TELEPATHOLOGY DIAGNOSIS BY MEANS OF DIGITAL STILL IMAGES - AN INTERNATIONAL VALIDATION-STUDY

Telepathology affords the means to provide pathological diagnosis and consultation to remote sites. However, before telepathology can become an acceptable medical tool, it will be vital to determine the diagnos tic accuracy of this technology. We report the results of a single-bli nd study of the accuracy of diagnosis performed using computerized sti ll images obtained from a telepathology workstation used in a French t elepathology network. Four pathologists, each working alone, reviewed a total of 200 cases of routine surgical pathology (50 cases each), an d performed diagnosis based on both computer CD-ROM still images (CD) and conventional glass slides (GS). Concordance between GS and CD diag nosis, as well as accuracy, were determined. Other factors related to performance were also measured, including diagnostic certainty, reason s for uncertainty, and causes of diagnostic error. Overall, there was good agreement between GS and CD diagnosis. There was 87.5% concordanc e between GS and CD diagnosis, and comparison to consensus (correct) d iagnosis showed accuracy of 95.5% and 88.5% for GS and CD diagnosis, r espectively. Marked variability in accuracy of CD diagnosis was observ ed among the four pathologists, and issues related to image selection and/or quality appeared responsible for 60% of the diagnostic errors. The lack of sufficient images and clinical information were frequently cited as reasons for diagnostic uncertainty, as well as feelings of i nsufficient expertise. It is likely that the opportunity for interacti on with the referring pathologist and the use of subspecialty consulta nts would likely improve the performance of telepathology. Copyright ( C) 1996 by W.B. Saunders Company.