Diagnostic reproducibility on whole digital slide in cytology and histology in oncologic screenings

Background Diagnostic reproducibility and accuracy in cytology and histology are major issues in Oncologic Screenings of cervix, breast and colorectal cancer : it can be achieved by procedures and 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 reading conventional microscope slides. The whole digital slide observed in a computer screen is a third, interesting, option to reach the purpose. In fact all the information on conventional sample are transferred into a file, easily archived, cataloged, duplicated or advice for quality control, but is especially available at a 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 publishing services into private or public networks server [2] and software able to track scanned cases comprehensive database to build large casistic archives on the net [3].While 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 nor self-evaluation 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 (Italy) with the objective to promote quality in diagnostic cytology and histology of Screenings by testing a different system involving pathologists and cytologists using digital slides, with a faster mechanism and reproducible than standard diagnostic sets and by distance training operators with a final consensus diagnosis 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 Region. This must be backed by software for the realization of network slide seminars to perform periodic tests of diagnostic reproducibility and proficiency test. The cases, collected and properly cataloged in an online, extensive and systematic digital archive of slides, easily accessible, with diagnoses discussed in clinical-pathology audit and validated by experts, can be used as diagnostic reference tool (casistic Atlas online ). The cataloging and indexing is performed with NAP codes, a Nomenclature derived from SNOMED [6], which contains terms in Italian and English and encompasses extensive synonyms and complex searches.