for further implementation of this method in exter- nal or internal audits and quality assurance programs. 6 Few studies have so far focused on the possible role of static telecytology as a tool of diagnosis and consultation in the everyday workflow. 7–11 Most of these studies have found a high (90–95%) concordance between telecytology and glass slide diagnoses. 7–11 Still there are not enough studies available referring to the method’s diagnostic reproducibility. 2 The aim of this study was to confirm static telecytology systems diagnos- tic reproducibility by measuring interobserver and intra- observer agreements among five cytopathologists that reviewed static, digitized, representative images from thy- roid fine-needle aspiration specimens. Materials and Methods The current study was carried out on 270 thyroid fine- needle aspiration specimens from 179 patients preopera- 1 Department of Cytopathology, University of Athens, Medical School, ‘‘Attikon’’ University Hospital, Athens, Greece 2 Department of Cytopathology, 401 General Army Hospital, Athens, Greece 3 2nd Department of Pathology, University of Athens, Medical School, ‘‘Attikon’’ University Hospital, Athens, Greece 4 4th Department of Surgery, University of Athens, Medical School, ‘‘Attikon’’ University Hospital, Athens, Greece *Correspondence to: Lazaros Skagias, M.D., 30 Menekratous Street, Athens 11636, Greece. E-mail: skacyt@yahoo.gr Received 25 November 2009; Accepted 18 March 2010 DOI 10.1002/dc.21419 Published online 20 August 2010 in Wiley Online Library (wileyonlinelibrary.com). ' 2010 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 39, No 7 495