BACKGROUND:The authors conducted an analysis of 2 telepathology systems with different resolutions to determine how resolution affects the pathologists' ability to provide preliminary diagnoses for fine-needle aspirations (FNA). METH-ODS: FNA cases evaluated by telepathology between February 1, 2011 and January 18, 2012 were reviewed. Concordance indices between preliminary and final diagnoses were calculated for cases assessed with two proprietary systems (the Remote Meeting Technologies iMedHD system and the Olympus NetCam system) using 3 diagnostic classifications (negative, atypical, and suspicious/positive). A Wilcoxon rank-sum test was used to compare the number of passes necessary to determine adequacy. RESULTS: In total, 298 NetCam cases and 26 iMedHD cases were evaluated. The concordance index, which was calculated using the 3 classifications, was 0.943 (95% confidence interval, 0.922-0.963) for NetCam compared with 0.951 (95% confidence interval, 0.898-1.000) for iMedHD. The mean value for the number of passes required to determine adequacy was 2.2 for NetCam and 2.1 for iMedHD (P 5.838). CONCLUSIONS: The results from statistical analyses demonstrated no difference in the concordance indices between preliminary and final diagnoses or in the number of passes necessary to render adequacy between the 2 telepathology systems. However, because it had higher resolution along with other features, the iMedHD system achieved greater user satisfaction. Cancer (Cancer Cytopathol) 2014;122:546-52. V C 2014 American Cancer Society.KEY WORDS: telepathology; telecytopathology; immediate evaluations; preliminary diagnoses; fine-needle aspirations. INTRODUCTIONTelepathology is defined by the College of American Pathologists as the practice of pathology in which a pathologist views digitized or analog images (video or still) and renders an interpretation for inclusion in a formal diagnostic report or for documentation in the patient record. The College of American Pathologists further categorizes telepathology into different modes, including static telepathology (interpretation based on preselected, still images), dynamic telepathology (viewing real-time images), and whole-slide imaging.1 The use of telepathology as an educational and diagnostic tool has been on the rise since the mid 1980s. 2,3 It has recently proven to be sufficient for making timely and accurate preliminary diagnoses of specimens obtained by fine-needle aspiration (FNA). 2,4-6 For the purposes of this article, this technology is referred to hereinafter as telecytopathology, because it is solely used for the assessment FNA specimens. Studies increasingly are demonstrating high concordance and accuracy rates for preliminary diagnoses provided by dynamic telecytopathology versus direct microscopic evaluation. One 2008 study reported a Original Article diagnostic concordance rate of 97% and a diagnostic accuracy of 99% when comparing diagnoses rendered by telecytopathology with the original diagnoses of previously finalized cases. 4 Alsharif et al observ...
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