A nationwide telepathology consultation and quality control program in China: implementation and result analysis

Abstract

BackgroundTelepathology may play an important role in pathology consultation and quality control for cancer diagnosis in China, as the country has the largest population of cancer patients worldwide. In 2011, the Pathology Quality Control Center of China and Ministry of Health developed and implemented a nationwide telepathology consultation and quality control program for cancer diagnosis in China. We here report the results of the two-year implementation and experiences.Methodsthe program built an Internet based telepathology platform to connect participating hospitals and expert consultants. The hardware and software used for the platform were validated in previous validation studies in China. The program had three regional centers consisting of Peking Union Medical College, Huasi Medical College of Sichuan and 2nd affiliated hospital of Zhejiang University. It also had 20 provincial consultation centers based in the provincial referral hospitals. 80 provincial or national pathologists served as expert consultants for the program, providing telepathology consultation for cancer diagnosis for more than 60 participating hospitals.Resultsfrom 2011 to July 2013, 16,247 pathology cases were submitted to the platform for consultation. Among them, 84% were due to diagnostic difficulty and 16% were due to request by patients. The preliminary diagnosis provided by submitting pathologists were in agreement with expert opinion in 59.8% of cases but was in disagreement with expert opinion in 24.2% of cases. 16.0% of cases were not provided with preliminary diagnosis. The distribution of pathology cases by system or organ were: digestive system, 17.3%; gynecologic system, 16.7%; head and neck, 15.7%; bone and soft tissue, 10.4%; lung and mediastinum, 8.6%; breast, 7.6%; urinary system, 7.5%; hematopathology, 6.4%; skin, 5.2%; neuropathology, 2.5% and cytopathology, 1.3%. Expert consultants also provided assessment of quality of slide preparation and staining, online lectures and guidance for pathology quality control.Conclusionour results of two years' implementation indicated that telepathology could solve the problem of uneven distribution of pathology resources and provide a solution for countrywide pathology quality control in China. Telepathology could play an important role in improving pathology diagnosis in China.

The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects

“…A nationwide telepathology consultation and quality control program was conducted in China from 2011 to 2013 (n = 16,247). 179 Pathology cases included digestive disorders (17.3%), gynecological (16.7%), head and neck (15.7%), bone and soft tissue (10.4%), lung and mediastinum (8.6), breast (7.6%), urinary tract (7.5%) hematology (6.4%), skin (5%), neuropathology (2.5%), and cytopathology (1.3%). In all cases, remote expert consultations were provided, including an assessment of the quality of slide preparation and staining as well as the delivery of lectures on quality control.…”

Telepathology at the Armed Forces Institute of Pathology: A Retrospective Review of Consultations From 1996 to 1997

“…A study from China in 2011-2013 showed that the concordance rate was 59.8%. 8 In a similar study at the University of Pittsburgh (Pittsburgh, Pennsylvania) in collaboration with China, authors reported a concordance rate of 25.6% among the 54.7% of cases where an outside diagnosis was provided. 9 Another study in India examined the role of telepathology in rural institutions and found a concordance rate of 90.2%, with approximately 9.7% being marked as major discrepancies.…”

“…6,7 In the study from China, the top 3 consultations were for the digestive system (17.3%), the gynecologic system (16.7%), and head and neck (15.7%). 8 In traditional pathology consultation services (ie, nontelepathology), the major discrepancy in diagnoses ranges from 10% to 64%, worldwide. [11][12][13] A study of pediatric neoplasms at St Jude Children's Research Hospital (Memphis, Tennessee) from referring international sites showed that the major disagreement rate between international sites and St Jude's was higher than that among US institutions (13% to 37% among the countries studied).…”

“…Within departments, there are issues that need to be improved for running an optimal service unit, such as, local information technology support, confidentiality, Health Insurance Portability and Accountability Act issues, and language barriers. 8 In spite of the challenges, the AFIP telepathology program demonstrated more than 20 years ago that this could be accomplished successfully in a manner that benefited everyone.…”

Validation of a whole‐slide image‐based teleconsultation network

“…[1][2][3] Remote digital revision and consultation is an important use of digital pathology and is used increasingly in the United States and a few other countries, but has not been studied widely. [4][5][6] In cases where a patient is referred from one hospital to another for further treatment, the pathology material (glass slides and possibly tissue blocks) is usually shipped by regular mail to the other hospital. In the receiving pathology laboratory, the slides are reassessed ('revised') by a local pathologist.…”