In Reply
Alberto Mario Marchevsky · Archives of Pathology & Laboratory Medicine · 2004
In Reply.—We thank Dr Grant for her interest in our article, and we are delighted to learn that it was the subject of a PhD dissertation in 1996. Her letter raises interesting questions regarding why computer-based proficiency testing did not “catch on.”We agree with Dr Grant that legal issues regarding the acceptance of this methodology for routine proficiency testing in gynecologic cytopathology and reluctance from pathologists and cytotechnologists to adopt newer computer-based technologies probably contributed to the “management and development” problems briefly discussed in the letter. However, the issue is more complex, as there have been technological and economic challenges that needed to be overcome for virtual microscopy to become widely used for routine proficiency testing. I am not familiar with the technology used in Dr Grant's work, but to my knowledge, “virtual slides” that include the 2-dimensional images from an entire Papanicolaou test are usually digitized at a single focal plane with the commercial systems that are currently available, which are already considerably more advanced than the methods used in our study. Although the technology is available for the preparation of 3-dimensional virtual slides that allow for changes in focal planes (the so-called z-plane), this requires the use of very large files that are difficult to process and store with current personal computers. It is possible to construct reproducible proficiency tests with 2-dimensional images, but the method does not exactly match the daily practice of cytopathology. Indeed, although virtual images are usually of good quality, the inability to focus up and down on an image introduces an additional element of guessing into the diagnostic process. In addition, it has been our experience and probably that of other colleagues that it takes longer to screen a Papanicolaou test with a computer-based system than with a light microscope.Additional developmental work is needed to overcome these technical challenges, raising the practical question about the availability of financial incentives to improve the technology. To my knowledge, there has been no large pot of gold waiting for the development of proficiency testing systems for cytopathology. The College of American Pathologists already has very successful proficiency testing educational programs for gynecologic and nongynecologic cytopathology using real glass slides. There have been, to my knowledge, limited funding sources to stimulate the development and implementation of virtual microscopy proficiency testing methods that can be practically implemented on a national scale. However, as computers are getting progressively less expensive and more powerful, and pathologists are becoming more comfortable with their use, virtual microscopy is very likely to mature in the next few years to become the method of choice for proficiency testing in pathology.