Experiences with an International Digital Slide Based Telepathology System for Routine Sign-out between Sweden and Hungary

Tamás Micsik; Göran Elmberger; Anders Mikael Bergquist; László Fónyad; Tamás Micsik; Göran Elmberger; Anders Mikael Bergquist; László Fónyad

doi:10.3934/medsci.2015.2.79

AIMS Medical Science

2015, Volume 2, Issue 2: 79-89. doi: 10.3934/medsci.2015.2.79

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Experiences with an International Digital Slide Based Telepathology System for Routine Sign-out between Sweden and Hungary

1.
Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary;
2.
Department of Laboratory Medicine, Pathology, Örebro University Hospital, Örebro, Sweden;
3.
Department of Pathology and Cytology, The Västernorrland County, Sundsvall, Sweden

Received: 23 January 2015 Accepted: 28 April 2015 Published: 05 May 2015

Digital microscopy combines the benefits of traditional optical microscopy and the advantages of computer sciences. Using digital whole slides in all areas of pathology is increasingly popular. Telepathology or long distance diagnosis is one such area. In our study we have evaluated digital slide based histopathology diagnosis in an international setting, between Sweden and Hungary. Routine cases from the Sundsvall County Hospital (Landstinget Vasternorrland) were collected. Glass slides were scanned using Pannoramic 250 Flash II. (3DHISTECH Ltd., Budapest, Hungary). During the first round of evaluation the glass slides were shipped to Hungary for primary diagnosis. Two pathologists from Hungary, reading glass slides and one pathologist from Sweden reading digital slides signed out 500 cases. Pathologists from Hungary reached the hospital information system with a secure connection. During the second round the pathologists in Hungary reevaluated 200 from the 500 cases using digital slides after three months washout period. Diagnostic accuracy was calculated and diagnostic errors was graded according to clinicopathological consequences. In 182/200 (91%) cases digital and optical diagnoses were in full agreement. Out of the remaining 18 cases, 1 (0.5%) critical error was identified. In this case the error had therapeutic and prognostic consequence and no uncertainty either because of case complexity or poor image quality was recorded by the pathologist. We think language and communication issues as well as differences in minimal data sets of pathological reports and in guidelines used in Sweden and in Hungary are factors potentially limiting the widespread use of digital slides in a teleconsultation service provided to Sweden from Hungary. We found the quality of digital slides in our study setting acceptable to reach correct primary diagnosis in routine, unselected, random cases of a small-to-medium sized pathology department in Sweden.
- virtual slide,
- telepathology,
- surgical pathology,
- quality control,
- diagnostic confidence
Citation: Tamás Micsik, Göran Elmberger, Anders Mikael Bergquist, László Fónyad. Experiences with an International Digital Slide Based Telepathology System for Routine Sign-out between Sweden and Hungary[J]. AIMS Medical Science, 2015, 2(2): 79-89. doi: 10.3934/medsci.2015.2.79

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Abstract

Digital microscopy combines the benefits of traditional optical microscopy and the advantages of computer sciences. Using digital whole slides in all areas of pathology is increasingly popular. Telepathology or long distance diagnosis is one such area. In our study we have evaluated digital slide based histopathology diagnosis in an international setting, between Sweden and Hungary. Routine cases from the Sundsvall County Hospital (Landstinget Vasternorrland) were collected. Glass slides were scanned using Pannoramic 250 Flash II. (3DHISTECH Ltd., Budapest, Hungary). During the first round of evaluation the glass slides were shipped to Hungary for primary diagnosis. Two pathologists from Hungary, reading glass slides and one pathologist from Sweden reading digital slides signed out 500 cases. Pathologists from Hungary reached the hospital information system with a secure connection. During the second round the pathologists in Hungary reevaluated 200 from the 500 cases using digital slides after three months washout period. Diagnostic accuracy was calculated and diagnostic errors was graded according to clinicopathological consequences. In 182/200 (91%) cases digital and optical diagnoses were in full agreement. Out of the remaining 18 cases, 1 (0.5%) critical error was identified. In this case the error had therapeutic and prognostic consequence and no uncertainty either because of case complexity or poor image quality was recorded by the pathologist. We think language and communication issues as well as differences in minimal data sets of pathological reports and in guidelines used in Sweden and in Hungary are factors potentially limiting the widespread use of digital slides in a teleconsultation service provided to Sweden from Hungary. We found the quality of digital slides in our study setting acceptable to reach correct primary diagnosis in routine, unselected, random cases of a small-to-medium sized pathology department in Sweden.

