Evaluation of low-cost portable microscopes for rapid on-site evaluation of fine-needle aspirates in a clinical environment.

INTRODUCTION

Rapid on-site evaluation (ROSE) of fine-needle aspiration biopsies improves diagnostic yield and patient care but is often limited to well-resourced centers, in part, due to the cost and space required for conventional microscopes. This study evaluates the feasibility of using low-cost portable microscopes (LCPMs) for ROSE in a real-time clinical environment.

MATERIALS AND

METHODS

After preliminary testing of multiple LCPMs, 3 were selected for comparison with standard microscopes to evaluate uncoverslipped fine-needle aspiration adequacy slides from 66 clinical cases. Cytopathology faculty and fellows performed real-time paired ROSE assessments using standard microscopes and LCPMs.

RESULTS

Two LCPMs were quickly excluded due to limitations in single optical magnification imaging capabilities and ergonomics. Across 105 evaluations, LCPM C demonstrated 83.8% concordance with standard microscope interpretations. Concordance rates were highest for lymph node, soft tissue, and salivary gland biopsies, but lower for thyroid nodules, due to difficulty visualizing three-dimensional material or samples with limited scattered cellularity. Users who performed ≥10 LCPM reads showed higher concordance than those who conducted 5-10, raising the possibility of a learning curve. Concordance rates did not differ significantly between cytopathology faculty (83.6%) and fellows (84.1%), indicating the device's usability across training levels.

CONCLUSIONS

These findings support the potential clinical use of LCPMs to serve as a viable alternative to traditional microscopes for ROSE. Certain specimen types, such as thyroid nodules, pose interpretive challenges. Importantly, this study evaluates the use of LCPMs strictly for ROSE adequacy assessment and not for cytologic screening or definitive diagnosis. Further prospective studies are warranted to evaluate the scalability, clinical feasibility, and integration into resource-limited cytopathology workflows.