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. 2015 Oct 28:6:55.
doi: 10.4103/2153-3539.168515. eCollection 2015.

Utility of telepathology as a consultation tool between an off-site surgical pathology suite and affiliated hospitals in the frozen section diagnosis of lung neoplasms

Taisia Vitkovski  1 , Tawfiqul Bhuiya  1 , Michael Esposito  1
Affiliations

Utility of telepathology as a consultation tool between an off-site surgical pathology suite and affiliated hospitals in the frozen section diagnosis of lung neoplasms

Taisia Vitkovski et al. J Pathol Inform. .

Abstract

Background: Increasingly, as in our institution, operating rooms are located in hospitals and the pathology suite is located at a distant location because of off-site consolidation of pathology services. Telepathology is a technology which bridges the gap between pathologists and offers a means to obtain a consultation remotely. We aimed to evaluate the utility of telepathology as a means to assist the pathologist at the time of intraoperative consultation of lung nodules when a subspecialty pathologist is not available to directly review the slide.

Methods: Cases of lung nodules suspicious for a neoplasm were included. Frozen sections were prepared in the usual manner. The pathologists on the intraoperative consultation service at two of our system hospitals notified the thoracic pathologist of each case after rendering a preliminary diagnosis. The consultation was performed utilizing a Nikon™ Digital Sight camera and web-based Remote Medical Technologies™ software with live video streaming directed by the host pathologist. The thoracic pathologist rendered a diagnosis without knowledge of the preliminary interpretation then discussed the interpretation with the frozen section pathologist. The interpretations were compared with the final diagnosis rendered after sign-out.

Results: One hundred and three consecutive cases were included. The frozen section pathologist and a thoracic pathologist had concordant diagnoses in 93 cases (90.2%), discordant diagnoses in nine cases (8.7%), and one case in which both deferred. There was an agreement between the thoracic pathologist's diagnosis and the final diagnosis in 98% of total cases including 8/9 (88.9%) of the total discordant cases. In two cases, if the thoracic pathologist had not been consulted, the patient would have been undertreated.

Conclusions: We have shown that telepathology is an excellent consultation tool in the frozen section diagnosis of lung nodules.

Keywords: Intraoperative; telepathology; thoracic; virtual.

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Figures

Figure 1
Figure 1
Remote consultation. The host pathologist is responsible for showing the areas of interest to the consultant, at multiple magnifications. The quality of the transmitted image depends on multiple factors, starting with the preparation of the slide. This screenshot shows the transmitted image as it appears on the desktop of the consultant pathologist
Figure 2
Figure 2
Adenocarcinoma. The distinction between adenocarcinoma and adenocarcinoma in situ was particularly challenging for the host pathologists in this study. This frozen section slide of adenocarcinoma was correctly interpreted as adenocarcinoma by the consultant pathologist and as AIS by the host pathologist
See this image and copyright information in PMC

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