Telepathology for Intraoperative Neuropathologic Consultations at an Academic Medical Center: A 5-Year Report

Abstract

Telepathology is an attractive solution for providing neuropathologic intraoperative expertise to geographically diverse hospitals from a center of excellence. To date, few reports specifically address the feasibility of such a system for intraoperative neuropathology specimens. The University of Pittsburgh Medical Center is a 20-hospital system in Southwest Pennsylvania in which the pathology department has adopted a subspecialty "centers of excellence" method of managing cases. The Division of Neuropathology is physically located at 1 hospital but provides neuropathologic expertise to the entire system. Adult neurosurgery is currently limited to 2 hospitals separated by 18 city blocks. We describe our experience in providing remote intraoperative neuropathologic consultations over a 5-year period, from 2002 to 2006. Several approaches are discussed, with emphasis on the current system and the evolution of imaging technology. Diagnostic outcomes are compared among >400 telepathology cases and >1,200 conventional intraoperative cases. Current technology is capable of facilitating teleneuropathologic intraoperative diagnoses in a timely manner, with accuracy rates comparable to those for conventional methods. However, the practice of providing these remote consultations requires a sophisticated and technologically advanced environment along with substantial planning, communication, and training of both pathologists and pathology assistants.

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 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.…”

“…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].…”

“…A more contemporary definition of TP would include the use of the internet to link a pathologist to a glass slide. Some centers have used TP extensively for routine surgical pathology [3][4][5][6], whereas others have used it more selectively for pathologist-to-pathologist consultation with frozen sections [7,8]. 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.…”

“…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.…”