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Real-Time Telepathology for Subspecialty Consultation

Real-Time Telepathology for Subspecialty Consultation

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Real-Time Telepathology for Subspecialty Consultation

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  1. Real-Time Telepathology for Subspecialty Consultation Nikolaj Lagwinski, MD September 10th, 2007

  2. Literature review • Usage of telepathology for routinefrozen section or permanent cases is well-documented • Limited focus on cases that are selected for subspecialty consults in general practice

  3. Objective • To evaluate prospectively the use of a dynamic telepathology system for cases that a general pathologist would select for subspecialty consult • Link a general pathologist at an ambulatory surgery center (ASC) with subspecialists at the main institution

  4. System installation • Host site (ASC) • PC (P4 2.8 GHZ, 512 MB RAM, 64 MB video card, Windows XP SP2) • Web-enabling software (Olympus Microsuite Basic with Netcam) • Host site (ASC) • Olympus (Olympus America, Melville, NY) BX-41 scope with fluorite objectives • Olympus DP70 digital camera

  5. System installation • Remote site (Main campus) • Staff computer running a Java-enabled web browser • No specific software requirements • High-speed internet access

  6. Study design • Subspecialty pathologist contacted • TP impression • Light microscopy • Final diagnosis

  7. Telepathology algorithm Case shown Deferral TP Impression Case complexity Image/technical LM diagnosis Discordant Concordant Major Minor

  8. Data analyzed • Reasons for deferring TP impression • Concordance rates • Dates • Telepathology consult • Final signout

  9. Results • 50 cases • 10 subspecialty pathologists • 2 GI • 3 GYN • 2 ENT • 1 Breast • 2 GU

  10. Results • 12/50 (24%) cases deferred • Additional levels needed (2) • Special stains needed (7) • Additional consults needed (3) • By subspecialty: • Breast (1/1, 100%) • GU (3/7, 42.9%) • ENT (4/10, 40%) • GYN (3/18, 16.7%) • GI (1/14, 7.1%)

  11. Results • Of remaining 38 cases: • Major discordance in 2 (5.3%) • GYN – Complex atypical hyperplasia with no atypia on TP; atypia on LM • GI – Gastric ulcer with no atypia on TP; atypia suggestive of dysplasia on LM • Minor discordance in 2 (5.3%) • ENT – Squamous epithelium with reactive changes on TP; mild dysplasia on LM • GI – Rectal biopsy suspicious for invasive CA on TP; invasive CA on LM

  12. Results • 34/38 cases (89.5%) concordant • By subspecialty: • GU (4/4, 100%) • GYN (14/15, 93.3%) • GI (11/13, 84.6%) * • ENT (5/6, 83.3%) * * A case showed minor discordance

  13. Results • Average time of TP consult was 2 minutes (Range 1-5 min) • Potential turnaround time saved by TP • 17 (44.7%) cases with difference of 0-1 days • 21 (55.3%) cases with difference of >2 days

  14. Results summary • High overall rate of concordance between TP and LM • Deferral rates varied among different subspecialties • Over half the cases could have potentially saved 2 or more days of turnaround time

  15. Discussion • Design limitations • Sample size • 6 month study • Multiple subspecialty pathologists • Variation in opinion and familiarity with setup • Effect on deferral rates • Preselected Cases • Selection bias

  16. Discussion • System requires a working relationship between consultant and consultee • Special stains / immunohistochemistry were not tested • Cases were inherently more complex • Workup of deferred cases was expedited

  17. Conclusions • Remote, real-time web-based telemicroscopy is an acceptable approach to subspecialty consultation in surgical pathology • Although certain subspecialty types may be more amenable to consultation, cases may still be worked up more efficiently via telemicroscopy

  18. Thank you • This study was made possible by a grant from the CAP Foundation underwritten by Olympus of America, Inc

  19. The end