Four years experience with teleneuropathology

Abstract

Between 2002 and 2005, we made 343 intraoperative frozen section diagnoses with a telepathology system, which connected a neurosurgical department to our department of pathology. An expert neuropathologist performed at least one brief gross examination, and this was followed by a smear preparation and a frozen section slide for each case. Frozen section diagnosis lasted on average 26.1 min, calculated from the beginning of gross examination until the surgeon was given the diagnosis. The majority of cases (283 or 83%) were diagnosed in 15-40 min. The mean time needed for macroscopic examination was 3.0 min, time for staining 4.2 min, smear diagnosis took 5.4 min and time for histological diagnosis 10.7 min. Telemicroscopy of a smear slide took 11 times longer compared with light microscopy, and telemicroscopy of a frozen section slide took 16 times longer than with light microscopy. In 6% of cases, the telepathology software posed technical problems, which delayed the time of diagnosis, but not by more than 4 min. We were able to render a diagnosis in all cases (system reliability 100%). After eliminating sampling errors (i.e. cases with no diagnostic material in the frozen section slides and/or in smear preparations), the diagnostic accuracy for telepathology was 97.9%.

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

“…As such, it would not be appropriate to compare our performance with TP programs that have looked at resection margins, breast biopsy specimens, or lymph nodes. There are, however, 2 published reports on the use of TP for primary frozen section diagnosis in neuropathology that are very similar to our situation [7,14]. Hutarew et al [14] reported the use of RM for 343 frozen sections between 2002 and 2005 in Salzburg, Austria.…”

“…TP was first used for primary frozen section diagnosis in 1989 in Norway [9], where videotelemicroscopy was used to provide intraoperative coverage with 100% accuracy to 5 remote hospitals. In spite of the success of the Norwegian program and others that have followed [7,[10][11][12][13][14][15][16][17][18], the pathology community as a whole has been slow to adopt this technology.…”

“…The latter concern persists in spite of the existence of several retrospective validation studies demonstrating an average accuracy rate of 95% (range, 84.1%-100%) [20][21][22][23][24] (Table 1) for TP frozen section diagnoses. Furthermore, there have been at least 11 reports published between 1991 and 2007 showing an average diagnostic accuracy of 96% (range, 89%-100%) when TP was used for primary frozen section diagnosis [7,[10][11][12][13][14][15][16][17][18] (Table 2). With the exception of a few outliers [10,11,22], most articles have reported diagnostic accuracy values that fall within the accuracy range for frozen sections reported by conventional light microscopy [25].…”

“…TP was viewed as a viable solution, and a solid business case could be made in support of its implementation. [14] 97.9 0 10.7 2007 Horbinski [7] 95.5-96.9 12-20 NA Abbreviation: NA indicates not available. a These reports did not provide deferral rates but rather the percentage of cases during which technical problems were encountered.…”

Le réseau de télépathologie de l’Est du Québec

“…Depuis ce temps, plusieurs réseaux ont été développés dans différents pays du monde afin de faciliter l'accès à des diagnostics primaires, des relectures ou des examens extemporanés [16][17][18][19]. Le Canada fait actuellement figure de leader mondial en la matière.…”