To the Editor.—

We read with interest the article entitled “Current State of Cytologic-Histologic Correlation Implementation for North American and International Laboratories” by Nguyen and colleagues.1  The authors performed a survey investigating current cytologic-histologic correlation (CHC) practices in cervicovaginal cytology among 653 laboratories located primarily in North America but covering 36 countries across most of America and Eurasia.

The benefits of CHC cannot be overstated, ranging from improvement of the health of the screened population to the continuous education and improvement of personnel. Hence, despite the high adoption rates found by the authors (568 of 653, 87%),1  too many laboratories still miss out on these benefits by not performing CHC.

The causes for such failure to perform CHC must be identified and corrected. The authors1  speculate that laboratories at the extremes of the spectrum of case volume seem to face more challenges than those in the middle. Large laboratories, in fact, may collect cytologic specimens from a large area without having access to the corresponding biopsies, while small laboratories may not have enough personnel to oversee the CHC process.

Review of previous slides is essential in CHC.2  This means that laboratories incur definite organizational and time costs in having to retrieve these slides from the archives. Furthermore, sometimes archival slides need to be remounted, or their staining is found to have faded. These time costs can be relevant for a small laboratory. Furthermore, old slides may be lost or broken. This has serious consequences since cytologic slides, unlike histologic ones, are unique. On the other side of the coin, large laboratories wanting to perform CHC encounter other difficulties, such as sourcing the slides. These may be stored in another laboratory, and thus both paperwork and transport are required before the slides can be assessed side-by-side in the same institution.

In our fully tracked, fully digital institution, we implemented a combined molecular/digital approach to cervicovaginal cancer screening, and thus we scan all liquid-based cervicovaginal cytology slides and we also receive the subsequent colposcopic biopsies.3 

This approach allows us to routinely (and almost effortlessly) match the liquid-based cytology and corresponding colposcopic biopsy, thus performing CHC for all our cases. While examining a new slide, be it from a Papanicolaou test or a colposcopic biopsy, the previous examinations are exactly 2 clicks away (Figure). Because this requires nearly no effort, no dedicated personnel are required and the CHC happens by default on any case where previous examinations are available.4  Furthermore, since the slides are digital, no mounting or staining issues can happen during the archival process, and they cannot be lost or broken.

The implementation of a fully digital workflow is a daunting but doable task whose benefits clearly outweigh the costs. Many laboratories, from small regional to large academic laboratories, have successfully undergone this transition, and their experiences have been documented elsewhere.35 

However, implementation of digital cytology may be extremely challenging,6  although the new-generation scanners (such as the scanners we use in our laboratory: Pannoramic 250 and 1000, 3DHISTECH, Budapest, Hungary) can overcome many of the previously perceived problems. Moreover, this can open the possibility to implement artificial-intelligence–based tools as computer-aided diagnosis even in cervicovaginal screening programs.7 

In conclusion, digital pathology can remove many obstacles that impede the adoption of CHC by the laboratories that still do not perform it. The time costs incurred by small laboratories in having to dedicate personnel to the collection, quality check, and re-archiving of slides are completely abolished by the use of whole slide images. The difficulties in sourcing cases from different, distant institutions are similarly reduced if not completely overcome by sharing whole slide images and the corresponding digital reports. Even for laboratories that are already performing CHC, adopting a digital workflow will undoubtedly reduce costs and simplify and streamline the process.5 

1.
Nguyen
LN,
Crothers
BA,
Davey
DD,
et al
Current state of cytologic-histologic correlation implementation for North American and international laboratories [published online
March
10,
2022]
.
Arch Pathol Lab Med.
2.
Layfield
LJ,
Hammer
RD,
Frazier
SR,
et al
Impact of consensus conference review on diagnostic disagreements in the evaluation of cervical biopsy specimens
.
Am J Clin Pathol
.
2017
;
147
(5)
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473
476
.
3.
Fraggetta
F,
Caputo
A,
Guglielmino
R,
Pellegrino
MG,
Runza
G,
L'Imperio
V.
A survival guide for the rapid transition to a fully digital workflow: the “Caltagirone example.”
Diagnostics (Basel)
.
2021
;
11
(10)
:
1916
.
4.
Caputo
A,
Gibilisco
F,
Belmonte
B,
Mondello
A,
L'Imperio
V,
Fraggetta
F.
Real-world digital pathology: considerations and ruminations of four young pathologists
[published online April 25, 2022]
.
J Clin Pathol.
5.
Fraggetta
F,
L'Imperio
V,
Ameisen
D,
et al
Best practice recommendations for the implementation of a digital pathology workflow in the anatomic pathology laboratory by the European Society of Digital and Integrative Pathology (ESDIP)
.
Diagnostics (Basel)
.
2021
;
11
(11)
:
2167
.
6.
Hanna
MG,
Pantanowitz
L.
Why is digital pathology in cytopathology lagging behind surgical pathology?
Cancer Cytopathol
.
2017
;
125
(7)
:
519
520
.
7.
Crowell
EF,
Bazin
C,
Saunier
F,
et al
CytoProcessor: a new cervical cancer screening system for remote diagnosis
.
Acta Cytol
.
2019
;
63
(3)
:
215
223
.

The authors have no relevant financial interest in the products or companies described in this article.