[1442] The Utility of Dynamic Passive Telepathology in Neuropathology Intraoperative Consultations: A Critical Evaluation of Cytologic and Frozen Section Preparations.

Murat Gokden, Shree G Sharma, Ali G Saad. University of Arkansas for Medical Sciences, Little Rock; Arkansas Children's Hospital, Little Rock

Background: Telepathology (TP) is becoming widely used especially in institutions where access to subspecialty expertise is limited. TP have been previously studied in intraoperative consultation (IOC) in neuropathology (NP), but its utility in smear preparations in NP is not well defined. We analyzed the utility of TP in NP with respect to neoplasm types, as well as the cytologic (C) and frozen section (FS) components.
Design: Total of 72 consecutive cases {43 gliomas of various histologic types and grades, 10 meningiomas, 4 lymphoid processes, 4 peripheral nerve sheath tumors (PNST), 8 metastatic carcinomas, 3 nondiagnostic cases} with available C & FS slides, were identified retrospectively from the files in 2009-2010. The TP System comprised of Nikon Digital Sight DS-L2 & Nikon Eclipse 55i microscope. It was operated by the neuropathologist (NPst) at the primary center while the NPst at the remote location reviewed the real-time images on a computer screen. Both were blinded to the final diagnoses and made independent diagnoses. The evaluation started with cytologic component and was limited initially to morphology; clinical & radiologic data were made available as requested. C & FS components were timed separately. The time used and concordance rates were analyzed; any practical issues were discussed.
Results: Average time for C/FS in seconds were: Glioma 48/69; lymphoid 54/67; metastatic carcinoma 58/49; PNST 52/109; meningioma 29/84; nondiagnostic 22/55; entire group 44/72 (range 10-209/24-376). There were no discrepancies between the two NPst in C or FS components. There were 11 discrepancies between IOC diagnoses and final diagnoses on permanent sections, mainly due to high grade-low grade discrepancy of gliomas. These were due to sampling variation. More importantly, no discrepancies occurred between the study and the actual IOC diagnoses.
Conclusions: TP proved to be highly efficient in C and FS component of NP IOC with high degree of concordance between the two NPst. It was felt that the operator's experience at the primary site is crucial for the speed and accuracy of the results by rapidly finding and displaying the diagnostically important fields, and by selecting and providing the critical clinical and radiologic information. In addition, TP can be utilized by those who practice IOC based only on cytologic evaluation.
Category: Informatics

Tuesday, March 1, 2011 1:00 PM

Poster Session IV # 185, Tuesday Afternoon

 

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