Diagnostic reproducibility on a digital evaluation system slide in cytology and histology in oncologic screening

Background Diagnostic reproducibility and accuracy in cytology and histology are the main issues in Oncologic Screening of cervix, breast and colorectal cancer: it can be achieved by programs for quality assurance (QA). The slides set standard represents the most used method to compare diagnostic proficiency, the chance of interpreting microscopic digital photographs provided an interesting alternative to read conventional microscope slides. The whole digital slide observed in a computer screen is a third, interesting, option to reach the goal. In fact all the information on conventional samples are transferred into a file, easily archived, catalogued, duplicated or advice for quality control, but is especially available at distance and from multiple locations simultaneously with drastic reduction of time needed to achieve proficiency test reproducibility [1]. The production of digital slides with modern scanners is relatively simple and quick. All suppliers offer services into private or public networks server in the literature [2] and software able to track scanned cases stored in comprehensive database to build large casistic archives online [3] Tools are already available for a teleconference discussion of cases with vision of cytological preparations on line [4,5], educational programs with integrated digital slides are poorly developed or proficiency tests for continuing education and professional updating are easily accessible. A project on Virtual Microscopy and Digital Pathology has been conducted in Emilia-Romagna Region (Italy) with the goal to promote quality in diagnostic cytology and histology in Screening programs by testing a different system involving pathologists and cytologists using digital slides, with a faster and reproducible program easier to manage than standard diagnostic sets and by distance for retraining of patrhologists with a final consensus meeting. The aim has been reached with the realization of a management system for cytological and histological wholeslides digital images and related clinical data and the building of a picture archive and communication system (PACS) among pathologists of our (and probably other) region. This must be backed by software for the realization of network slide seminars to perform periodic diagnostic reproducibility and proficiency test. The cases, collected and properly catalogued in an online, easily accessible and systemic digital archive of slides, with diagnoses discussed in clinical and pathologic audit meetings and validated by experts, can be used as diagnostic reference tools (case registry online ). The cataloguing and indexing is performed with NAP codes derived from SNOMED [6], which contains terms and definitions in Italian and English and encompasses extensive synonyms and complex researches.