Intraoperative Pathologic Consulation by Telepathology: An Accuracy Study of 104 Analysis Performed by the Eastern Quebec Telepathology Network
Emilie Perron, Bernard Tetu. CHUQ-Hotel-Dieu de Quebec, Quebec, QC, Canada; Centre Hospitalier de Baie-Comeau, Baie-Comeau, QC, Canada; Faculty of Medicine, Université Laval, Quebec, QC, Canada
Background: In 2004, Quebec ministry of health and Canada Health Infoway supported the creation of the "Eastern Quebec Telepathology Network" aimed at providing uniform diagnostic telepathology services in a huge territory (408,760 km2 and 24 hospitals). The objective of this study is to evaluate the accuracy of the first frozen sections performed by telepathology and to assess the time required to perform the analysis.
Design: We performed a retrospective review of the first 104 consecutive intraoperative frozen sections evaluated by telepathology. The real-time gross evaluation was performed using a macroscopy station (PathStand 40, Diagnostic Instruments, Sterling Height, USA) and two videoconferencing devices (PCS-XG80DS Codec, Sony, Minato, Tokyo, Japan). Those equipments were obtained from Olympus Canada.Inc (Markham, Canada). The slides were scanned at a 20X magnification on a Nanozoomer 2.0 HT (Hamamatsu Photonics, Shizuoka Prefecture, Japan). The visualisation was at a 1680 x 1050 pixels resolution with the mScope v.3.6.1 (Aurora Interactive Ltd., Montreal, Canada) software. The diagnosis given to the surgeon and documented in the intraoperative pathology report was compared with the final pathology report. In the cases of a discrepancy, the frozen section slides, the paraffin slides and the scanned slides were reviewed to determine the reason for the error.
Results: Of the 104 cases, 102 cases were either concordant or with no clinically significant discrepancies (8 diagnoses were slightly discrepant because of differences in terminology in the same category of interpretation). Therefore, the percentage of agreement was 98%. Two significant discordant cases were reported: a change from a negative margin to a low grade intraepithelial lesion and the finding of a micrometastase in a lymph node. The average time from the arrival of the specimen to the intraoperative diagnosis was 20 minutes and it took an average of 8 minutes once the frozen section slide was ready until the diagnosis.
Conclusions: The Eastern Quebec Telepathology Network allowed to maintain a quality intraoperative frozen section service in a hospital where no pathologist was available on site. Telepathology allows greater flexibility in practice, avoids unnecessary travel and facilitates a better organisation of work in a vast territory with a shortage of pathologists.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 313, Monday Morning