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The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), which was adopted in 2018, is an excellent tool for the diagnosis and management of salivary glands lesions. A telemedical application is a valuable tool for cytopathologists in order to manage and promote interlaboratory collaboration. The result is better cytological data management and sharing. Telecytological diagnoses should be as reliable as those made using conventional microscopy. There are very few studies available that have focused on the implementation digital images, captured by static telecytology stations for telemedical applications in the field of cytopathology. The present study aims to evaluate the diagnostic reproducibility of telecytology in salivary glands aspiration specimens among three cytopathologists using representative simages captured by a static telecytology station. The study also examined the agreement between contributor and the reviewer diagnoses.

Objective The objective of this study was to investigate the feasibility of implementing videos captured by static telecytological applications for remote cytological diagnosis of fine needle aspiration (FNA) specimens from salivary gland lesions. Methods The current study was performed on 102 specimens from patients referred to the Alpha Prolipsis Cytopathology Department for preoperative evaluation of salivary gland lesions. In all cases, surgical excision followed the initial cytological diagnosis. (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23). Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor’s and reviewer’s diagnoses were collected, recorded and statistically evaluated. Results Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of precaptured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71-0.89. Conclusions Videos production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary glands FNAs. Videos of salivary glands FNAs can be used for accurate diagnosis, educational and second opinion purposes,. They can also be used for archiving, teleconsultation and educational purposes, improving the performance of the already existing static telecytology stations and small cytology departments’ quality indices.

This study aimed to present the 2-year experience of the implementation of the Milan System for Reporting Salivary Gland Cytopathology at Alpha Prolipsis Medical Laboratories, a private medical laboratory located in Athens, Greece. A totaI of 102 Fine Needle Aspirations (FNAs) performed since 2018 were included in the study. Reports were issued according to the Milan System for Reporting Salivary Gland Cytopathology. Aspirates were prepared with both conventional and liquid-based cytological methods and were evaluated by two or three Board-certified cytopathologists. Diagnostic reproducibility and accuracy were evaluated. All cases included in this study had histologic follow-up. The diagnostic accuracy of FNA for differentiating between benign and malignant disease according to MSRSGC classification was 93.3%, the specificity was 97.5% and the sensitivity was 82.2%. The positive and negative predictive values were 93.2 and 87.2%, respectively. Our results show that FNA is a valuable examination technique in the preoperative evaluation of salivary gland lesions. The integration of the 2018 Milan System for Reporting Salivary Gland Cytopathology is effective, with an overall accuracy around 95%.

The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology. The study was performed on representative short videos captured from a total of 404 cervical smears that were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of short videos and digital images. Short videos production by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes.

OBJECTIVE The objective of this study was to investigate the feasibility of implementing short videos captured by static telecytological applications for remote evaluation of cervical smears prepared by means of liquid-based cytology. METHODS The study was performed on representative short videos captured from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; adenocarcinoma, 2) that were sent via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on the overall digital video quality. Contributors' and reviewers' diagnoses were collected, recorded, and statistically evaluated. RESULTS Statistical evaluation detected no significant difference in diagnostic accuracy between cytological diagnoses based on short videos versus conventional slides. The overall interobserver agreement ranged from substantial to almost perfect with κ values of 0.74-0.91. CONCLUSIONS Short videos produced by static telecytology applications can be used as an alternative method for telecytological diagnosis of cervical smears, particularly for quality control purposes. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into the daily workflow. Short pre-captured videos of cervical smears can be used for rapid and accurate diagnosis, diminishing turnaround times and improving small cytology departments' quality indices. They can also be used for archiving, teleconsultation, and second opinion purposes, improving the performance of already existing static telecytology stations.

