Telecytologic diagnosis of cervical smears for triage of self-sampled human papillomavirus–positive women in a resource-limited setting: concept development before implementation

• Published in: Journal of the American Society of Cytopathology JASC 2023-05, Vol.12 (3), p.170-180
• Main Authors: Vassilakos, Pierre, Clarke, Holly, Murtas, Micol, Stegmüller, Thomas, Wisniak, Ania, Akhoundova, Farida, Sando, Zacharie, Orock, George Enow, Sormani, Jessica, Thiran, Jean-Philippe, Petignat, Patrick
• Format: Article
• Language: English
• Subjects: Cervical cancer; Cytology; Diagnostic imaging; Female; Human Papillomavirus Viruses; Humans; Papanicolaou Test; Papillomavirus Infections; Prevention; Prospective Studies; Telepathology; Triage - methods; Uterine Cervical Neoplasms - pathology; Vaginal Smears - methods
• ISSN: 2213-2945; 2213-2945
• DOI: 10.1016/j.jasc.2023.02.001

Cytology is an option for triaging human papillomavirus (HPV)-positive women. The interpretation of cytologic slides requires expertise and financial resources that are not always available in resource-limited settings. A solution could be offered by manual preparation and digitization of slides on site for real-time remote cytologic diagnosis by specialists. In the present study, we evaluated the operational feasibility and cost of manual preparation and digitization of thin-layer slides and the diagnostic accuracy of screening with virtual microscopy. Operational feasibility was evaluated on 30 cervical samples obtained during colposcopy. The simplicity of the process and cellularity and quality of digitized thin-layer slides were evaluated. The diagnostic accuracy of digital versus glass slides to detect cervical intraepithelial neoplasia grade 2 or worse was assessed using a cohort of 264 HPV-positive Cameroonian women aged 30 to 49 years. The histologic results served as the reference standard. Manual preparation was found to be feasible and economically viable. The quality characteristics of the digital slides were satisfactory, and the mean cellularity was 6078 squamous cells per slide. When using the atypical squamous cells of undetermined significance or worse threshold for positivity, the diagnostic performance of screening digital slides was not significantly different statistically compared with the same set of slides screened using a light microscope (P = 0.26). We have developed an innovative triage concept for HPV-positive women. A quality-ensured telecytologic diagnosis could be an effective solution in areas with a shortage of specialists, applying a same day “test-triage-treat” approach. Our results warrant further on-site clinical validation in a large prospective screening trial. •Telecytology may be a feasible method of triaging HPV-positive women in low-resource settings.•The manual preparation of slides and their digitization is simple and low cost.•Accuracy of digital screening does not differ from light microscopy screening when ≥ASC-US.•Digital screening by remote specialists could be used in a one visit test-triage-treat approach.