Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol

Abstract

Objective/Background Telepathology has been widely adopted to allow intraoperative pathology examinations to be performed remotely and for obtaining second opinion teleconsultation. In the Italian northern region of South Tyrol, the widespread geographical distances and consequent cost for the health system of having a travelling pathologist cover intraoperative consultations in peripheral hospitals was a key driver for the implementation of a telepathology system. Methods In 2010, four Menarini D-Sight whole slide scanners to digitize entire pathology slides were placed in the peripheral hospitals of Merano, Bressanone, Brunico, and in the hub hospital of Bolzano. Digital workstations were also installed to allow pathologists to remotely perform intraoperative consultations with digital slides. This study reviews the outcome after 12 years of telepathology for this intended clinical use. Results After an initial validation phase with 100 cases which yielded a sensitivity of 65% (CI 43–84%) and specificity of 100% (CI 95–100%), there were 2058 intraoperative consultations handled by telepathology. The cases evaluated were mainly breast sentinel lymph nodes, followed by urological, gynecological and general surgical pathology frozen section specimens. There were no false-positive cases and 165 (8%) false-negative cases, yielding an overall sensitivity and specificity of 65% (CI 61–69%) and 100% (CI 99–100%), respectively. Conclusion Telepathology is reliable for remote intraoperative diagnosis and, despite technical issues and initial acquaintance issues, proved beneficial for patient care in satellite hospitals, improved standardization, promoted innovation, and resulted in cost savings for the health system.

Validation of Remote Digital Pathology based diagnostic reporting of Frozen Sections from home

“…On average, the scanning time per slide @40x magnification was <5 min, which was in concordance with high-end scanners used in other studies ( Table 1 ). 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Scanning at 20x can significantly reduce the scanning time (Average – 1:47 min/slide) using the same scanner as demonstrated in our previous study on FS. 8 Further, the image quality of these digitalised slides was reasonably good, despite few artefacts observed in these digital FS slides as expected due to inherent nature of FS glass slide preparation (more section thickness, folds and freezing artefacts – Fig 2 , Fig 7 ).…”

“…The median TAT of 27.27 min per case reported in the remote reporting arm in the current study was slightly longer than reported in the literature [range – 11–38 min/case (average 17.75 min) Table 1 ]. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 The longer time TAT in the current study was very significant, as it can challenge the clinical use of this system for FS interpretation as being a failure to meet the expected TAT of less than 20 min for FS reporting as per CAP recommendations. 29 …”

“…A high diagnostic concordance (97.6%) for remote FS reporting was accomplished in this study using a low-cost portable digital slide scanner and consumer-grade laptops/desktops by 5 pathologists. Several studies have demonstrated accuracy rates of over 90% for WSI systems for FS compared to conventional microscopy 8 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ( Table 1 ). In addition to successful validation for remote FS sign-out as per CAP recommendation (discordance rate <5%), there was almost perfect intra- and inter-observer agreement amongst pathologists, highlighting the reproducibility of this WSI system in routine clinical use.…”

“…Advancements in the WSI technology, information technology(IT) infrastructure and better connectivity, along with validation studies for FS consultation across the globe, have endorsed its safe adoption for clinical use for telepathology/remote reporting ( Table 1 ). 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Till date, the role of DP in FS diagnosis was primarily based on experience over the digital network established either within the same hospital or between a group of hospitals within the same health system (hub and spoke model) in a controlled working environment. However, few investigators have attempted its clinical validity for the remote FS sign-out beyond conventional hospital networks.…”

Second Opinion in the Italian Organ Procurement Transplantation: The Pathologist Is In

“…Implementing digital pathology can be costly since it typically requires the purchase of scanners, computers, and infrastructure for image acquisition, storage, and delivery. In most cases, several factors could result in a return on investment [ 36 , 37 , 38 ]. Because both radiology and pathology are subspecialties dealing with image-intensive data, some authorities have advocated for joint radiology/pathology programs to manage the large images produced by scanners [ 39 , 40 ].…”