Kamal K Khurana

State University of New York, New York City, New York, United States

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Publications (8)16.11 Total impact

  • Kamal K Khurana · Bella Graber · Dongliang Wang · Ajoy Roy ·
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    ABSTRACT: Objective: Advances in digital imaging methods have resulted in use of telecytology in the immediate assessment of fine-needle aspiration (FNA) specimens. We retrospectively compared the nondiagnostic rate for endoscopic ultrasound-guided (EUS) FNA of pancreatic lesions in two groups: one with on-site evaluation for adequacy via telecytopathology and the other without on-site adequacy evaluation. Subjects and methods: All patients undergoing EUS-FNA of pancreatic lesions over a 2-year period were included. Direct smears were immediately wet-fixed or air-dried, and any residual material was rinsed in saline for cell block or cytospin preparation. Patients were divided into two groups: Group 1 had on-site telecytopathology evaluation for adequacy by a cytopathologist, and Group 2 had no on-site adequacy evaluation. The cytologic diagnoses were reviewed, and the nondiagnostic rates for each group were calculated. The age, sex, and characteristics of pancreatic lesions (solid versus cystic) between the two groups were compared. Results: In total, 217 patients were included. Telecytopathology on-site evaluation was provided for 95 (43.8%) cases. There was no difference between the groups in terms of age and sex. Pancreatic lesions were predominantly solid in the group that underwent telecytopathology on-site evaluation (p<0.005). The nondiagnostic rates for solid lesions in Group 1 and Group 2 were 3.7% and 25.6%, respectively (p<0.0001). Although the nondiagnostic rate for cystic lesion was higher in Group 2, it did not reach a level of statistical significance (16.5% versus 7.1%; p=0.249). After adjusting for the effects of sex and lesion characteristics (solid versus cystic lesion) with multivariate logistic regression, the odds of having a nondiagnostic specimen in Group 2 was 6.9 times greater than in Group 1, and the result was statistically significant (p=0.0013). Conclusions: Telecytopathology on-site evaluation of EUS-FNA of pancreatic lesions reduces the nondiagnostic rate, especially in lesions with solid characteristics, and may serve as an effective substitute for on-site evaluation by a cytopathologist.
    Telemedicine and e-Health 08/2014; 20(9). DOI:10.1089/tmj.2013.0316 · 1.67 Impact Factor
  • Kamal K Khurana · Andra Kovalovsky · Dongliang Wang · Robert Lenox ·
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    ABSTRACT: Objective: Rapid on-site evaluation (ROSE) at the time of endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBFNA) is useful in obtaining adequate samples and providing preliminary diagnosis. We present our experience with ROSE of EBUS-TBFNA using telecytopathology. Materials and methods: Real-time images of Diff-Quik (Mercedes Medical, Sarasota, FL)-stained cytology smears were obtained with an Olympus (Olympus America, Center Valley, PA) digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a cytopathologist in a cytopathology laboratory who rendered a preliminary diagnosis while communicating with an on-site cytotechnologist via the Vocera (San Jose, CA) voice communication system. The endoscopy suite was located a block away from the cytopathology laboratory. Accuracy of ROSE via telecytopathology was compared with an equal number of cases that received ROSE, prior to introduction of telecytopathology, via conventional microscopy. Results: ROSE was performed on a total of 200 EBUS-TBFNAs. The telecytopathology system and conventional microscopy were used to evaluate equal numbers of cases (100 each). Preliminary diagnoses of negative/benign, atypical/suspicious, and positive for malignancy were 58%, 14%, and 24% for telecytopathology and 57%, 10%, and 31% for conventional microscopy. Four percent of telecytopathology cases and 2% of conventional microscopy cases were deemed unsatisfactory at the time of ROSE. The overall concordance between the preliminary and final diagnoses was 96% for telecytopathology and 93% for conventional microscopy. The causes of discordant preliminary and final diagnoses could be mainly attributed to difficulty in distinguishing small cell carcinoma versus reactive lymph node due to crush artifact, atypia related to reactive bronchial epithelial cells, and availability of cell block material and Papanicolaou-stained slides for review at the time of final cytologic sign out. Conclusions: Telecytopathology is comparable with conventional microscopy in ROSE of EBUS-TBFNA. It can serve as a valid substitute for conventional microscopy for on-site assessment of EBUS-TBFNA.
