Remote Real Time Reporting of Urgent Liver Biopsies: Whole Slide Imaging Is Feasible in a Quaternary Care Academic Center
M Guindi, SL Asa, AJ Evans, R Chetty. University Health Network, Toronto, ON, Canada
Background: The acquisition of Telepathology (TP) systems in North America is steadily increasing along with interest in its diagnostic uses. At University Health Network (UHN), whole-slide imaging (WSI) which represents a major technological advance in the area of TP, is available routinely. UHN is a large liver referral center in Canada with one of the largest liver transplant programs in North America. Thus, there is a constant need for urgent liver biopsy (LB) interpretation especially post-transplant biopsies requiring subspecialty expertise. Objectives: To test the feasibility and diagnostic accuracy of utilization of WSI for the off site reporting of urgent LB in real time.
Design: From February 2008 to September 2008, off hours (after 5pm) urgent LB were interpreted by TP using WSI. H and E sections (+/- trichrome) were scanned at 20x by histotechnologists to create compressed JPEG files. Patient identifiers were removed, and files uploaded via a UHN portal creating an internet link that is emailed to the off site pathologist, who accessed the scanned slides via the UHN email system, viewed them on their computer or laptop, and communicated the diagnosis directly to the UHN hepatologist or surgeon by email or phone. The glass slides were later evaluated by light microscopy (LM) and, TP and LM diagnoses compared. A survey of 15 clinicians (hepatologists and surgeons) receiving this service was also conducted.service was conducted.
Results: WSI was used to make 22 primary LB diagnoses. Out of hospital sites of reporting included pathologist's residence, Denver at USCAP 2008, San Diego, and Montreal. Case mix: 15 post transplant LB? rejection, 3 donor LB, 2 nontransplant LB, 2 liver failure LB (1 at pretransplant work up). Download time of files: mean 7.25 and median 1.57 minutes. An average of 10 minutes was required to review WSI file(s) for a diagnosis. File size: mean 56 and median 41 Mbytes/slide (range 22.5-143). Diagnostic accuracy was 99% for WSI compared to LM. In 2 cases, only preliminary diagnoses could be made by TP and LM; final diagnosis required the aid of immunohistochemical stains.
Conclusions: TP allows continuity of subspecialty interpretation of urgent LB while the pathologist is out of town, readily facilitates consultation with non-liver pathologist colleagues on call thus improving on call services, and has been met with unanimous acceptance and admiration of user clinicians. Diagnostic accuracy and timeliness is unaffected by the use of TP.
Tuesday, March 10, 2009 1:00 PM
Platform Session: Section G, Tuesday Afternoon