Over the last decade, cytopathology laboratories wishing to achieve an automated and seamless workflow process, to diminish turnaround times and to improve their diagnostic accuracy have successfully adopted information technologies and automation. New types of cameras and microscopes, connected to computers, have made possible image capture and transmission (telecytology). New innovative information technologies, including e-health and telemedical applications, constitute a valuable tool for interlaboratory collaboration and quality improvement. New applications are expected to enhance the opportunities for improvement in the field of cytological data management and sharing. In this article, we emphasize on the possible use of short videos captured by static telecytology applications in a modern cytopathology laboratory wishing to establish an effective interlaboratory comparison system and obtain expert opinions in diagnostically challenging cases from distant consultants with well recognized diagnostic competence and experience in the field of thyroid cytology.

Published studies compare static and dynamic telecytology systems. Still, no study has focused on implementing short videos captured by static telecytology stations for telemedical applications. The chapter aims to evaluate the diagnostic reproducibility of telecytology in thyroid fine-needle aspiration specimens prepared using liquid-based cytology among four cytopathologists using representative short duration videos captured by a static telecytology station. It also examines the agreement between the contributor's and the reviewer's diagnoses.

Telecytology can be defined as the process of diagnostic cytology performed on digital images. The process of diagnostic cytology performed on digital images can be used for teaching, professional examinations, obtaining expert opinions on severe cases, and routine diagnosis of the entire laboratory workload. Ηowever, little information exists about its possible use for proficiency testing purposes. The existing studies have found a high (90%–95%) concordance between telecytological and glass slide diagnoses, but they refer to a small number of cases. Thus, the purpose of the chapter is to examine the feasibility of developing a proficiency testing scheme for cytology labs wishing to be accredited according to ISO 15189:2012 by using low-cost telemedical applications.

Cytopathology became a popular since George Papanicolaou proposed the famous test Pap 60 years ago. Today cytopathology laboratories use the microscope as primary diagnostic device; however modern laboratories host numerous modalities for molecular tests and exchange data via networks; additionally, there are imaging systems producing pictures and virtual slides at enormous sizes and volume. The latest technological developments for cloud computing, big data and mobile devices has changed the way enterprises, institutions and people use computerized systems. In this chapter are explored potential applications of these technologies in the cytopathology laboratory including: data storage, laboratory information systems, population screening programs, quality control and assurance, education and proficiency testing, e-learning, tele-consultation, primary diagnosis and research. The impact of their adoption on the daily workflow is highlighted, possible shortcomings especially for security and privacy issues are identified and future research directions are presented.

Objective: The objective of this study was to investigate the impact of applying static telecytology for teleconsultation purposes during preoperative evaluation of challenging thyroid fine-needle aspiration specimens. Materials and Methods: The study was performed on 141 cytologically challenging specimens of 125 patients referred to Alpha Prolipsis Cytopathology Department. All cases were finally confirmed histologically. During the study, 10 characteristic images from each case were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists, with documented experience in the field of thyroid cytology. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered based on digitized images and conventional slides. Telecytology is a prompt and valid method for acquisition of a second opinion diagnosis in challenging cases and can be integrated into daily workflow. The use of telecytology for teleconsultation purposes in the laboratory's daily workflow will further ensure the accuracy of preoperative cytological diagnoses and will contribute to cytopathologists continuous education and better understanding of the criteria applied in thyroid gland lesions cytomorphological diagnosis. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered based on digitized images among contributing cytopathologists. The overall interobserver agreement was very good with κ values of 0.73-0.88. Conclusions: The widespread availability of imaging technology and telecommunication enables instant access to global expert cytopathologists. Static telecytology can be used as an efficient method for acquisition of second opinion in challenging thyroid fine-needle aspiration specimens. It can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.

Objective: The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology. Materials and Methods: The study was performed on representative digital cytological images from a total of 808 cervical smears (benign, 270; atypical squamous cells of undetermined significance, 184; low-grade squamous intraepithelial lesion, 124; high-grade squamous intraepithelial lesion, 174; squamous cell carcinoma, 52; and adenocarcinoma, 4) that were transferred through file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded, and statistically evaluated. Their reports were recorded and classified. Results: Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of digitized images and conventional slides. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97. Conclusions: Static telecytology can be used as an alternative method for the cytological diagnosis of cervical smears, particularly in quality assurance programs. It is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices.

