Diagnostic Challenges and Advantages of International Telepathology between Two Medical Institutions
Christina Di Loreto, John W Bishop, Marco Gambarotti, Robert Canter, Dariusz Borys. University of California Davis, Sacramento, CA; Rizzoli Orthopedic Institute, Bologna, Italy
Background: Digital pathology is an evolving field with immense value. Though used primarily as an educational or research tool, digital imaging is starting to be incorporated into daily pathology practice and has already been implemented in certain remote areas with limited access to pathologists. The aim of this study is to demonstrate the diagnostic accuracy of telepathology used in the setting of an actual surgical pathology consultation between two medical centers from different countries and time zones.
Design: Over a twenty-five day period, slides for bone and soft tissue subspecialty cases were captured with the Aperio ScanScope CS whole slide scanner at University of Califorrnia Davis (UCD) upon receipt from the histology department. The slides for each case were viewed virtually by a pathologist with expertise in bone and soft tissue located at Rizzoli Orthopedic Institute, Bologna, Italy using the Aperio Spectrum WebScope. The pathologist had secure access to the UCD Laboratory Information System (LIS), electronic medical records, and radiology images. Case discussions and requests for deeper sections and immunohistochemistry were accomplished by secure hospital email. The glass slides for these cases were later viewed by light microscopy in a single-blinded fashion by the three pathologists to evaluate for concurrence or discrepant findings with the originally reported results.
Results: Fifty-two cases were scanned and evaluated virtually, providing a primary diagnosis in fifty-one cases and a second opinion in one case. The mean time between scanning cases and reporting results was 2.29 days. The majority of cases (69.2 %) were evaluated and reported within one day, either on the day they were scanned (8/52) or by the following day (28/52). One histologic discrepancy (1.9 %) was identified upon light microscopic review. The virtual image for the discrepant case was reexamined, and the image was found to be of poor quality.
Conclusions: Our international telepathology experience has shown that digital pathology is adequate for primary diagnosis and consultation and can be included in daily pathology practice without delaying diagnosis. However, image quality should be closely monitored to ensure accurate diagnosis. This study also shows that digital pathology can bridge the temporal and geographic gaps between medical centers from different countries and time zones in an accurate and timely fashion, providing access to expert subspecialists that would otherwise not be within reach.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 272, Wednesday Afternoon