The Implementation of Cloud-Based Telemedical Applications for External Quality Control Purposes in the Field of Cytopathology

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.