Cytopathology is a popular discipline since George Papanicolaou proposed the famous test pap about 60 years ago. Today modern cytopathology laboratories still use the microscope as the primary diagnostic device and additionally they host modalities performing medical tests and exchange data via networks and have imaging systems producing pictures and virtual slides; the volume of produced data nowadays is enormous. Simultaneously mobile phones and tablets have evolved; their capabilities compete desktop computers and have the advantage of being always connected and at the side of users. Despite there are rather limited applications relevant to cytopathology for the mobile device, there is potential for uses in numerous activities of the cytopathology laboratory, including and not limited to: training, reporting, diagnosis and consultation, laboratory management, whole slide imaging, interactions between patient-doctor, doctor-doctor and within the laboratory personnel, quality control and assurance. Mobile devices can offer important benefits to the modern cytopathology laboratory.

Modern cytopathology laboratories offer an outstanding portfolio of testing services that are vital for patients. Due to their clinical importance, such laboratories have to provide results of high quality and credibility. Accreditation status and the implementation of a Quality Management System according to ISO15189 requirements are usually the most effective strategies to reach the optimum quality standards. However, laboratory quality should be constantly monitored and assessed in order to avoid potential deviations from the pre-defined values. The design of a unified system of Quality Control and Assurance procedures that will guarantee excellent performance and results is essential. The authors present their experience on the implementation of such a system and describe in detail strategies for efficient quality management. Useful recommendations for the design of such a system are provided. Finally, a mobile health application that could potentially enhance the entire quality control and assurance system is also presented.

Nowadays, due to the latest advances in Laboratory Medicine, diagnostic medical laboratories with their highly qualified personnel and state-of-the-art analytical equipment, have completely changed the way modern healthcare is offered. In order to maintain or even increase the already high quality level of the provided testing services, diagnostic laboratories including the cytopathology ones, need to design and apply a Quality Management System (QMS) in agreement with the requirements of the ISO 15189 International Standard. The authors present their experience on the implementation of such a QMS in cytopathology laboratories and highlight the most important general and management parameters that should be taken into consideration when moving from ISO 15189:2007 to the latest ISO 15189:2012. In addition, useful recommendations and suggestions that could make the transition to the latest Standard easier are included. Finally, possible issues and potential adverse events associated with the laboratory's implementation of the ISO 15189:2012 are also described.

Modern cytopathology has advanced from the point when conventional Pap testing was adequate enough for medical diagnosis thanks to the implementation of the latest Laboratory Diagnostics. No matter how well-structured a cytopathology laboratory may be, it is still subjected to potential risks that could dramatically affect its services. Risk identification, evaluation and management via a Quality Control Plan can become a powerful tool for cytopathology laboratories wishing to maintain or/and enhance the quality of their diagnostic services. The authors present their experience on the implementation of such a risk analysis and control system covering all the necessary parameters and issues that should be addressed. Also, a hypothetical structure for a risk analysis is presented with useful guidance associated with cytological laboratories conducting morphological and molecular examinations. Finally, a mobile health solution is proposed that, if designed properly, could further optimize and harmonize risk management strategies globally.

Modern diagnostic medical laboratories personnel should be an ideal combination of highly qualified scientists and technologists who use innovative analytical equipment to provide high quality diagnostic services to mankind. A well-designed and a well-implemented Quality Management System (QMS) according to the ISO 15189 requirements is regarded as a prerequisite that will ensure that a cytopathology laboratory is capable enough to provide precise and credible results. The authors present their knowledge on the implementation of such a QMS in cytopathology laboratories and emphasize the most crucial technical parameters that should be considered when advancing from ISO 15189:2007 to the latest ISO 15189:2012. Furthermore, helpful advice and pointers that could accommodate relative transition are included. Finally, potential issues related to the laboratory's implementation of ISO 15189:2012 and a mobile technology application for better personnel management are also depicted.

