Validation Study of Telepathology on Frozen Section Diagnosis in a Multi-Hospital Subspecialized Pathology Department
Wendong Yu, Cesar Llanos, Vania Nose, Carmen Gomez. University of Miami Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, Miami, FL
Background: Telepathology is increasingly used for intraoperative frozen section (FS) with great accuracy. In our department, 2 rotating on-duty specialty pathologists cover FS in 3 hospitals, located about a 15-minute-walking distance from each other. Offices for the pathologists are located in 2 of the 3 hospitals. Telepathology has the great potential to improve the turnaround time (TAT) and facilitate consultation. We explored the feasibility of implementing dynamic telepathology for FS in our department.
Design: Our telepathology system includes an Olympus BX40 microscope, an Olympus DP71 camera and MicroSuite Pathology Edition software in the FS suite. Access to the internet and internet browser are the only requirements for the pathologist's computer terminal. For this study, 10 FS cases were randomly chosen by an assistant. The slides were transmitted in real time to 10 specialty pathologists by a junior resident. Short patient history and specimen site were provided. The pathologists independently evaluated each FS slide and rendered a telepathology diagnosis (TPD). Afterward, the glass slides were reviewed and each gave a light microscope diagnosis (LMD). Neither the resident nor the pathologists knew the original FS diagnoses (FSD) or the permanent section diagnoses (PSD). There were no discrepancies between the FSD and PSD.
Results: There were 100 TPD and LMD diagnoses among the 10 pathologists. The overall TPD accuracy was 97%; the LMD accuracy was 98%. For 12 of the 100 TPD responses, the diagnoses were made by pathologists who are specialists in the specimens being evaluated. For the remaining 88 TPD responses, the pathologists were evaluating specimens outside their specialty areas. Nine out of 88 diagnoses (10%) made by specialists outside their own specialty area included diagnoses that were less specific, requested additional tissue or deferred the diagnosis to permanent sections. This did not occur for any of the 12 diagnoses (0%) made by the pathologists in their specialty area.
Conclusions: The diagnostic accuracy of telepathology for FS is good (97%), similar to the conventional method (98%). Therefore, it appears to be a valid alternative, especially when there is an emergent situation to improve the TAT. Additionally, the specialists' diagnoses within their specialty area are more specific and well-defined. Therefore, by facilitating consultation, telepathology holds the promise to improve the overall FS diagnostic accuracy with minimal delay of the TAT.
Category: Quality Assurance
Monday, March 19, 2012 1:30 PM
Platform Session: Section G, Monday Afternoon