Real-Time Telepathology for Subspecialty Consultation
Nikolaj Lagwinski, MD
September 10th, 2007
Literature review
• Usage of telepathology for routine frozen section or permanent cases is well-documented
• Limited focus on cases that are selected for subspecialty consults in general practice
Objective
• To evaluate prospectively the use of a dynamic telepathology system for cases that a general pathologist would select for subspecialty consult
• Link a general pathologist at an ambulatory surgery center (ASC) with subspecialists at the main institution
System installation • Host site (ASC)
– Olympus (Olympus America, Melville, NY) BX-41 scope with fluorite objectives
– Olympus DP70 digital camera
• Host site (ASC)– PC (P4 2.8 GHZ, 512
MB RAM, 64 MB video card, Windows XP SP2)
– Web-enabling software (Olympus Microsuite Basic with Netcam)
System installation• Remote site (Main
campus)– Staff computer
running a Java-enabled web browser
– No specific software requirements
– High-speed internet access
Study design
Diagnostic Question
Telepathology Consult
Courier case or bring it in person
Case signed out with consult
Diagnostic Question
Courier case or bring it in person
Case signed out with consult
1. Subspecialty pathologist contacted
2. TP impression
3. Light microscopy
4. Final diagnosis
Telepathology algorithm
Case shown
TP Impression Deferral
Concordant Discordant
Major
Case complexity Image/technical
Minor
LM diagnosis
Data analyzed
• Reasons for deferring TP impression
• Concordance rates
• Dates– Telepathology consult– Final signout
Results
• 50 cases
• 10 subspecialty pathologists– 2 GI– 3 GYN– 2 ENT– 1 Breast– 2 GU
Results• 12/50 (24%) cases deferred
– Additional levels needed (2)– Special stains needed (7)– Additional consults needed (3) – By subspecialty:
• Breast (1/1, 100%)• GU (3/7, 42.9%) • ENT (4/10, 40%)• GYN (3/18, 16.7%)• GI (1/14, 7.1%)
Results
• Of remaining 38 cases:– Major discordance in 2 (5.3%)
• GYN – Complex atypical hyperplasia with no atypia on TP; atypia on LM
• GI – Gastric ulcer with no atypia on TP; atypia suggestive of dysplasia on LM
– Minor discordance in 2 (5.3%) • ENT – Squamous epithelium with reactive changes on
TP; mild dysplasia on LM• GI – Rectal biopsy suspicious for invasive CA on TP;
invasive CA on LM
Results
• 34/38 cases (89.5%) concordant• By subspecialty:
– GU (4/4, 100%)– GYN (14/15, 93.3%)– GI (11/13, 84.6%) *– ENT (5/6, 83.3%) *
* A case showed minor discordance
Results
• Average time of TP consult was 2 minutes (Range 1-5 min)
• Potential turnaround time saved by TP– 17 (44.7%) cases with difference of 0-1 days– 21 (55.3%) cases with difference of >2 days
Results summary
• High overall rate of concordance between TP and LM
• Deferral rates varied among different subspecialties
• Over half the cases could have potentially saved 2 or more days of turnaround time
Discussion
• Design limitations– Sample size
• 6 month study
– Multiple subspecialty pathologists• Variation in opinion and familiarity with setup• Effect on deferral rates
– Preselected Cases• Selection bias
Discussion
• System requires a working relationship between consultant and consultee
• Special stains / immunohistochemistry were not tested
• Cases were inherently more complex
• Workup of deferred cases was expedited
Conclusions
• Remote, real-time web-based telemicroscopy is an acceptable approach to subspecialty consultation in surgical pathology
• Although certain subspecialty types may be more amenable to consultation, cases may still be worked up more efficiently via telemicroscopy
Thank you
• This study was made possible by a grant from the CAP Foundation underwritten by Olympus of America, Inc
The end
Top Related