Objective The objective of this study was to examine the feasibility of implementing videos captured by static telecytological applications for remote cytological evaluation of fine needle aspiration specimens from salivary gland lesions. Methods The current study was carried out on 102 fine needle aspiration specimens from salivary gland lesions with histological confirmation (benign lesions, 11; benign neoplasms, 68; malignant neoplasms, 23), retrospectively selected from the department’s registry. Videos were transferred via file transfer protocol to password-protected accounts for remote review by three independent cytopathologists. In addition to diagnosis, reviewers commented on overall digital video quality. Contributor’s and reviewer’s diagnoses were collected, recorded and statistically evaluated. Results Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy between the diagnoses proffered on the basis of pre-captured videos and conventional slides. The overall interobserver agreement was ranging from substantial to almost perfect with κ values of 0.71–0.89. Conclusions Video production by static telecytology applications can be used as an alternative method for telecytological diagnosis of salivary gland fine needle aspirations. Videos of salivary gland fine needle aspirations can be used for rapid and accurate diagnosis, by diminishing turn-around times and improving the quality indices of small cytology departments. They can also be used for archiving, teleconsultation, educational and second opinion purposes, improving the performance of the already existing static telecytology stations.

Modern cytopathology labs offer an outstanding portfolio of important testing services that must be of high quality and credibility. Over the last decade, clinical cytopathology was influenced by the wide implementation of computer sciences. Cytopathology labs wishing to achieve a seamless workflow process have successfully adopted automation and information management systems. Innovative information technologies, including e-health, constitute a valuable tool for interlaboratory collaboration and quality improvement. Cloud computing will enhance the opportunities in cytological data management and sharing. The authors present thorough research of mobile applications related to cytopathology and try to foresee applications that may benefit modern cytopathology. Also, the feasibility of such applications for inter-laboratory comparisons, proficiency testing, and diagnostic accuracy validation is examined. Finally, the role of mobile applications for providing and/or enhancing the laboratory capabilities through educational training and other research activities is investigated.

The aim of this study was to analyze in details the implementation of an accredited proficiency testing scheme by cytopathology labs wishing to establish external quality control measures according to ISO 15189:2012. The proficiency testing scheme was based on simple Cloud-based telemedical applications and was enthusiastically accepted by all colleagues due to its simplicity and its low cost. Six major cytopathology laboratories contributed fifty conventional pap smears with histological confirmation from their registries voluntarily. Twenty board-certified cytopathologists reviewed the smears voluntarily and recorded their diagnoses. Four major diagnostic categories of cytological reports were used for statistical purposes. In addition to diagnosis, reviewers also commented on overall smears quality. Ten smears in which diagnostic interobserver accordance was almost perfect were selected for further study. A characteristic video from each one of the 10 selected smears was transferred via a simple cloud application to password-protected accounts for remote review by independent cytopathologists. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. The statistical evaluation of each participation' s results were a valuable external quality control tool for each participating laboratory and its members.

During the last decade, there is a stringent and ongoing requirement by regulatory bodies, and often enforced by law, for the implementation of measures increasing the confidence of cytological laboratories (expressed as requirement for accreditation via ISO 15189 or 17025). In this study, we present a quality control and assurance (QC&QA) method and results based on Cytology-Histology (C-H) and Cytology-Cytology (C-C) comparisons, on the basis of real data related to cervical cancer. The proposed QC&QA methodology allows the assessment of laboratory performance over time and the assessment of the laboratory as a facility and individual personnel as well. Moreover, we propose a high-level design for a Laboratory Information System capable of supporting the proposed methodology. The usual methodology to regularly control laboratory performance (once or twice per year), is not nowadays efficient, LIS implementation following the proposed scheme can support instant QC&QA, thus ensuring laboratories confidence and timely initiation of corrective actions.

