The Role of Telecytology in the Primary Diagnosis of Thyroid Fine-Needle Aspiration Specimens.

INTRODUCTION: The Acibadem Health Group (AHG) has been using telepathology/digital pathology stations since 2006. In 2013, the system was changed from videoconferencing to digital pathology (whole-slide imaging) utilizing 3DHISTECH scanners and software. In 2017, digital cytology started to be used for routine cytopathologic diagnosis for thyroid fine-needle aspiration (FNA) cases. MATERIAL AND METHODS: Two hundred and twenty-seven thyroid cases were received for analysis using telecytology (TC) during the period from November 2017 to May 2018. Rapid on-site evaluation was performed at the Atakent Hospital of the AHG by a cytotechnologist and scanned on the same day. For every case, there were Diff-Quik- and Papanicolaou-stained FNA smears. Each glass slide was digitized with a 3DHISTECH whole-slide scanner in 1 focal Z-plane at ×40 magnification. RESULTS: Two hundred and twenty-seven thyroid FNA specimens were retrieved, of which 25 had histologic follow-up. Samples were classified as nondiagnostic in 3%, benign in 74%, atypia of undetermined significance/follicular lesion of undetermined significance in 13%, suspicious for follicular neoplasia/follicular neoplasia in 3%, suspicious for malignancy in 4%, and malignant in 3%. When only the "suspicious for malignancy" and "malignancy" categories were considered positive tests, cytology sensitivity and specificity using TC for diagnosis was 100%. CONCLUSIONS: Our data demonstrate that TC is suitable to provide a primary diagnosis in daily routine cytology practice. Despite the promising results, there were some challenges stemming from the novelty of using TC for the primary diagnosis. The study also addresses both advantages and disadvantages of TC in daily practice to increase the efficiency of the technique in primary diagnosis.

Continuous arterial pressure waveform analysis accurately detects cardiac output in cardiac surgery: a prospective comparison with thermodilution, echocardiography, and magnetic resonance techniques.

OBJECTIVE: The aim of this study was to compare the accuracy of cardiac output (CO) measurements of noninvasive continuous arterial pressure waveform analysis, thermodilution technique and echocardiography with magnetic resonance (MRI) imaging. METHODS: Eleven patients who underwent coronary bypass surgery under cardiopulmonary bypass were prospectively enrolled in this study in 2008. Repeated arterial pressure based, thermodilution, echocardiography, and MRI cardiac output measurements were performed at the postoperative 24th hour. RESULTS: Mean CO values were 5.58 +/- 0.98, 5.97 +/- 0.8, 5.31 +/- 0.52, and 5.32 +/- 0.92 measured with MRI, echocardiography, arterial pressure waveform analysis, and thermodilution techniques, respectively. Bland-Altman analysis showed good overall agreement between the MRI vs arterial waveform analysis and MRI vs thermodilution; values for bias +/- SD were -0.27 +/- 1.06 (95% confidence interval [CI] [-2.3 to 1.8]; P = .42) and -0.26 +/- 0.89 (95% CI [-2.0 to 1.5]; P = .34), respectively. Poor agreement was defined between MRI and echocardiography: bias +/- SD, 0.39 +/- 1.28 (95% CI [-2.1 to 2.9]; P = .34). CONCLUSIONS: Arterial pressure-based and thermodilution CO measurement systems yielded results comparable to those obtained with cardiac MRI assessment after cardiac surgery. Arterial pressure wave-form analysis systems for CO measurement may be feasible, noninvasive methods for use in cardiac surgery.

The effectiveness of magnetization transfer technique in the evaluation of acute plaques in the central nervous system of multiple sclerosis patients and its correlation with the clinical findings.

PURPOSE: To determine the value of magnetization transfer (MT) imaging in the evaluation of acute plaques, which cause clinical findings in the brain magnetic resonance (MR) images of patients with relapsing-remitting multiple sclerosis, and its correlation with the clinical findings. MATERIALS AND METHODS: Forty patients with relapsing-remitting multiple sclerosis were included in the study. They were being followed-up for the diagnosis of relapsing-remitting multiple sclerosis based on McDonald's criteria. To evaluate the acute plaques of the patients, their T1- weighted spin echo sequences were divided into 3 groups: precontrast and postcontrast MT images (group 1), postcontrast MT images only (group 2), and precontrast and postcontrast non-MT images (group 3). The sensitivity and positive predictive values were calculated to determine the correlation between the patients considered to have had attacks and the acute plaques detected during MR imaging examinations with T1-weighted spin echo. RESULTS: After clinical examinations, in 25 of 40 patients (62.5%), there were neurological findings suggesting acute attacks. Among the 3 imaging groups, there was a significant difference in the number of acute plaques. In group 1 there were a total 30 findings suggesting acute plaques; in group 2 33; and in group 3 there were 20. When the correlation between the patients who were considered to have had attacks after their clinical examinations and the acute plaques detected with T1- weighted spin echo examinations were evaluated, the sensitivity and positive predictive values were 97% and 100% in group 1, 87% and 78% in group 2, and 65% and 100% in group 3, respectively. CONCLUSION: In MS, T1-weighted MT examinations yield more reliable results for following up the treatment and changes in the development of the disease. They also offer a more effective evaluation of the acute plaques that cause clinical findings.