Utility of digital cell imaging as an aid to enhance pathologist peripheral blood smear review for routine and on call practice: A verification study

Abstract Introduction/Objective Microscopic examination of peripheral blood smear (PBS) provides important information to support the diagnosis of hematological diseases. However, manual microscopic examination of PBS is labor-intensive and cannot be done remotely. CellaVision is digital cell imaging technology that provides pre-classification and digital imaging of the red blood cells (RBCs), white blood cells (WBCs), and platelets, myeloid, lymphoid and erythroid precursors. Several studies have evaluated the performance of this technology in the hematology laboratory as tool to assist laboratory technologists; our study evaluates its use for pathologist review of peripheral blood smears both during routine and on call practice. Methods/Case Report Our study included 30 PBS and two hematopathologists with greater than 10 years’ experience in performing PBS review. We compared pathologist’s own impression of microscopic PBS review to their own impression using CellaVision software (intraobserver comparison). Additionally, pathologist to pathologist impression was compared for both methods (interobserver comparison). All 30 cases revealed abnormal findings including, but not limited to: pancytopenia, leukocytosis, leukopenia, anemia, thrombocytopenia, and thrombocytosis. Of the 30 cases, 5 “on-call” were cases when the pathologist had to come on–site for pathologist PBS review. Results (if a Case Study enter NA) The pathologists own PBS interpretation (intraobserver) by microscopy and CellaVision had a concordance of 96.7%. The pathologist to pathologist interpretation of both methods had a concordance of 96.7%.The one discrepant case was a smear with platelet clumping and normal platelet count. On chart review of this case, this discrepancy would have minimal impact on patient care. Conclusion Pathologist use of CellaVision in their routine practice may result in speedier PBS review, particularly in cases with leukopenia, and better communication with laboratory technologists. CellaVision is less reliable in identifying platelet clumps and should not be used in isolation in evaluating thrombocytopenia. Used with other relevant data, CellaVision has the potential to preempt in person microscopic review of PBS when on-call in certain situations.