DIAGNOSTIC-ACCURACY OF A RURAL LIVE VIDEO TELEPATHOLOGY SYSTEM

Accuracy of diagnoses rendered using a live video telepathology networ k was assessed for permanent sections of surgical pathology specimens. To determine accuracy, telepathology diagnoses were compared with tho se obtained by directly viewing the glass slide using a standard micro scope. A total of 294 cases were read via both telepathology and glass slide by attending pathologists at a tertiary care medical center. Ov erall accuracy was defined as exact concordance between diagnoses. Cli nically insignificant differences in diagnoses were excluded to determ ine clinically significant accuracy. For the 285 cases with complete d ata, the overall accuracy for telepathology was 0.912 (95% confidence interval [CI], 0.872-0.941), whereas the overall accuracy for glass sl ide readings was 0.968 (95% CI, 0.939-0.985). This difference is stati stically significant (p = 0.009). When focusing on clinically signific ant discrepancies, where the difference in diagnosis might affect ther apeutic decisions, the video accuracy was only slightly less than the glass slide accuracy (0.965 [95% CI, 0.934-0.982] vs. 0.982 [95% CI, 0 .957-0.994], respectively), but this difference is not statistically s ignificant (p = 0.302). Most of the cases with clinically significant differences involved lesions with inherently high interobserver variat ion. Certainty of diagnosis did not differ between video and glass sli de readings (p = 0.911), but there was an association between certaint y of diagnosis and diagnostic accuracy for video (p = 0.003 for clinic ally significant accuracies). Based on these findings, we recommend wh en using this telepathology system that only preliminary diagnoses sho uld be given in the following situations: for diagnostic areas with kn own high interobserver variability: when the consultant has any degree of uncertainty about the presence or absence of the lesion in questio n, and when then is insufficient experience using telepathology as a d iagnostic medium.