International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

Abstract

Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service.

Materials and methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014.

Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases.

Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated pathologists who understood the language and culture on both sides. Lack of clinical information, missing gross pathology descriptions, and insufficient tissue sections submitted for evaluation were the main reasons for indefinite diagnoses. The overall experience encourages international telepathology practice for second opinions.

Keywords: China; digital pathology; teleconsultation; telepathology; whole slide imaging.

Figure 1

Customized University of Pittsburgh Medical Center KingMed teleconsultation web portal

Figure 2

Screenshot from the telepathology portal illustrating the value of bidirectional communication

Figure 3

Examples of challenging soft tissue pathology consultation cases. (Top left) recurrent acral myxoinflammatory fibroblastic sarcoma. The clinical image shown in this case was supplied by KingMed upon request. (Top right) Extraskeletal mesenchymal chondrosarcoma. (Bottom left) retiform hemangioendothelioma. (Bottom right) Pleomorphic hyalinizing angiectatic tumorwere

Figure 4

Examples of rare gynecologic and breast pathology consultation cases. (Left panel) 17-year-old female with an ovarian embryonal carcinoma (top left H & E; bottom left positive CD30 immunostain). (Right panel) 45-year-old female with a breast metaplastic carcinoma showing chondroid differentiation (top right H & E; bottom right cytokeratin 5/6 immunostain)

Figure 5

Examples of challenging lymphoma consultation cases. (Top panel) anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (top left H & E; top right CD30 immunostain). (Bottom panel) classical Hodgkin lymphoma (bottom left H & E; bottom right CD30 immunostain)