Validation of an Inexpensive Telepathology System for Frozen Section Diagnosis
SJ Sirintrapun, MJ Schniederjan, S Logani, AB Carter. Emory University, Atlanta, GA
Background: Emory Neuropathology is housed within Emory University Hospital (EUH). In June 2007, a neurosurgical practice began at Emory Johns Creek Hospital (EJCH) with about 5 frozen sections (FS) per month. The distance between EJCH and EUH (21.9 mi) prompted development of a telepathology consultation service. CapSure (GlobalMedia) was selected for its low cost ($16,500) and good image quality.
Design: The system has a microscope-mounted digital camera and networked computer which project live images to the EUH viewing station using web conferencing software (GoToMeeting). A pathologist is present at EJCH to drive the slide under the microscope. Patient identifiers are related via telephone only. The system was validated using 17 previous neuropathology FS cases. Each NP was provided with only the patient's age, gender, specimen and clinical history. Concordance between the CapSure FS diagnosis to the rendered final diagnosis was determined according to Horbinski et al (J Neuropathol Exp Neurol 2007;66:750-9). Costs of the system were also evaluated.
Results: The validation results are listed in Table 1.
Table 1. Concordance of CapSure FS Diagnosis to Final Diagnosis.Category assignment / total number of examinations. None were deferred. E: Exact; EC: Essentially Concordant; D: Discrepant (Horbinski et al).
|Meningioma||4||11/11||1 evaluated by 2 NPs|
|Anaplastic Astrocytoma (WHO Grade III)||1||3/3|
|Glioblastoma Multiforme (WHO Grade IV)||4||5/12||6/12||1/12||D: radiation necrosis|
|Metastatic Sarcoma||1||2/2||Evaluated by only 2 NPs|
|High Grade Lymphoma||1||2/3||1/3||D: multiple myeloma|
|VALIDATION TOTAL||17||32/49 (65.3%)||14/49 (28.6%)||3/49 (6.1%)||E + EC = 93.9%|
The cost of a NP commuting to EJCH for on-site FS diagnosis is estimated to range between $800-1400 per month and $9600-16,800 per year.
Conclusions: CapSure provides an inexpensive mechanism for telepathology as compared to other telepathology systems and is estimated to pay for itself in 1-2 years. Disadvantages are the required participation of an EJCH pathologist and the NP's lack of direct slide control. Of the 3 discrepant diagnoses, the most concerning is the false negative. The remaining misclassifications were unlikely to be clinically significant. Concordance rates are similar to those reported with other systems. *Note: No financial or other support was received from any vendor for this project.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 198, Monday Morning