Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol

Abstract

Objective/background: Telepathology has been widely adopted to allow intraoperative pathology examinations to be performed remotely and for obtaining second opinion teleconsultation. In the Italian northern region of South Tyrol, the widespread geographical distances and consequent cost for the health system of having a travelling pathologist cover intraoperative consultations in peripheral hospitals was a key driver for the implementation of a telepathology system.

Methods: In 2010, four Menarini D-Sight whole slide scanners to digitize entire pathology slides were placed in the peripheral hospitals of Merano, Bressanone, Brunico, and in the hub hospital of Bolzano. Digital workstations were also installed to allow pathologists to remotely perform intraoperative consultations with digital slides. This study reviews the outcome after 12 years of telepathology for this intended clinical use.

Results: After an initial validation phase with 100 cases which yielded a sensitivity of 65% (CI 43-84%) and specificity of 100% (CI 95-100%), there were 2058 intraoperative consultations handled by telepathology. The cases evaluated were mainly breast sentinel lymph nodes, followed by urological, gynecological and general surgical pathology frozen section specimens. There were no false-positive cases and 165 (8%) false-negative cases, yielding an overall sensitivity and specificity of 65% (CI 61-69%) and 100% (CI 99-100%), respectively.

Conclusion: Telepathology is reliable for remote intraoperative diagnosis and, despite technical issues and initial acquaintance issues, proved beneficial for patient care in satellite hospitals, improved standardization, promoted innovation, and resulted in cost savings for the health system.

Keywords: Italy; digital pathology; frozen section; intraoperative consultation; telepathology.

Figure 1.

Geographical map of South Tyrol (credits for the map to Ref. ).

Figure 2.

The workstations at the hub hospital of Bolzano (right) and each of the spoke hospitals at Merano, Bressanone, and Brunico. The arrows indicate the direction of image transmission during intraoperative teleconsultation.

Figure 3.

Graphical distribution of case population.

Figure 4.

Paired images of a representative case of sentinel lymph node where FS was negative (a), permanent section showed more adipose tissue and histiocytes (b), while a micrometastasis appeared only in a deeper section cut according to sentinel lymph node protocol examination (c).