References

[1]	Weinstein RS, Graham AR, Richter LC, et al. (2009) Overview of telepathology, virtual microscopy, and whole slide imaging: prospects for the future. Hum Pathol 40: 1057-1069. doi: 10.1016/j.humpath.2009.04.006
[2]	Al-Janabi S, Huisman A, Van Diest PJ (2012) Digital pathology: current status and future perspectives. Histopathology 61: 1-9.
[3]	Ghaznavi F, Evans A, Madabhushi A, et al. (2013) Digital Imaging in Pathology: Whole-Slide Imaging and Beyond. Annu Rev Pathol 8: 331-359. doi: 10.1146/annurev-pathol-011811-120902
[4]	Al-Janabi S, Huisman A, Nap M, et al. (2012) Whole slide images as a platform for initial diagnostics in histopathology in a medium-sized routine laboratory. J Clin Pathol 65: 1107-1111. doi: 10.1136/jclinpath-2012-200878
[5]	Bauer TW, Schoenfield L, Slaw RJ, et al. (2013) Validation of Whole Slide Imaging for Primary Diagnosis in Surgical Pathology. Arch Pathol Lab Med 137: 518-524. doi: 10.5858/arpa.2011-0678-OA
[6]	Bauer TW, Slaw RJ (2014) Validating Whole-Slide Imaging for Consultation Diagnoses in Surgical Pathology. Arch Pathol Lab Med 138: 1459-1465. doi: 10.5858/arpa.2013-0541-OA
[7]	Campbell WS, Lele SM, West WW, et al. (2012) Concordance between whole-slide imaging and light microscopy for routine surgical pathology. Hum Pathol 43: 1739-1744. doi: 10.1016/j.humpath.2011.12.023
[8]	Cornish TC, Swapp RE, Kaplan KJ (2012) Whole-slide imaging: routine pathologic diagnosis. Adv Anat Pathol 19: 152-159. doi: 10.1097/PAP.0b013e318253459e
[9]	Fonyad L, Krenacs T, Nagy P, et al. (2012) Validation of diagnostic accuracy using digital slides in routine histopathology. Diagn Pathol 7: 35. doi: 10.1186/1746-1596-7-35
[10]	Thorstenson S, Molin J, Lundström C (2014) Implementation of large-scale routine diagnostics using whole slide imaging in Sweden: Digital pathology experiences 2006-2013. J Pathol Inform 5: 14. doi: 10.4103/2153-3539.129452
[11]	Laszlo K, Tamas M, Gabor K, et al. (2011) Technical note on the validation of a semi-automated image analysis software application for estrogen and progesterone receptor detection in breast cancer. Diagn Pathol 6: 6. doi: 10.1186/1746-1596-6-6
[12]	Krenacs T, Zsakovics I, Micsik T, et al. (2010) Digital microscopy - the upcoming revolution in histopathology teaching, diagnostics, research and quality assurance. Microscopy: Science, Technology, Applications and Education. pp. 965-977.
[13]	Fonyad L, Gerely L, Cserneky M, et al. (2010) Shifting gears higher - digital slides in graduate education - 4 years experience at Semmelweis University. Diagn Pathol 5: 73. doi: 10.1186/1746-1596-5-73
[14]	Pantanowitz L, Sinard JH, Henricks WH, et al. (2013) Validating Whole Slide Imaging for Diagnostic Purposes in Pathology Guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med 137: 1710-1722. doi: 10.5858/arpa.2013-0093-CP
[15]	Swedish Society of Pathology-website. Awailabe from: http://www.svfp.se/.
[16]	Lankshear S, Srigley J, McGowan T, et al. (2013) Standardized Synoptic Cancer Pathology Reports-So What and Who Cares? A Population-Based Satisfaction Survey of 970 Pathologists, Surgeons, and Oncologists. Arch Pathol Lab Med 137: 1599-1602.
[17]	Srigley JR, McGowan T, Maclean A, et al. (2009) Standardized Synoptic Cancer Pathology Reporting: A Population-Based Approach. J Surg Oncol 99: 517-524. doi: 10.1002/jso.21282
[18]	Gu J, Taylor CR (2014) Practicing Pathology in the Era of Big Data and Personalized Medicine. Appl Immunohistochem Mol Morphol 22: 1-9. doi: 10.1097/PAI.0000000000000022
[19]	Farmer ER, Gonin R, Hanna MP (1996) Discordance in the histopathologic diagnosis of melanoma and melanocytic nevi between expert pathologists. Hum Pathol 27: 528-531. doi: 10.1016/S0046-8177(96)90157-4
[20]	Ackerman AB (1996) Discordance among expert pathologists in diagnosis of melanocytic neoplasms. Hum Pathol 27: 1115-1116. doi: 10.1016/S0046-8177(96)90301-9
[21]	Cai B, Ronnett BM, Stoller M, et al. (2007) Longitudinal evaluation of Interobserver and intraobserver agreement of cervical intraepithelial neoplasia diagnosis among an experienced panel of gynecologic pathologists. Am J Surg Pathol 31: 1854-1860. doi: 10.1097/PAS.0b013e318058a544
[22]	Leung ST, Kaplan KJ (2009) Medicolegal aspects of telepathology. Hum Pathol 40: 1137-1142. doi: 10.1016/j.humpath.2009.01.009

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