Routine surgical telepathology in the Department of Veterans Affairs: Experience-related improvements in pathologist performance in 2200 cases

Objective: To determine whether diagnostic concordance, case deferral rate, and/or time required to review slides changed significantly as telepatholo gists gained additional experience using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system on the 2000 cases following an initial 20 0 consecutive surgical cases, previously reported. Materials and Methods: Gross surgical pathology specimens were prepared by specially trained personnel in Iron Mountain, Michigan. For TP, glass slide s were placed on the stage of a robotic microscope at the Iron Mountain VAM C (remote site); control of the motorized microscope was then transferred t o a pathologist located 220 miles away at the Milwaukee, Wisconsin, VAMC (h ost site). For each case, a telepathologist had the option of either render ing a diagnosis or deferring the case for later analysis by conventional li ght microscopy (LM). After the slides were read by TP and a surgical pathol ogy report had been generated (for nondeferred cases), the slides were tran sported to Milwaukee, where they were reexamined by the same pathologist, n ow using LM. When there was disagreement between the TP and LM diagnosis, a supplemental or revised report was issued, and the referring physician was notified by telephone immediately. All supplemental and revised reports we re reviewed by a third pathologist in the group. The slides were then revie wed by the pathology group practice or, when there was no consensus, by the Armed Forces Institute of Pathology to establish a "truth" diagnosis. To d etermine changes in telepathologist performance with experience after the i nitial start-up of the service, their performance in handling 10 consecutiv e sets of 200 surgical pathology cases was analyzed. Results: Concordance rates for clinically significant TP and LM diagnoses w ere high for all 10 sets, ranging from 99% to 100%. Comparing the first set (Cases 201-400) with the last set (Cases 2001-2200), viewing times per cas e were reduced from 10.26 min to 3.58 min. Viewing times per slide were red uced from 3.44 min to 1.13 min per slide, comparing the first and last sets . Case turnaround times (TAT) decreased from 2.46 days to less than or equa l to 1.5 days. Conclusion: These results demonstrate that improvements in TP services occu r over time as the result of additional experience using the TP system. The high diagnostic concordance and low rate of case deferral lend additional support to the proposal that a host-site pathologist using HDSF TP can subs titute effectively for an on-site pathologist as a service provider.