Telecytology as a Triage Tool in LMICs

Pilot Study Evaluating the Feasibility of Digitalised Cytolological Slides for Telecytology, Before Implementation in Cameroon

The investigators will collect PAP-test samples from women undergoing colposcopy. Laboratory providers will prepare the samples with a liquid-based cytology method. The providers will then digitalise the slides using a digital scanner. The slides will be sent to cytopathologists who will assess the quality of the slides.

Study Overview

• Status: Completed
• Conditions: Cervical Cancer
• Intervention / Treatment: Diagnostic test: Cervical smear test

Detailed Description

The study will take place over four months. The consultation where the clinician undertakes the colposcopy and takes the additional cytological sample will be the only visit necessary for the patient in relation to the study.

The investigators will require thirty usable cervical samples from the colposcopy clinic of the Maternity of Geneva. The spatula used to take the smear should be immediately transferred to a 10ml sample pot and the head of the spatula should be snapped off and left inside. The investigators will only accept samples that have followed the aformentioned conditions, and it is expected to recruit more than the 30 participants needed if sampling is insufficient. The samples will be prepared by one of 3 laboratory technicians at the same hospital using the manual Surepath® liquid-based preparation method. This includes cell randomization, pipetting and enrichment of diagnostic cervical cells through centrifugation using a settling chamber to create a cellular slide preparation in a circle of 13 mm diameter. The Pap staining procedure is then applied within the chamber.

All thirty glass slides will be scanned and digitalized with a compact portable scanner (Ocus, ®40 by Grundium, Finland). The same laboratory technician who prepared the cervical sample will scan the slide. Ocus ®40 has a 1-slide capacity and permits the acquisition of a whole-slide image as well as robotic microscopy. The scanner features a 12-megapixel image sensor with a 40x objective (numerical aperture: 0.75) and can be connected to a laptop computer over a Wireless Local Area Network (WLAN) connection. To avoid areas being out of focus, the Z-stack modality of acquisition will be used at three focal plane levels with a 1 µ interval. In Europe, Ocus®40 is IVDR certified for diagnostic use.

The ease of the manual preparation method and scanning of slides will be assessed by asking the laboratory technician to rate the difficulty from very easy to very difficult on a 5-point rating scale (score 1= very difficult, 5=very easy) for each preparation step. The time taken for the manual preparation and scanning of glass slides will also be measured with a stopwatch and recorded by the technician.

Quality characteristics of the thirty digitalized slides will be scored as excellent, good, fair, or poor (based on sharpness and visualization through thick cell clusters) by two cytopathologists reading the slides. The time taken to screen digitized slides will be calculated.

In addition, cellularity will be assessed in the preparation area of the glass slide. Under a 40× objective and an eyepiece with a field number of 20, the total number of cells will be computed using the following formula: N=n(acd/amf), where N=total cell count, n=mean cell count of 10 adjacent fields of view along the horizontal diameter in the center of the circle, acd=area of cell deposit and amf=area of microscopic field.

The following data will be recorded and stored for each patient

• the number between 1-30 that has been given to the patient plus previous cytological diagnosis
• the easiness rating for each step of the manual preparation of the slide (lab technician)
• The easiness rating for the scanning/digitalization of the slides (lab technician)
• the quality rating based on sharpness and visualization through thick cell clusters for each slide (cytopathologists)
• the cellularity of each slide (cytopathologists)
• the time taken to prepare (lab technician), digitalize (lab technician) and read (cytopathologists) the slides

There will be a separate form for the laboratory providers and the cytopathologists. The data from the lab technician and the cytopathologists will be subsequently unified.

• Study Type: Observational
• Enrollment (Actual): 30

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland, 1205
    • University Hospitals Geneva

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

women aged >18 who are undergoing colposcopy at the Geneva University Hospitals (HUG)

Description

Inclusion Criteria:

• Women aged > 18 who are undergoing colposcopy at the Geneva University Hospitals (HUG)
• Women who are able to give informed consent as documented by signature
• Availability of an adequate sample for analysis

Exclusion Criteria:

• Pregnant women
• Women who have had a hysterectomy
• Women in whom cytology is indicated at time of colposcopy (independently of this study)

Study Plan

How is the study designed?

Design Details

• Observational Models: Other
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
quality of digitalized slide	Quality of the prepared and digitalised slide as measured by a score allocated by cytopathologists pertaining to sharpness and visualisation through thick cell clusters (scored as excellent (maximal value), good, fair or poor (minimum value)) as well as the cellularity of the slide.	4 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Simplicity of process	- Easiness score allocated by the laboratory providers after the preparation and digitalisation of each slide (1=very difficult; 5=very easy)	4 months

Collaborators and Investigators

• Sponsor: University Hospital, Geneva
• Collaborators: Ecole Polytechnique Fédérale de Lausanne

Study record dates

Study Major Dates

• Study Start (Actual): April 25, 2022
• Primary Completion (Actual): November 30, 2022
• Study Completion (Actual): December 30, 2022

Study Registration Dates

• First Submitted: July 22, 2022
• First Submitted That Met QC Criteria: July 22, 2022
• First Posted (Actual): July 26, 2022

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 28, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: cytopathology
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Uterine Diseases; Genital Diseases, Female; Genital Neoplasms, Female; Uterine Cervical Diseases; Uterine Neoplasms; Uterine Cervical Neoplasms
• Other Study ID Numbers: 2022-00314

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No