During the last decade, there is an increasing need for quality improvement of medical laboratories via the use of quality related standards. Recently regulatory bodies suggest and sometimes enforce the application of ISO 15189, which is designed especially for medical laboratories. Despite the standard does oblige the application of Laboratory Information Systems (LISs), it is evident that without a LIS it is difficult for laboratories to operate efficiently. Modern cytopathology laboratories form complex systems composed of a multidisciplinary human team coupled with medical modalities and capabilities. Hopefully, such laboratories have well standardized and defined workflow. The adoption of the standard, creates numerous management requirements, introduces new functions and associated overhead. In this paper, we present design and implementation issues of an enhanced LIS to support ISO 15189 in a cytopathology laboratory. The LIS designed around ISO 15189 management requirements can improve, enhance and facilitate the standard application and adoption.

Medical laboratories are complex systems composed of specialized personnel and medical modalities. Despite complexity, they are well-organized systems with standardized workflow. Especially for cytopathology laboratories the human factor is extremely important, because examination of glass slides is the majority of the workflow from experts (cytopathologists). Recently there is an increasing need to ensure the quality of medical laboratories by applying quality standards, such as ISO 15189:2012 which is proposed by many organizations and in many countries is enforced by law. ISO15189 does not oblige the application of Laboratory Information Systems (LISs); however, nowadays, it is extremely difficult for a laboratory to routinely operate without it. In this paper we present the design and requirements of an enhanced LIS (eLIS), adapted to support not only the standard routine of a cytopathology laboratory (and other laboratory types) but to facilitate the support of technical requirements posed by ISO15189.

The purpose of this study was to examine the feasibility of developing an external quality control program for cytopathology labs wishing to be accredited according to ISO 15189:2007, by using low cost telemedical applications and solutions. One hundred twenty four fine-needle aspiration specimens from patients preoperatively aspirated under ultrasonographic guidance and on 104 pap smears with histological confirmation were retrospectively selected from the department’s registry. Three diagnostic categories of cytological reports were used. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for re-mote review by five independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor’s and reviewer’s diagnoses were collected, recorded and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered on the basis of digitized images and conventional slides.

Human papilloma viruses (HPVs) have been acknowledged to be the leading risk factor of cervical intra-epithelial lesion creation (CIN) and cervical cancer development (CxCa). Many different techniques have been created and utilized in HPV detection and monitoring with a vast amount of them being commercialized and few of them integrated in official screening strategies. A growing trend for DNA typing of the 14 most commonly accepted high risk HPV types has been introduced, supporting that in many cases molecular testing could replace classic morphologic diagnostic routines, even though DNA detection has lower specificity than other molecular and morphology tests. However, there have been limited attempts in combining data from all different techniques to provide efficient patient triaging schemes, since, apart from the obvious increase of patient cost, the amount of data and its interpretation in patient management has been impossible. Complex computer based clinical support decision systems, many of which are based on artificial intelligence may abolish these limitations.

Previous studies have shown that visfatin is significantly elevated in patients with gastric carcinoma and postmenopausal breast cancer (PBC). We thus explored whether serum visfatin could be used as a potential diagnostic and prognostic tool for PBC, taking into account clinicopathological features, serum tumor markers, anthropometric and metabolic parameters.Serum visfatin, tumor marker CA 15-3, carcinoembryonic antigen, metabolic and anthropometric parameters were determined in 103 postmenopausal women with pathologically confirmed, incident invasive breast cancer, 103 controls matched on age and time of diagnosis, and 51 patients with benign breast lesions (BBL).Mean serum visfatin was significantly higher in cases than in controls and patients with BBL (p0.001). In cases, visfatin was significantly associated with CA 15-3 (p=0.03), hormone-receptor status (p0.001), lymph node invasion (p=0.06) but not with metabolic and anthropometric variables (p0.05). Multivariable regression analysis revealed that absence of estrogen and progesterone receptors (ER-PR-) was the strongest significant determinant of serum visfatin (p0.001) in cases adjusting for demographic, metabolic and clinicopathological features. Based upon receiver operator characteristic analysis, serum visfatin outperformed CA 15-3 only in discriminating between PBC cases with early cancer stage than those with late stage, and in differentiating particularly patients with ER-PR- breast tumors.Further prospective and longitudinal studies are needed to determine whether serum visfatin could be used as a prognostic tool in the armamentarium of PBC monitoring and management in conjunction with other biomarkers.

