We evaluated the concordance rate and diagnostic accuracy of digital cytology slides reviewed by experienced pathologists at the University of Miami and the Ohio State University in comparison with review of conventional glass slides by the pathologist at the Mashhad University of Medical Sciences. In addition, we evaluated interobserver reproducibility in telecytology diagnosis in pleural effusion smears between Ohio State and Miami University. For this, we selected 50 pleural effusion smears with different diagnoses. For each case, digital images were sent via the Internet to the consulting pathologists at the two US universities. The accuracy of the telecytology diagnoses was 83% and 87% at the two US universities and the accuracy of glass slide review was 89%. The inter-observer reproducibility of telecytology diagnosis between these two universities was 0.71. The concordance rate, inter-observer reproducibility and diagnostic accuracy of telecytology diagnosis in pleural effusion smears between the three institutions were good. Telecytology diagnosis of pleural effusion smears is potentially useful in screening and diagnosis and may allow more efficient use of scarce cytopathologist resources and expertise.