    Telemedicine and e-Health 04/2013; 19(4):265-71. DOI:10.1089/tmj.2012.0168 · 1.67 Impact Factor
  • Kamal K Khurana · Andra Kovalovsky · Deepa Masrani ·
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    ABSTRACT: In the recent years, the advances in digital methods in pathology have resulted in the use of telecytology in the immediate assessment of fine needle aspiration (FNA) specimens. However, there is a need for organ-based and body site-specific studies on the use of telecytology for the immediate assessment of FNA to evaluate its pitfalls and limitations. We present our experience with the use of telecytology for on-site evaluation of ultrasound-guided FNA (USG-FNA) of axillary lymph nodes in a remote breast care center. Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered preliminary diagnosis while communicating with the on-site cytotechnologist over the Vocera system. The accuracy of the preliminary diagnosis was compared with the final diagnosis, retrospectively. A total of 39 female patients (mean age: 50.5 years) seen at the breast care center underwent USG-FNA of 44 axillary nodes. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 41, 52, and 7%, respectively. Only one of the 23 cases that were initially interpreted as benign was reclassified as suspicious on final cytologic diagnosis. Seventeen of 18 suspicious/malignant cases on initial cytology corresponded with a malignant diagnosis on final cytology. One suspicious case was reclassified as benign on final cytologic diagnosis. All unsatisfactory cases remained inadequate for final cytologic interpretation. The presence of additional material in the cell block and interpretative error were the main reasons for discrepancy, accounting for the two discrepant cases. This retrospective study demonstrates that the on-site telecytology evaluation of USG-FNA of axillary lymph nodes in patients at a remote breast care center was highly accurate compared with the final cytologic evaluation. It allows pathologists to use their time more efficiently and makes on-site evaluation at a remote site possible.
    09/2012; 3(1):36. DOI:10.4103/2153-3539.101803
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    ABSTRACT: Objective In this study we discuss the diagnostic accuracy and unsatisfactory rate of onsite evaluation of ultrasound guided fine needle aspiration (USGFNA) of thyroid nodules using telecytopathology and compare it to that of a control group without telecytopathology.Methods This was a retrospective analysis of USGFNA of thyroid nodules over a 9 month period with and without telecytopathology. There was no randomization for selection of the groups with and without telepathologist. A single provider performed all the procedures. Real time images of Diff Quik stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via the internet by a cytotechnologist to a pathologist who communicated the preliminary diagnosis and sample adequacy. The unsatisfactory specimen rate was compared between a group whose images were transmitted (n=45) vs. another group without onsite adequacy assessment (non-transmitted) (n=47).Results A total of 92 nodules in 67 patients were aspirated with ultrasound guidance. The unsatisfactory sample rate in the transmitted group was 13% (6/45) and that of the non-transmitted group was 23% (11/47). In the transmitted group, the cytology specimens of 3 patients that were initially deemed inadequate by the pathologist were considered adequate after 2 additional passes. In the transmitted group preliminary diagnosis concurred with the final diagnosis in 96% of cases. Four passes were made in the non-transmitted group vs. 2 passes in the transmitted group.Conclusions Immediate assessment of USGFNA via telecytopathology assures adequacy of the cytology sample and may reduce number of passes per nodule. Preliminary onsite telecytopathology diagnosis was highly accurate when compared to final diagnosis.
    Endocrine Practice 09/2012; 19(1):1-20. DOI:10.4158/EP11374.OR · 2.81 Impact Factor
  • Kamal K Khurana ·
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    ABSTRACT: The advancement of telecommunication technology in the area of digital transfer of images form distant site has resulted in exploration of this technology in the area of cytopathology. Telecytology facilitates the electronic transmission of microscopic images using static, dynamic, and whole slide imaging systems. Recent articles have generated an interest in the use of this technology for immediate assessment of fine-needle aspirations. Telecytology has potential for use in second opinion, quality assurance, slide archiving, proficiency testing, and distance-based education. This review discusses the current and potential applications of telecytology in cytopathology practice and its limitation and advantages.
    Diagnostic Cytopathology 06/2012; 40(6):498-502. DOI:10.1002/dc.22822 · 1.12 Impact Factor