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 cytopathologists (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 cytopathologists 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 significant difference in diagnostic accuracy among initial and review diagnoses. The overall interobserver agreement was almost perfect with κ values of 0.869–0.939, whereas intraobserver agreement ranged from almost perfect to perfect with κ values of 0.967–1 in all diagnostic rounds. Digitized cytological images transmission and remote evaluation allows reproducible diagnosis of thyroid gland lesions. Diagnoses made by using static telecytology systems can be equally reliable to those made by using conventional microscopy, provided that representative images are utilized and that the standard cytological diagnostic criteria are applied. Diagn. Cytopathol. 2010. © 2010 Wiley-Liss, Inc.

INTRODUCTIONOsteoblastoma is a rare benign bone tumor commonly located at spine and long bones. However, rib involvement has been reported less frequently.PRESENTATION OF CASEIn this report, we describe a young adult male presenting with left posterolateral chest wall pain. Chest computed tomography showed a calcified tumor in the left third posterior segment of the rib. Radical mass resection was performed and histopathology confirmed a benign osteoblastoma. At last follow-up, 10 months postoperatively, the patient has eventually relieved of the unbearable chest pain. Imaging evaluation revealed no evidence of recurrent tumor.DISCUSSIONOsteoblastoma is an uncommon primary bone tumor accounting for only 1% of all bone tumors. Ribs are involved in less than 5% of patients. The disease has usually good prognosis with a tendency for local destruction and recurrence.CONCLUSIONRadical surgery remains the treatment of choice to prevent recurrences and to provide a definite diagnosis differentiating it from osteoblastoma-like osteosarcoma.

Lung tumors with combined histological pattern are seldom seen exhibiting a more aggressive clinicopathological picture than tumors with a single histology. Herein, we present a 58-year-old male with mixed squamous and large-cell lung carcinoma. The patient was initially diagnosed through fluoroscopy-guided transbronchial lung biopsy with large-cell lung carcinoma of the left upper lobe. He received neo-adjuvant chemotherapy and then underwent left upper lobectomy. Postoperative pathological diagnosis was combined squamous and large-cell neuroendocrine carcinoma. Two months after surgery, restaging revealed brain metastatic deposits. Local radiotherapy was promptly applied with relatively good response and the patient is under observation eight months after diagnosis. A brief review of the current literature is also included with special emphasis on the clinicopathologic aspects and prognosis of lung tumors with mixed histology.

Cloud computing is changing the way enterprises, institutions, and people understand, perceive, and use current software systems. Cloud computing is an innovative concept of creating a computer grid using the Internet facilities aiming at the shared use of resources such as computer software and hardware. Cloud-based system architectures provide many advantages in terms of scalability, maintainability, and massive data processing. By means of cloud computing technology, cytopathologists can efficiently manage imaging units by using the latest software and hardware available without having to pay for it at non-affordable prices. Cloud computing systems used by cytopathology departments can function on public, private, hybrid, or community models. Using cloud applications, infrastructure, storage services, and processing power, cytopathology laboratories can avoid huge spending on maintenance of costly applications and on image storage and sharing. Cloud computing allows imaging flexibility and may be used for creating a virtual mobile office. Security and privacy issues have to be addressed in order to ensure Cloud computing wide implementation in the near future. Nowadays, cloud computing is not widely used for the various tasks related to cytopathology; however, there are numerous fields for which it can be applied. The envisioned advantages for the everyday practice in laboratories' workflow and eventually for the patients are significant. This is explored in this chapter.

