Validation of Remote Robotic Microscopy Using the iScan Coreo Au Platform
Michael J Thrall, Hidehiro Takei, Andreana L Rivera, Suzanne Z Powell. Methodist Hospital, Houston, TX
Background: Remote robotic microscopy (RRM) allows a remote pathologist to manipulate and view a slide via the internet. This technology is useful for intraoperative assessments (IA) when whole slide imaging (WSI) would be too time-consuming. Touch/squash preparations are especially difficult for WSI because of the widely dispersed and 3-dimensional diagnostic material.
Design: Our pathology department receives occasional requests for neuropathology IA from a branch hospital with no neuropathologist. We validated the iScan Coreo Au "Live Mode" RRM for touch/squash preparations to address this problem. 100 cases were selected, including 75 consecutive neuropathology cases with IA and 25 consecutive general surgical pathology cases with touch preparation IA. Three neuropathologists and one general surgical pathologist participated; each viewed 25 cases. Half of the cases were viewed on glass slides by conventional microscopy and half by RRM, followed by a delay of at least 3 weeks, after which the cases were viewed by the other modality. Diagnoses and times spent viewing were recorded. Intraobserver variation was analyzed.
Results: Of the 100 cases, 78 showed perfect intraobserver agreement and 10 more showed minor discrepancies (less specific diagnoses). There were 12 cases with significant discrepancies (listed below).
|Glass Slide||Remote Robotic Microscopy||Final Permanent Section Diagnosis|
|Consistent with meningioma||Scant interpretable material - defer||Atypical meningioma|
|Glial neoplasm||Mildly hypercellular glial tissue||Glioblastoma|
|Gliotic brain||Possible infarct||Consistent with infarct|
|High grade astrocytoma||Ependymoma||Ependymoma|
|High grade astrocytoma||Non-diagnostic - defer||Glioblastoma|
|High grade glioma||Schwannoma||Large B-cell lymphoma|
|Infiltrating glioma||Mildly hypercellular glial tissue||Glioblastoma|
|Low grade glioma||Hemorrhagic lesion||Pleomorphic xanthoastrocytoma|
|Meningioma||Cannot focus - defer||Meningioma|
|Metastatic carcinoma||Small round blue cell lesion||Metastatic breast carcinoma|
|Spindle cell lesion||Necrotic debris||Schwannoma|