The practice of fine needle aspiration (FNA) has grown exponentially in popularity, serving as a cost-effective and minimally invasive alternative for diagnosing various lesions. As FNA's become more prevalent, the role of rapid on-site evaluation (ROSE) has become a dominant responsibility for cytopathologists. ROSE of FNA specimens offer immediate, initial assessment of collected material, and ensure appropriate sampling of the lesion for diagnosis and ancillary testing (i.e., immunohistochemistry, flow cytometry analysis, molecular studies, microbiology cultures). Thus, the use of ROSE in cytology plays an important role in patient management.

However, the ascent of ROSE has come with its own complications. As appreciation for ROSE increases, a subsequent increase in testing and sites where FNAs can be performed have erupted. Cytopathologists have multiple responsibilities outside of the operating room, including signing out cases, maintaining the quality of cytology laboratories, and teaching trainees. Taking additional time to be physically present during procedures in the operating room, particularly if they are across multiple sites in the same day, increases the turnaround time for other pending cases, which can have a negative impact on patient care.

One solution for the increasing demands of cytopathologists to perform ROSE involves incorporating remote operations via telecytology (TC). TC involves a cytopathologist evaluating slides remotely in real time. Methods differ across institutions, ranging from a cytotechnologist sending static images to a cytopathologist, or using live video, to the use of robotic microscopes that can be controlled by the cytopathologist remotely [1]. The former method requires, on one hand, adequate training of the operator, and on the other hand the cytopathologist should trust the operator on-site skills. Costs and benefits vary depending on which method is utilized, with some being costly, time-consuming and requiring extensive training among cytotechnologist staff as well as adequate technology literacy among the cytopathologists [1].

Currently, our healthcare system maintains three separate locations, separated by just over 30 miles at greatest distance, with a case load of approximately 1200 FNA's per year. All ROSEs on the main campus are performed by the cytopathologist in-person, while a combination of TC and in-person ROSE is completed at the other two campuses. Our cytopathologists may be called upon to provide ROSE at several procedural suites at each of our campuses including interventional radiology (i.e., ultrasound [US] and computed tomography [CT] scan suites), endoscopic US (EUS) and endobronchial US (EBUS)-guided FNA/biopsies procedures. In this study, we analyzed all ROSEs done on our three campuses over a two-year period. We correlated the preliminary diagnosis provided during ROSE with the final diagnosis of the case and additionally compared any cases with discrepancies among TC and in-person evaluations. We sought to assess the overall accuracy of TC for FNAs by specimen source compared to traditional in-person ROSE within our healthcare system.