Over the last decade, cytopathology laboratories wishing to achieve an automated and seamless workflow process, to diminish turnaround times, and to improve their diagnostic accuracy have successfully adopted information technologies and automation. New types of cameras and microscopes connected to computers made possible image capture and transmission (telecytology). New innovative information technologies, including e-health and telemedical applications, constitute a valuable tool for interlaboratory collaboration and quality improvement. New applications are expected to enhance the opportunities for improvement in the field of cytological data management and sharing. In this chapter, the authors emphasize quality management concepts applied to cytopathology laboratories and the application of innovative information technologies in a modern cytopathology laboratory wishing to establish an effective quality management system and meet all current requirements concerning all aspects of its routine workflow (personnel, premises, environmental conditions, equipment, information systems and materials, pre-examination processes, examination processes, and the post-examination phase).

Oncocytomas are benign tumors that infrequently involve ocular adnexa. We describe a case of oncocytoma of the lacrimal gland which was initially diagnosed by fine-needle aspiration cytology. An 83-year-old patient presented to the cytology laboratory with a peripunctal mass in the right eye. The tumor was aspirated. The cytoplasm of the tumor cells was rich in eosinophilic granules. The initial cytological diagnosis was oncocytoma. The tumor was then completely excised and the histological diagnosis confirmed the initial cytological one. Oncocytoma is a rare entity which must be considered in differential diagnosis of a peripunctal mass in elderly patients. The literature was reviewed confirming the rarity of such a presentation and the novelty of this case. Cytological criteria of malignancy are not yet established. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc.

Cloud computing has quickly emerged as an exciting new paradigm providing models of computing and services. Via cloud computing technology, bioinformatics tools can be made available as services to anyone, anywhere, and via any device. Large bio-datasets, highly complex algorithms, computing power demanding analysis methods, and the sudden need for hardware and computational resources provide an ideal environment for large-scale bio-data analysis for cloud computing. Cloud computing is already applied in the fields of biology and biochemistry, via numerous paradigms providing novel ideas stimulating future research. The concept of BioCloud has rapidly emerged with applications related to genomics, drug design, biology tools on the cloud, bio-databases, cloud bio-computing, and numerous applications related to biology and biochemistry. In this chapter, the authors present research results related to biology-related laboratories (BioLabs) as well as potential applications for the everyday clinical routine.

Human papilloma viruses (HPVs) have been acknowledged to be the leading risk factor of cervical intra-epithelial lesion creation (CIN) and cervical cancer development (CxCa), while recently, a vaccine protecting from the most commonly HPV types found in CxCa has been produced and introduced in vaccination schemes across the globe. Many different techniques have been created and utilized in HPV detection and monitoring with a vast amount of them being commercialized and few of them integrated in screening strategies. However, there has been no effort in combining data from all the different techniques and provide efficient patient triaging schemes, since, apart from the obvious increase of patient cost, the amount of data and its interpretation in patient management has been impossible.

In recent years, informatics and computer sciences have changed dramatically the practice of clinical cytopathology. New types of cameras and microscopes, connected to computers made possible image capture and transmission (telecytology). The wide implementation of telemedical systems in the field of cytopathology became a necessity dictated by the need of real-time results for therapeutic decisions. A telemedical application is a valuable tool for cytopathologists in order to manage and promote interlaboratory collaboration. The result is better cytological data management and sharing. ISO 15189:2007 for medical laboratories requires successful participation in proficiency testing programs. This chapter emphasizes on the necessity of developing a proficiency test for cytopathology labs wishing to be accredited according to ISO 15189:2007, and examines the feasibility of using low cost telemedical applications and solutions for this purpose. Furthermore, this chapter gives clear and comprehensive guidance concerning various financial, legal, professional, and ethical problems in this field.

ISO 15189:2007 constitutes an international certification standard, based upon ISO/IEC 17025 and ISO 9001, which can be used by medical laboratories wishing to improve their quality standards. The requirements of this standard form a group of general guidelines that will help laboratories establish and enhance their quality systems. Although direct references to the use of computer systems are made in only 7 cases, through the mandatory section of the ISO 15189:2007, many more clauses of the standard include indirect references to electronic medical records handling. The chapter analyzes the guidelines concerning the use of laboratory information systems for medical records storage and retrieval. Furthermore, the authors discuss challenging difficulties that may be detected during implementation of ISO 15189:2007 in the field of electronic laboratory medical records.