  • Kamal K Khurana · Rong Rong · Dongliang Wang · Ajoy Roy ·
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    ABSTRACT: We evaluated dynamic telecytopathology for on-site-evaluation of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples of the pancreas. Realtime images of stained cytology smears were assessed by a cytopathologist while communicating with the on-site operator by telephone. A total of 55 consecutive cases was assessed; preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 69%, 7% and 24%. We also reviewed 55 consecutive cases of EUS-guided FNA of pancreas which had had conventional microscopic on-site evaluation prior to the introduction of telecytopathology. Preliminary diagnoses of benign, atypical/suspicious and positive for malignancy were 60%, 9% and 31%. The overall concordance between the preliminary and final diagnosis was 84% for telecytopathology and 87% for conventional microscopy. Neuroendocrine neoplasms and well-differentiated adenocarcinoma were diagnostically challenging for both telecytopathology and conventional microscopy. Telecytopathology was similar in accuracy of preliminary diagnosis to conventional microscopy during EUS-FNA of pancreas.
    Journal of Telemedicine and Telecare 02/2012; 18(5):253-9. DOI:10.1258/jtt.2011.110706 · 1.54 Impact Factor
  • Roberto Izquierdo · Roopa Shankar · Kara Kort · Kamal Khurana ·
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    ABSTRACT: The reported incidence of thyroid nodules in children and adolescents is estimated to be between 1% and 2%. However, this incidence may be increasing because diagnostic radiological procedures are detecting incidental thyroid nodules in children. The objective of this study was to assess the diagnostic accuracy, sensitivity, and specificity of ultrasound-guided fine-needle aspiration (US-FNA) of thyroid nodules in children and adolescents. Forty-two children (mean age, 14.75 years) underwent US-FNA of 52 thyroid nodules. The specificity, sensitivity, diagnostic accuracy, and unsatisfactory rates were compared to other similar studies. Six patients had a cytological diagnosis of papillary thyroid cancer, which was confirmed at surgery. There were no false-negative specimens, and cytological diagnostic accuracy was 93.7%. The inadequate rate was only 1.9%. US-FNA of thyroid nodules in children and adolescents is highly accurate in experienced hands and is associated with a very low inadequate rate.
    Thyroid: official journal of the American Thyroid Association 06/2009; 19(7):703-5. DOI:10.1089/thy.2009.0058 · 4.49 Impact Factor
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    ABSTRACT: To investigate the role of thyroid ultrasonography in our outpatient endocrine practice. We compared the efficacy of ultrasound-guided fine-needle aspiration biopsy (US-FNAB) of thyroid nodules with that of palpation-guided aspiration (P-FNAB) and determined the malignancy rates of palpable and nonpalpable nodules. All patients referred for assessment of thyroid nodular disease from October 1997 through August 2001 were included in the study. Fine-needle aspirations were performed by palpation guidance until October 1999, after which US-FNAB was exclusively performed. All thyroid examinations, ultrasound imaging, and aspiration biopsies were performed by the same endocrinologist in an office-based setting. Histopathologic and cytologic diagnoses were compared for patients who underwent thyroidectomy. A total of 376 nodules in 276 patients were aspirated during a 47-month period. P-FNAB was used on 157 nodules, and US-FNAB was performed on 219 nodules (both procedures were done on 21 nodules). For palpable thyroid nodules that were resected, the cytologic diagnostic accuracy rate was 60.9% and 80% for P-FNAB and US-FNAB, respectively. With use of ultrasound guidance, the sensitivity, positive predictive value, and negative predictive value increased significantly. In addition, the inadequate specimen rate decreased from 11.2% in the P-FNAB group to 7.1% in the US-FNAB group. Among the nodules that were not palpable, the malignancy rate was similar to that for the palpable thyroid nodules (5.1% versus 6.8%). US-FNAB improved the cytologic diagnostic accuracy, sensitivity, and positive predictive value and reduced the false-negative rate in comparison with P-FNAB. The malignancy rate for nonpalpable thyroid nodules was similar to that for palpable nodules.
    Endocrine Practice 11/2006; 12(6):609-14. DOI:10.4158/EP.12.6.609 · 2.81 Impact Factor

Publication Stats

99 Citations
16.11 Total Impact Points


  • 2012
    • State University of New York
      New York City, New York, United States
  • 2006-2012
    • State University of New York Upstate Medical University
      • Department of Pathology
      Syracuse, New York, United States