Prospective trial of telepathology for intraoperative consultation (Frozensections)

Telepathology is a maturing technology that, for a variety of reasons, has not been widely deployed. In addition, clinical validation is relatively mo dest compared with accepted telemedicine applications such as teleradiology . A prototype telepathology system (TelePat(sm)) featuring high-resolution images selected from a remote microscope site has been developed at the Uni versity of Alabama at Birmingham (UAB). To validate the diagnostic efficacy of the system, a prospective study was undertaken of parallel diagnoses by conventional microscopy and telepathology with a remotely operated microsc ope. Slides from 99 intraoperative consultations from 29 tissue/organ sites in the University of Alabama Hospitals by 9 academic pathologists were use d in the study. Each microscopic and telepathology diagnosis was compared w ith the final diagnosis rendered by a referee pathologist. Diagnoses were c lassified as correct, false positive, or false negative or classification e rror. Of the 99 frozen sections evaluated, 3 Eases were deferred. Of the re maining 96 Eases, 2 received incorrect diagnoses in both the microscopic an d telepathology arms of the study. Three errors occurred only in the telepa thology arm. There was 1 false-positive diagnosis, 1 false-negative diagnos is, and 1 classification error. Statistical analysis indicated no significa nt difference between telepathology and conventional microscopy. Qualitativ e data indicated that the pathologists were generally satisfied with the pe rformance of the system. Telepathology using this system paradigm is suffic iently accurate for real time utilization in a complex surgical environment . Telepathology therefore may be an effective model to support the surgical services of hospitals lacking full-time pathology coverage, resulting in f ull-time access to anatomic pathology services. Copyright (C) 2000 by W.B. Saunders Company.