Robotic telecytology and EUS-FNA

Aim: To explore the feasibility of integrating robotic telecytology with endoscopic ultrasound fine-needle aspiration (EUS-FNA). Background: The diagnostic accuracy of EUS-FNA is critically dependent on the use of 'in-room' cytologic assessment of FNA specimen adequacy. A major problem facing EUS centers is the cost and limited availability of cytopathologists. One solution might be dynamic robotic telepathology (DT), a sophisticated technique in which light microscopy is transmitted in real-time to an off-site pathologist. Methods: EUS-FNA was performed on an 18×15mm pancreatic cystic lesion. The cystic fluid was treated with 95% ethyl alcohol and Toluidine Blue by a cytotechnician. The portable DT system (MedMicro, Trestle Corporation, Irvine, CA, USA) included an Olympus BX50 microscope with 2–40x objectives mounted on a motorized nosepiece. The microscope was fitted with an x, y, z-axis motorized stage (Prior Scientific, Rockland, MA, USA) and an Olympus PMTV camera linked to an internal digitizer and network. A 600×395 pixel image was sent to an off-site pathologist with full control of the microscope. The DT virtual slide was compared to conventional static cytopathology (CT). Results: The time estimated to review the entire slide by DT was 15 minutes and 4 minutes by CT. Adequacy was insufficient by DT or CT, but image quality by DT was sufficient to make the determination. Challenges include movement artifact from wet mounted slides, inability to focus rapidly through cell layers, and slow scanning in pauci-cellular aspirates. Conclusion: This case demonstrates the feasibility of DT in conjunction with EUS-FNA. With minor refinements, DT EUS-FNA might provide a critical physician-physician link expanding the reach and improving the accuracy of EUS-FNA.