TELEPATHOLOGIC REVIEW - UTILITY, DIAGNOSTIC-ACCURACY, AND INTEROBSERVER VARIABILITY ON A DIFFICULT CASE CONSULTATION SERVICE

The diagnostic accuracy of telepathologic analysis has not been compar ed to that of conventional light microscopic review on a difficult cas e consultation service, The anatomic pathology consultation files of t he University of Iowa were retrospectively examined, and 105 difficult cases from a variety of organs were chosen for real-time telepatholog ic and light microscopic review. The telepathologic and light microsco pic crude agreement of five pathologists were compared, with use of th e original consultation diagnosis as the ''gold standard.'' Cases were scored as correct, partially correct, or incorrect. After making a vi deo diagnosis, the pathologists reported whether they wanted to review the case with use of a light microscope, The pathologists performed s ignificantly better with the light microscope, even after excluding ca ses in areas of inexpertise (P = .005), The mean percentage of cases t hat the pathologists wanted to review with the light microscope was 64 %, and the major reason for review was diagnostic uncertainty, Cases i ncorrectly diagnosed with use of the video monitor were almost always requested for review. We conclude that, on a difficult case consultati on service, pathologists perform significantly better with use of ligh t microscopic than with telepathologic analysis; rarely make an incorr ect diagnosis and do not request that case for light microscopic revie w; and exhibit high telepathologic diagnostic accuracy in areas of exp ertise.