The Value of Telepathology during Intraoperative Diagnosis of Pediatric Neuropathology.
Ali G Saad, Shree G Sharma, Murat Gokden. Arkansas Children's Hospital, Little Rock; University of Arkansas for Medical Sciences, Little Rock
Background: Telepathology is a rapidly evolving field of digital pathology, particularly important for rapid expert opinion or assistance by a specialist during frozen section (FS). The aim of this study was to evaluate the accuracy and maneuverability of telepathology as a tool in seeking expert opinion in pediatric neuropathology. To the best of our knowledge, the value of telepathology in pediatric neuropathology has not been studied before.
Design: The study included primary central nervous system tumors received in the last 5 years. The cases were reviewed by two pathologists; the neuropathologist at the primary site operated the microscope and the neuropathologist at the other center analyzed the cases while communicating on phone. The telepathology system comprised of Nikon's Eclipse 55i microscope and Nikon's digital camera DS-L2. The data collected were: time taken to render the diagnosis, types of challenges during this process, and when applicable, reasons and types of discrepancy. All slides were reviewed for accuracy of diagnosis.
Results: The search yielded 38 cases- 18 cases with their corresponding FS and 20 cases with no FS. Final diagnoses were: 12 gliomas, 6 meningiomas, 6 ependymomas, 5 medulloblastomas, 1 choroid plexus papilloma, 1 schwannoma, 1 hemangioblastoma, 1 cavernous hemangioma, 1 papillary craniopharyngioma, 2 subependymomas, 1 mucormycosis, and 1 Langerhan's cell histiocytosis. The average time taken to analyze each frozen case was 52 seconds (range: 19–180 seconds). Only one FS case (gemistocytic astrocytoma) had a discordant diagnosis with the final diagnosis ( ependymoma) because of the absence of diagnostic area on the frozen section. The median time and standard deviation (in seconds) taken to diagnose cases were: medulloblastoma (94.5 ±3.5), gliomas (67±8.4), meningiomas (67±0.7), ependymoma ( 95 ±37.47), choroid plexus papilloma (45), schwannoma (53), hemangioblastoma (38), cavernous hemangioma (28), papillary craniopharyngioma (16), subependymomas (27), mucormycosis (26), and Langerhan's cell histiocytosis (60).
Conclusions: The diagnosis of FS using telepathology technology system proved to be a great asset in seeking expert opinion during FS interpretation or to seek second opinion in challenging cases with near perfect concordance rate. A potential important role for this technology would be to assist remote and/or understaffed hospitals during interpretation of FS.
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 184, Tuesday Afternoon