Dermatopathology in the Digital Era
A Al Habeeb, D Ghazarian. UHN, Toronto, ON, Canada; Timmins Hospital, Timmins, ON, Canada
Background: Teledermatopathology has the potential to deliver quality service to underserviced areas. Our airms are: To validate teledermatopathology as a diagnostic tool in underserviced areas To test its utilization in inflammatory and melanocytic lesions To compare the impact of 20x and 40x resolution on diagnostic accuracy.
Design: A total of 103 cases were studied. Routine skin cases (n=79) from Timmins were scanned at 20x using aperio 5 slides scanscope. A pathologist diagnosed these cases using light microscopy. Subsequently, these were provided to a UHN pathologist along with the information on the requisition . The pathologist was blinded to the diagnoses. Additional 12 cases of inflammatory skin biopsies (IS )and 12 melanocytic lesions (ML) were scanned at 20x and 40x with an emphasis on assessing objective findings. For IS, these findings were divided into three main columns: epidermal, dermal and other findings. For ML, benign and malignant cases were mixed and objective findings were evaluated utilizing epidermal, and dermal attributes. The quality of picture was assessed in a scale from 1-3 (1=inferior, 2= similar, and 3= superior quality compared to light microscope). The UHN pathologist was blinded to the clinical information and the final diagnoses.The assessment started with the 20x proceeding to 40x.
Results: The concordance rate for the routine cases scanned from Timmins was (96%). There were 3 minor discrepancies in 3 cases (Intradermal nevus vs. compound nevus, actinic keratosis vs. in-situ squamous cell carcinoma, and seborrheic keratosis vs. verruca vulgaris). These discrepancies were thought to represent judgment bias rather than a function of picture resolution. All the inflammatory skin findings corresponded to the original report except one case where leukocytoclastic vasculitis was originally reported but was not recorded by the UHN pathologist though it was suggested. There was a focus in the original slide that was lost in the scanned recut slide. The 20x scanned slides were given a score of 2 each, however, 40x scanned slides were given a score of 3.The melanocytic lesions showed 100% concordence rate in both the 20x and 40x. However, in malignant and atypical melanocytic lesions 40x gave a superior resolution with detailed nuclear features and easier pick up of mitoses.
Conclusions: Teledermatopathology can serve as a primary and a second opinion diagnostic tool with a potential for expansion to underserviced areas to deliver quality service. Scanning at 40x is superior to 20x particularly in inflammatory and atypical melanocytic lesions.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 215, Wednesday Afternoon