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Real-Time Telepathology for Subspecialty Consultation
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![Page 1: Real-Time Telepathology for Subspecialty Consultation](https://reader036.fdocuments.us/reader036/viewer/2022062517/56813177550346895d97f077/html5/thumbnails/1.jpg)
Real-Time Telepathology for Subspecialty Consultation
Nikolaj Lagwinski, MD
September 10th, 2007
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Literature review
• Usage of telepathology for routine frozen section or permanent cases is well-documented
• Limited focus on cases that are selected for subspecialty consults in general practice
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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
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System installation • Host site (ASC)
– Olympus (Olympus America, Melville, NY) BX-41 scope with fluorite objectives
– Olympus DP70 digital camera
• 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)
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System installation• Remote site (Main
campus)– Staff computer
running a Java-enabled web browser
– No specific software requirements
– High-speed internet access
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Study design
Diagnostic Question
Telepathology Consult
Courier case or bring it in person
Case signed out with consult
Diagnostic Question
Courier case or bring it in person
Case signed out with consult
1. Subspecialty pathologist contacted
2. TP impression
3. Light microscopy
4. Final diagnosis
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Telepathology algorithm
Case shown
TP Impression Deferral
Concordant Discordant
Major
Case complexity Image/technical
Minor
LM diagnosis
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Data analyzed
• Reasons for deferring TP impression
• Concordance rates
• Dates– Telepathology consult– Final signout
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Results
• 50 cases
• 10 subspecialty pathologists– 2 GI– 3 GYN– 2 ENT– 1 Breast– 2 GU
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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%)
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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
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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
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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
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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
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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
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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
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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
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Thank you
• This study was made possible by a grant from the CAP Foundation underwritten by Olympus of America, Inc
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The end