Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience

Telemedicine and neurosciences

We investigated 109 randomly selected frozen section specimens from lung surgery patients in a retrospective blind mode using telepathology equipment. The telepathology system applied (HISTKOM) used one ISDN B-channel and telemicroscopy with a remotely operated robotic microscope. The performance of telepathological frozen section diagnosis was compared with that of conventional frozen section diagnosis. The false-positive rate achieved was identical for both methods. The sensitivity (P=0.03), but not the specificity, was significantly lower for the telepathological method. The time needed to establish a diagnosis with the remote microscope was too high; therefore, upgrading to multichannel technology is recommended. The quality of the images transmitted was judged to be sufficient by the pathologists involved in the study. In conclusion, with further technical improvements in telemicroscopy and additional experience in telepathology, remote diagnosis seems to be feasible.

The validity of telepathological frozen section diagnosis with ISDN-mediated remote microscopy.

One of the most promising applications of telepathology (pathology at a distance by electronic transmission of images in pathology) is frozen section diagnosis, especially because by means of this tool operations requiring an intraoperative histopathological diagnosis are feasible at hospitals without a pathologist on-site. For the introduction of this diagnostic tool into pathologist’s daily practice the evidence of its diagnostic accuracy comparable to that of the conventional frozen section diagnosis is crucial. For this purpose the literature on the diagnostic accuracy of telepathological frozen section diagnosis was reviewed. In a metaanalysis these studies and reports, in which a total of more than 1290 cases had been examined, showed a slightly lower overall diagnostic accuracy (of the telepathological frozen section diagnosis) of about 0.91 than the conventional frozen section diagnosis with an average accuracy of about 0.98 found in an analysis of several studies (on frozen section diagnosis of different organs). This difference is at least predominantly caused by a higher rate of deferred and false negative frozen section diagnoses in the telepathological method, while the specificity of both methods, each more than 0.99 was not significantly different. In conclusion, the introduction of a telepathological frozen section diagnosis for hospitals without an acceptable access to a pathologist is justifiable already at the current state of the technological development especially when considering the advantages (time saving, reduction in costs) compared to the alternative of surgical interventions without access to an intraoperative diagnosis.

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Reliability of telepathology for frozen section service.

The concept of using telepathology as a way of increasing the efficiency of pathologists is not new. There have been many studies attempting to evaluate the role of telepathology diagnosis, predominantly using transmission of still digital images. This study evaluates the potential value of remote diagnosis using robotic microscopy in the setting of a one-stop breast clinic. A Zeiss Axiopath telepathology system was used. The aim was to identify deficiencies in software and the minimum specifications for the computer hardware and network capability needed for reproducible pathological diagnosis with a view to developing a system that can preclude the need for an on-site pathologist. Forty-seven fine needle aspiration smears were diagnosed simultaneously by a pathologist in the breast clinic and by a different pathologist operating a robotic microscope situated in the clinic in a different wing of the hospital from the pathology department. The diagnoses, the time taken for clinic and remote diagnosis, and difficulties in using the system were recorded. Absolute correlation was achieved in 80.9% of cases. There was one false-positive diagnosis of cancer and no false negatives. The mean time taken for diagnosis per case was 2.39 min in clinic and 10.81 min by remote control robotic microscopy. However, as the pathologist did not have to leave the department, remote diagnosis was overall more economical of pathologists' time. Image quality was generally found to be good and not an obstacle to diagnosis. There were operational and technical problems that made remote diagnosis tedious and lengthy. Although at present the system is not capable of replacing an on-site pathologist, the results were encouraging and suggest that remote control remote diagnosis has the potential to increase the efficiency of pathologists.

Telepathology in a routine clinical environment: implementation and accuracy of diagnosis by robotic microscopy in a one-stop breast clinic.

DEFINITION Since 1992 we transfer digitalized frozen section images by means of videomicroscope and a personal computer through the public telephone network (ISDN) to the Institut of Pathology at the University Hospital in Basel. The aim of this study is to determine whether the quality of frozen section diagnosis obtained by telepathology is comparable to the conventional one. METHOD The frozen section diagnoses by telepathology from Oct. 1992 to May 1996 (n = 94) are compared to the paraffin sections performed in each case after the primary examination. The result is then compared to the well documented data of conventional frozen section diagnosis in the literature. RESULTS From Oct. 1992 to May 1996 we performed 94 frozen sections. In 84 cases the diagnosis was correct compared to the paraffin section (89%). The sensitivity to detect a malignant tumor was 92%, the specifity 100%. Four examinations were not conclusive and one examination had to be canceled because of technical problems. DISCUSSION In the literature, 92% of malignancy is diagnosed by conventional frozen section [1]. Telepathology gives the same result.

Frozen section diagnosis using telepathology

Schnellschnittuntersuchung mittels Telepathologie

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Frozen section diagnosis using telepathology

Schnellschnittuntersuchung mittels Telepathologie