Dr. Stewart is an anatomic and clinical pathologist with research interests in cytopathology, telepathology, and improved diagnostic utility of fine-needle aspiration (FNA) cytology, a diagnostic technique used to sample cellular material from superficial and deep masses. These efforts involve finding better ways of delivering advanced patient care using deep FNAs to obtain biopsy material.They also involve telepathology in which cytotechnologists, residents, and fellows working with clinicians at one site can prepare specimens and transmit images for cytopathologists at another site to analyze in real time and render a preliminary diagnosis.This is also known as telecytopathology.
Stewart has participated in validation studies of telecytopathology including a retrospective one that combined mostly ultrasound-guided fine-needle aspiration of thyroid and head and neck lesions and real-time images of stained cytology smears.These images were transmitted via a secured virtual private network by cytotechnologists to cytopathologists who made a preliminary diagnosis. The results showed a high degree of concordance between the preliminary diagnosis based on telecytopathology and review of slides via direct microscopy after an appropriate "wash out" period of at least two weeks.In Stewart's view, telecytopathology has the potential to enhance the efficient use of time and resources for cytopathologists as well as provide more timely diagnosis for patients.Although telecytopathology has achieved diagnostic quality resolution, each telepathology protocol is subject to careful study and must undergo and pass a validation process to be approved for general use in the field as per College of American Pathology (CAP) checklists and Center for Medicare and Medicaid Services (CMS) regulations.Potential obstacles include patient identifiable data security during image transmission, adapting to advances in technology such as whole-slide scanning in multiple-planes (3D), and narrowing differences in "locator skills" among cytotechnologists.These locator skills involve locating and highlighting the parts of the transmitted image that merit the attention of the cytopathologist.Dr. Stewart sees continuing progress in telecytopathology in light of advances in technology, changes in the practice of medicine that emphasize efficiencies, cost savings, and improved clinical outcomes, and the incorporation of telepathology into the training of pathology residents and fellows.He will be involved in these efforts as well as efforts to incorporate advances in fine-needle aspiration cytology into molecular diagnostics and resident and fellowship training.
Rothrock AT, Stewart lll J, Li F, Racila E and Amin K. Exploration of INSM1 and hASH1 as additional markers in lung cytology samples of high-grade neuroendocrine carcinoma with indeterminate neuroendocrine differentiation. Diagnostic Cytopathology, 11 February 2022. https://doi.org/10.1002/dc.24938
- Rabe K. & Stewart J. Cardiac Tumor in a 51-Year-Old Woman. 2021; Chicago, IL: ASCP Case Reports.
- Goswami A, Zhang AJ, Vahidi S, Mettler T, Stewart 3rd J, and Amin K. Oncocytic features in salivary duct carcinoma, a potential pitfall for misdiagnosis as Warthin tumor in fine needle aspiration specimens: A cytomorphologic analysis of 14 cases. Diagnostic Cytopathology, April 9, 2020. https://doi.org/10.1002/dc.24426
- Moisini I, Amin K, Mallery S, Stewart J 3rd, Mettler T. Efficacy of endoscopic-guided fine-needle aspiration in the diagnosis of gastrointestinal spindle cell tumors. Diagn Cytopathol. 2018 Aug;46(8):663-669. doi: 10.1002/dc.23976.
- Hupp M, Najmuddin M, Dincer HE, Mallery JS, Amin K, Stewart J 3rd, Cytomorphologic features of malignant or high risk solitary fibrous tumors of the mediastinum sampled by endoscopic and endobronchial ultrasound-guided fine needle aspiration: a comparison of two case reports. Diagnostic Cytopathology, April 2019. doi: 10.1002/dc.24192.
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