The objective of this study was to investigate the role of telecytology as a tool with increased quality standards in the optimal evaluation of thyroid fine-needle aspiration specimens prepared by the ThinPrep(R) technique (Cytyc Co., Boxborough, MA). The study was performed on 252 adequate specimens of 157 patients referred to the Cytopathology Department of University Hospital "Attikon" for preoperative evaluation of thyroid nodules. In all cases, surgical excision followed the initial cytological diagnosis. Three diagnostic categories of cytological reports were used. All cases were confirmed by histological diagnosis of surgical specimens. Ten characteristic images from each case were transferred via file transfer protocol to password-protected accounts for remote review by four independent cytopathologists. In addition to diagnosis, reviewers also commented on overall digital image quality. Contributor's and reviewer's diagnoses were collected, recorded and statistically evaluated. No significant difference in diagnostic accuracy could be detected between the diagnoses proffered on the basis of digitized images and conventional slides. Telecytology is a prompt and valid method for quality assessment and proficiency testing and can be integrated into daily workflow. The use of liquid-based cytology ensures that additional material is preserved for ancillary studies (if necessary) and that a sufficient number of replicate microscope slides can be produced. The use of telecytology in the daily workflow will ensure the reproducibility of cytological diagnoses and make feasible the production of digital educational material. Besides diagnostic accuracy, the implementation of a diagnostic telecytology system requires consideration of numerous financial, legal, professional, and ethical issues.

This study evaluated the accuracy and reproducibility of telecytological diagnoses proffered on the basis of digitized images from cervical smears prepared by means of liquid-based cytology.Representative digital cytological images from a total of 404 cervical smears (benign, 135; atypical squamous cells of undetermined significance, 92; low-grade squamous intraepithelial lesion, 62; high-grade squamous intraepithelial lesion, 87; squamous cell carcinoma, 26; and adenocarcinoma, 2) were uploaded to the CytoTrainer e-learning telecytology platform (developed in the Department of Cytopathology, "ATTIKON" University General Hospital, Athens, Greece) with specific password-protected accounts and were reviewed remotely by four independent board-certified cytopathologists (checking round). Their reports were recorded and classified. After 12 and 24 months, the same representative digital images were transferred in random order to the same cytopathologists and were reviewed again (first and second review rounds, respectively). The cytopathologists' first and second round diagnoses were recorded and compared with their initial ones.Statistical evaluation of cytological diagnoses detected no significant difference in diagnostic accuracy among checking and review diagnoses. The overall interobserver agreement was almost perfect with κ values of 0.79-0.97, whereas intraobserver agreement ranged from almost perfect to perfect with κ values of 0.76-1 in all diagnostic rounds.Digital images of cervical smears can be used for rapid and accurate diagnosis, by diminishing turnaround times and improving small cytology departments' quality indices. Diagnoses made by using static telecytological systems can be as reliable as those made by using conventional microscopy, under the conditions that representative images are taken and that standard cytological diagnostic criteria are applied. Telecytology can be used as an alternative method for the cytologic diagnosis of cervical smears, particularly in quality assurance programs.

Background: Herpes simplex virus (HSV) has been shown to cause respiratory tract infections mostly in severely immunocompromised patients. Endobronchial tumor-like lesions have been described very rarely as HSV pulmonary manifestations in critically ill patients or in immunosuppressed individuals. Case presentation: This case study describes a 75-yr-old male who presented with persistent hoarseness. Fiberoptic bronchoscopy showed marked mucosal thickening protruding in mid and distal trachea causing stenosis. Biopsy specimens demonstrated cytopathological changes consistent with HSV type 1 and 2 infection. Conclusions: To the best of the authors’ knowledge, this is the first reported case of HSV presenting as an endotracheal tumor in an immunocompetent person.