STATIC IMAGE-ANALYSIS OF SKIN SPECIMENS - THE APPLICATION OF TELEPATHOLOGY TO FROZEN-SECTION EVALUATION

Although the ability to transmit high-resolution images of histopathol ogical sections could have a profound impact on the practice of pathol ogy, the application of video microscopy to the daily activities of su rgical pathology has not been rigorously evaluated. In particular, cer tain aspects of video microscopy relating to frozen section evaluation have not been adequately assessed. We conducted a retrospective analy sis of 48 excisional skin biopsy specimens encompassing a spectrum of benign and malignant lesions. To simulate an actual frozen section eva luation, only original frozen section slides were evaluated. Fields we re selected and digitized (Roche Image Analysis System) by a pathology resident. Two sets of diagnoses were subsequently rendered by a surgi cal pathologist, the first set based on the digitized images and the s econd based on direct microscopic examination of the histological slid es. The two sets of diagnoses were compared, and the concordance rates were as follows: malignant diagnoses, 100%; benign diagnoses, 100%; p ositive margins, 96%; negative margins, 99%. One (4%) of the 25 positi ve margins tvas indexed as negative by image analysis. Conversely, one (1%) of the 121 negative margins was indexed as positive by image ana lysis. In both of these cases, error was attributable to selection and digitization of an inappropriate field. We conclude that telepatholog y of static images is an accurate method of evaluating frozen sections of skin lesions. Potentially, this technology could he applied to the frozen section evaluation of other lesions as well, Static image anal ysis is, however, susceptible to errors induced by inappropriate field selection, emphasizing the need for trained and skillful personnel on both sides of the video camera. Copyright (C) 1997. Copyright (C) 199 7 by W.B. Saunders Company.