Neurosurgical emergencies in patients who are unfit for transfer: Is a mobile neurosurgeon a feasible option?

Abstract

pathologists' diagnosis, that is, the consensus diagnosis (CD). Kappa scores for diagnostic accuracy (benign, in situ and invasivecancer) are calculatedandtransmittedtoparticipants by National HealthService regional coordinators. NEQAS has raisedkappa scores; for example cancer grading improved fromless than0.1toover 0.65after sixyears. Implementation islogisticallycumbersome, andthe participatingpathologists' submitted diagnoses and return informationabout performance are still sent by conventional mail. Telepathology theoretically represents an alternative modality to slide circulation in histopathology NEQAS. We tested this hypothesis by assessing the technical and clinical effectiveness of robotic interactive telepathology (RITPath) in two trials. The initial study involved a single pathologist examining 87 breast cases chosen randomly froma series of 192 fromthe UKbreast pathology NEQAS file. The average time taken for telepathology (TP) diagnosis was 3.9 min. The diagnostic accuracy of TP compared with light microscopy (LM) was 100%, for all cases benign and malignant. The accuracy of TP versus LMand CDwas 91%for carcinoma in situgrading(21/23cases). TPgradingofbreast cancer achieved accuracy of 98%(43/44) compared with LMand CD. In tumour typing, TPaccuracywas97%(65/67)usingLMandCD as comparators. The second study of similar designinvolved sevenpathologists of varyingexperience, eachassessing20-33 cases. Average diagnostic times per slide were 4.5-6.5 min. Concordance with CDwas 88-96%. These data demonstrate that telepathology of the RITPath type is a clinically and technically effective modality for histopathology quality assurance schemes. In addition, all RITPathdata can be transmittedfor analysis without a 'paper trail'. This hasimplications for National HealthServicequality assurance schemes in future.