State of the Art of Teledermatopathology

Abstract

Teledermatopathology may involve real-time transmission of images from distant locations to consulting pathologists by the remote manipulation of a robotic microscope. Alternatively, the static store-and-forward option involves the single-file transmission of subjectively preselected and captured areas of microscopic images by a referring physician. The recent introduction of virtual slide systems (VSS) involves the digitization of whole slides at high resolution thus enabling the user to view any part of the specimen at any magnification. Such technology has surmounted previous restrictions caused by the size of preselected areas and specimen sampling for telepathology. In terms of client access, these VSS may be stored on a virtual slide server, made available on the Web for remote consultation by pathologists via an integrated virtual slide client network. Despite store-and-forward teledermatopathology being the most frequently used and less expensive approach to teledermatopathology, VSS represents the future in this discipline. The recent pilot studies suggest that the use of remote expert consultants in diagnostic dermatopathology can be integrated into daily routine, teleconsultation, and teleteaching. The new technology enables rapid and reproducible diagnoses, but despite its usability, VSS is not completely feasible for teledermatopathology of inflammatory skin diseases as the performance seems to be influenced by the availability of complete clinical data. Improvements in the diagnostic facility will no doubt follow from further development of the VSS, the slide processor, and of course training in the use of virtual microscope. Undoubtedly, as technology becomes even more sophisticated in the future, VSS will overcome the present drawbacks and find its place in all facets of teledermatopathology.

Influence of evaluation of clinical pictures on the histopathologic diagnosis of inflammatory skin disorders

“…These diseases undergo biopsy almost exclusively by physicians without sufficient experience in dermatological disorders (mostly young residents and general practitioners); nonetheless, these cases, too, represent a diagnostic challenge for dermatopathologists sitting at the microscope. All of these limitations, as well as the intrinsic difficulties associated with histopathologic diagnosis of cutaneous inflammatory disorders, 11,20 probably account for a score lower than expected by the 9 dermatopathologists. On the other hand, even considering the limiting factors just mentioned there was a statistically highly significant improvement in the number of correct diagnoses, number of differential diagnoses, and level of confidence, thus showing that even under these conditions, the addition of clinical pictures clearly helps in making a better histopathologic diagnosis of inflammatory skin disorders.…”

A static-image telepathology system for dermatopathology consultation in East Africa: The Massachusetts General Hospital Experience

“…1,2,4,6,8,9,25,26 Technical factors include field selection error, inadequate photographic sampling, and poor image quality. In our study, field selection error was identified as the major contributing factor in the initial misdiagnosis of the toxic epidermal necrolysis case (Table I, case 26), in which the diagnostic area was not present in static telepathology images submitted for review.…”

Newer insights in teledermatology practice

“…[40][41][42][43][44][45] Teledermatopathology is achieved by (i) video-image (dynamic) analysis; (ii) store and forward (static); and (iii) web-based virtual slide system. [46] A virtual slide system is a recently Kanthraj Teledermatology practice developed technology where a robotic microscope is used; any field of the specimen is selected for better digitalization at any required magnification at the discretion of the dermatopathologist. [43] Teledermoscopy Pigmented skin lesions and melanoma are analyzed based on the dermoscopic criteria [47,48] that depend on characteristic changes in epidermis and dermis.…”