Use of Mobile High Resolution Device for Remote Frozen Section Evaluation of Whole Slide Images.
Joel P Ramey, KarMing Fung, Lewis A Hassell. Oklahoma University Health Sciences Center, Oklahoma City; Oklahoma City Veterans Affairs Medical Center, OK
Background: Mobile, internet-capable, high resolution viewing devices (MVD) coupled with whole slide images (WSI) create a new paradigm for pathology consultation. Validation of results from use of these devices may be important for practitioners and regulators. We evaluate the potential use of MVD in frozen section (FS) analysis.
Design: A series of 72 consecutive cases with FS requests were selected for potential study. FS slides were scanned using an Aperio Scanscope scanner at 20x magnification. Scan times were recorded. All materials utilized in the FS consultation including gross images and descriptions, clinical information, cryostat sections and cytologic preparations were catalogued with the images and available to reviewers via MVD. A sample of WSI FS cases were presented to 3 pathologists for diagnosis on an iPad MVD using the InterpathHD application accessing the server running Aperio Spectrum software. Times to diagnosis were noted. The WSI FS results were compared to original reported and final diagnosis to derive kappa values. Cases with discrepancies were subjected to further consensus review of the original glass slides.
Results: Scan times averaged two minutes 15 seconds/case. Evaluation times averaged two minutes 29 seconds/slide. Complete concordance between initial FS diagnosis and that rendered via MVD was 89%. Minor discrepancy in WSI diagnosis and initial FS diagnosis that would not have impacted therapy at the time was observed in the remaining 11% of cases. The kappa statistic for this series was 0.83. Use of the InterpathHD application on the iPad presented challenges to users related to the movement of the slide at higher magnifications. Users were unable to smoothly navigate the image at high magnification, but were required to revert to a low magnification before they could locate another area to examine at high power.
Conclusions: Image fidelity and resolution make the iPad potentially suitable for WSI evaluation for diagnostic purposes. An acceptable level of accuracy is attainable for FS interpretation. The user interface may account for more rapid interpretation capability that that reported for similar processes using standard interface techniques. But while technically possible to obtain acceptable results, use of the iPad with InterpathHD to view WSI is not easy. The obstacle to examining the full slide at intermediate magnification and continguous areas at high magnification could introduce frustrations and delays or errors.
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 183, Tuesday Afternoon