Telepathology for Subspecialty Consultation in Surgical Pathology
Best Scientific Session - Pathology Imaging Informatics ApplicationsWalter H. Henricks MD; Cleveland Clinic; Nikolaj Lagwinski MD; Cleveland Clinic; Lynn Schoenfield MD; Cleveland Clinic;
Content:
While telepathology has been studied in routine practice, few studies have reported on its use specifically for subspecialty consultation. We present a systems evaluation of a dynamic telepathology system for cases that a general pathologist would select for consultation with subspecialty pathologists.
Technology:
The telepathology system consisted of a high resolution digital camera (DP70, Olympus Corp., Melville, NY) attached to a microscope (Olympus BX41). The camera was connected to a PC (Pentium 4 2.8 GHz processor, 512 MB RAM, 64 MB video card, Windows XP SP2) running web-enabling software (Olympus Microsuite Basic with Netcam). The system used TCP/IP to broadcast images to a static IP address. (Project was supported by the CAP Foundation Grant for Telepathology via Olympus Corporation).
Design:
To initiate a consultation, the general pathologist telephoned a subspecialty pathologist (e.g. gynecologic) at a remote location. The system enabled the remote subspecialty pathologist to use a Java-enabled web browser to view a live image of a slide as it was viewed and navigated on the microscope by the general pathologist. The consulting pathologist presented the areas of interest to the consultant, who recorded a telepathology impression. Glass slides were subsequently delivered to the same consultant to render a diagnosis. Telepathology impressions and final diagnoses were compared. Discordant cases were stratified as major or minor, depending on clinical severity. Telepathology deferral reasons were classified as due to case complexity or technical problems.
Results:
During the study 50 subspecialty consults were shown to 10 different subspecialty pathologists. Twelve of 50 (24%) of cases were deferred, all due to case complexity. Of 38 remaining cases, 34 (89.5%) were concordant. There were two major and two minor discordances. The average time of each telepathology consult was 2 minutes. In 55% of cases (21/38) telepathology could have saved 2 or more days in turnaround time.
Conclusion:
A high overall rate of concordance between telepathology impressions and light microscopy diagnoses was observed in cases referred for subspecialist consultation. Real-time telepathology is a feasible option for subspecialty pathologist consultation and may improve turnaround time by eliminating the need for slide delivery to consulting pathologists.
