Cytology consultations with associated image quality evaluation – experiences of the Virtual International Pathology Institute (VIPI)

  • Gian Kayser Institute of Pathology, University of Freiburg, Freiburg, Germany
  • Stephan Borkenfeld International Academy of Telepathology, Heidelberg, Germany
  • Essam Ayad Institute of Pathology, Cairo University, Cairo, Egypt
  • Armina Djenouni Institute of Cytology and Pathology, Batna, Algeria
  • Armaz Mariamidze Institute of Pathology, National Cancer Center, Tblisi, Georgia
  • Armen Mkhitaryan HistoGen, Armenian-German Practical Scientific Center of Pathology, Yerevan, Armenia
  • Klaus Kayser Institute of Pathology, Charite, Berlin, Germany


Background: The virtual international Pathology Institute (VIPI, is the only image consultation forum that is organized in close organization to a conventional institute of pathology. Its approximately 160 experts in pathology and cytology consult and diagnose difficult cases on the basis of a convent weekly duty plan.  Herein we report the consultation results of a specific series of cytology specimens, and discuss potential application in routine virtual cytology.

Material and Methods: Still images of fine needle aspirations sent for consultation to VIPI were evaluated by five members of VIPI. A total of forty and seven cases was analyzed, and scored in four classes (benign, probably benign, probably malignant, and malignant). In addition, the consultants evaluated and graded their impression of colour, focus and general image quality in 10 classes (10 = very good <> 1 = not acceptable). Automated measurements of objective image quality, calculation of the regions of interest (ROI), and automated diagnosis classifications were performed too.

Results: The experts’ diagnostic conformity was computed 4.2/5; i.e., at average 4.2 experts stated the same diagnosis of each case. The automated classification supported the summarized experts’ diagnoses in 38/47 cases. The experts interpreted the image quality diversely. Two of them evaluated with tendency of low, and two of them of high grades. The individual interactive image quality evaluations showed statistically significant relationship to the diagnostic accuracy (p<0.05). A helpful and correct automated ROI detection was stated in more than 95% of images.

Conclusion: The study indicates that electronic transmission of acquired conventional cytology smears is a useful tool to get access to experts’ knowledge worldwide. The case related diagnostic agreement of experts can serve for gold standard of virtual cytology (for example conformity > 80%). Additional automated measurements might support the diagnosis. Implementation of virtual slide technology and automated ROI visualization are additional tools in order to support the diagnostic accuracy. Virtual international pathology institutions are able to successfully work together with or even replace conventional cytology laboratories.


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How to Cite
KAYSER, Gian et al. Cytology consultations with associated image quality evaluation – experiences of the Virtual International Pathology Institute (VIPI). Diagnostic Pathology, [S.l.], v. 3, n. 1, dec. 2017. ISSN 2364-4893. Available at: <>. Date accessed: 24 jan. 2018. doi: