Analytical Cellular Pathology - Volume 21, issue 3-4

Authors: Remmelinck, Myriam | Lopes, M. Beatriz S. | Nagy, Nathalie | Rorive, Sandrine | Rombaut, Katja | Decaestecker, Christine | Kiss, Robert | Salmon, Isabelle

Article Type: Research Article

Abstract: The present paper reports our experience with, and our opinion of static telepathology as applied to neuropathology by means of the PHAROS acquisition system and conventional telephone data transmission (modem). The classical procedure of expert consultation based on surface mailing of histological slides is routinely performed, especially in highly specialized fields of pathology. Telepathology is an easy means of sharing scientific expertise at international level and could thus improve diagnosis particularly in neuropathology, where certain tumor types are very rare and complex to diagnose. Dynamic telepathology allows the referring pathologist to capture by himself images supporting their diagnosis. Using static …telepathology the pathologist could be limited in diagnosis by problems in fields selection. We devoted a whole year to collecting all the technical parameters characterizing the use of digitized neuropathological data files in order to investigate the feasibility of telepathology and the extent to which its use could improve diagnoses. Our results on a series of 38 histological brain examinations illustrate how we successfully established an international connection between two departments of pathology in Belgium and the USA. The referring pathologists gave diagnoses in 35 cases and deferred only 3. Despite a time‐consuming procedure for the telepathology session of a few cases, this tool provides easy access to expert diagnosis and real‐time discussion, both of which are of considerable interest and offer significant improvements in neuropathology. Show more

Keywords: Static telepathology, neuropathology, data transmission, expert consultation

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 177-182, 2000

Authors: Szymas, Janusz

Article Type: Research Article

Abstract: Our experience in creating and using telepathology system and multimedia database for education is described. This program packet currently works in the Department of Pathology of University Medical School in Poznan. It is used for self‐education, tests, services and for the examinations in pathology, i.e., for dental students and for medical students in terms of self‐education and individual examination services. The system is implemented on microcomputers compatible with IBM PC and works in the network system Netware 5.1. Some modules are available through the Internet. The program packet described here accomplishes the TELEMIC system for telepathology, ASSISTANT, which is the …administrator for the databases, and EXAMINATOR, which is the executive program. The realization of multi‐user module allows students to work on several working areas, on random be chosen different sets of problems contemporary. The possibility to work in the exercise mode will image files and questions is an attractive way for self‐education. The standard format of the notation files enables to elaborate the results by commercial statistic packets in order to estimate the scale of answers and to find correlation between the obtained results. The method of multi‐criterion grading excludes unlimited mutual compensation of the criteria, differentiates the importance of particular courses and introduces the quality criteria. The packet is part of the integrated management information system of the department of pathology. Applications for other telepathological systems are presented. Show more

Keywords: Telepathology, teleeducation, automated score, teleteaching

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 183-191, 2000

Authors: Brauchli, K. | Christen, H. | Meyer, P. | Haroske, G. | Meyer, W. | Kunze, K.D. | Otto, R. | Oberholzer, M.

Article Type: Research Article

Abstract: Although telepathology systems have been developed for more than a decade, they are still not a widespread tool for routine diagnostic applications. Lacking interoperability, software that is not satisfying user needs as well as high costs have been identified as reasons. In this paper we would like to demonstrate that with a clear separation of the tasks required for a telepathology application, telepathology systems can be built in a modular way, where many modules can be implemented using standard software components. With such a modular design, systems can be easily adapted to changing user needs and new technological developments and …it is easier to integrate modular systems into existing environments. Show more

Keywords: Telepathology, expert system, modular design, robotic microscope

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 193-199, 2000

Authors: Stauch, G. | Schweppe, K.W. | Kayser, K.

Article Type: Research Article

Abstract: Telepathology (TP) as a service in pathology at a distance is now widely used. It is integrated in the daily workflow of numerous pathologists. Meanwhile, in Germany 15 departments of pathology are using the telepathology technique for frozen section service; however, a common recognised quality standard in diagnostic accuracy is still missing. In a first step, the working group Aurich uses a TP system for frozen section service in order to analyse the frequency and sources of errors in TP frozen section diagnoses for evaluating the quality of frozen section slides, the important components of image quality and their influences …an diagnostic accuracy. The authors point to the necessity of an optimal training program for all participants in this service in order to reduce the risk of diagnostic errors. In addition, there is need for optimal cooperation of all partners involved in TP service. Show more

Keywords: Telepathology, frozen section service, diagnostic error

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 201-206, 2000

Authors: Kayser, K. | Kayser, G. | Becker, H.D. | Herth, F.

Article Type: Research Article

Abstract: Aim: To analyze the diagnostic accuracy of telediagnostic procedures for transbronchial fine needle aspirations. Material and methods: A double blind study was performed on cytological slides of 54 randomly selected cases with transbronchial fine needle aspirations. The slides were digitized using a Leica digital camera DC100 mounted on a microscope Leica Laborlux S, and analyzed by an experienced pathologist without knowing the definite diagnosis or any additional clinical data. The diagnoses stated by analyzing the digital images were compared to the final conventional diagnoses. In addition, the duration of the digital diagnosis, used magnifications, and difficulties for correct sampling were …documented. Results: The “digital” diagnoses of the 54 cases were all in general agreement with the definite diagnoses. No wrong positive or wrong negative case in respect to malignant/non‐malignant (31/23) or to small cell/non‐small cell (9/22) occurred. The performance of a digital diagnosis lasted for 115 s at average (15–260 s), and is significantly longer compared to that of conventional fine needle aspiration judgement (20 s). The screening magnification was commonly set to ×2.5, that for definite diagnostic analysis ×40. Benign diseases (2 tuberculosis and 3 sarcoidosis cases) were correctly classified. Conclusions: Telepathology systems can probably be used for fine needle aspiration analysis without major diagnostic errors. Their use can improve the endoscopic sampling and avoid second anesthesia when missing the lesion of request during the first examination. Show more

Keywords: Fine needle aspiration, lung, telepathology, feasibility study

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 207-212, 2000

Authors: Wellnitz, Uwe | Binder, Bernd | Fritz, Peter | Friedel, Godehard | Schwarzmann, Peter

Article Type: Research Article

Abstract: One of the most promising applications of telepathology (pathology at a distance by electronic transmission of images in pathology) is frozen section diagnosis, especially because by means of this tool operations requiring an intraoperative histopathological diagnosis are feasible at hospitals without a pathologist on‐site. For the introduction of this diagnostic tool into pathologist's daily practice the evidence of its diagnostic accuracy comparable to that of the conventional frozen section diagnosis is crucial. For this purpose the literature on the diagnostic accuracy of telepathological frozen section diagnosis was reviewed. In a metaanalysis these studies and reports, in which a …total of more than 1290 cases had been examined, showed a slightly lower overall diagnostic accuracy (of the telepathological frozen section diagnosis) of about 0.91 than the conventional frozen section diagnosis with an average accuracy of about 0.98 found in an analysis of several studies (on frozen section diagnosis of different organs). This difference is at least predominantly caused by a higher rate of deferred and false negative frozen section diagnoses in the telepathological method, while the specificity of both methods, each more than 0.99 was not significantly different. In conclusion, the introduction of a telepathological frozen section diagnosis for hospitals without an acceptable access to a pathologist is justifiable already at the current state of the technological development especially when considering the advantages (time saving, reduction in costs) compared to the alternative of surgical interventions without access to an intraoperative diagnosis. Show more

Keywords: Telepathology, frozen section diagnosis, diagnostic accuracy, metaanalysis

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 213-222, 2000

Authors: Seiwerth, S. | Danilovic, Z.

Article Type: Research Article

Abstract: Telepathology as a demanding branch of telemedicine poses a real challenge to experts. The introduction of telepathology in underprivileged countries with poor infrastructure and low health‐care budget is a difficult task. On the other hand these countries would mostly benefit by introducing telemedicine/telepathology. In our experience it is possible to build an efficient telepathology/teleradiology network using analogue telephone links and still image transmission, and a store and forward mode of operation. This experience is based on the application of telepathology in Croatia for seven years leading to a national teleradiology network. In this paper the ideas, development and software solutions …in the process of establishing a national telepathology and teleradiology network are highlighted. Show more

Keywords: Telepathology, Croatia, teleradiology, still image transmission

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 223-228, 2000

Authors: Tennstedt, Cornelia | Sunkel‐Wehrstedt, Kathrin | Vogel, Martin | Hufnagl, Peter

Article Type: Research Article

Abstract: Goal: In a study of 10 autopsy cases with congenital cardiac malformations we investigated whether obtaining a second opinion by means of telepathology could satisfy quality standards for the diagnosis of cardiac malformations and what the advantages and disadvantages of such a procedure might be. Material: The investigatory samples were 10 formalin‐fixed hearts with complex malformations from 9 fetuses and one newborn on which autopsies had been performed at the Pathological Institute of the Charité Hospital. The requests for a second opinion, which included text and image data, were sent in the form of Microsoft PowerPoint presentations to 5 experts …in 4 countries. Per case the number of images that were sent was between 3 and 7. The size of the files was between 439 and 942 kb. The time required for preparation of the cases for sending them to the specialists was between 1 and 2 hours: this encompassed the time for putting the notation on the images, compressing them, creating a file that included both the images and the clinical data and then sending the case file. Results: All 10 cardiac malformations were correctly identified. In 8 of the 10 cases at least one expert had questions. After these questions had been answered and further images had been sent final correct diagnoses were made in all cases. All experts said that the quality of the images was very good. Use of a standardized findings questionnaire, which also included the marking of anatomic structures and of pathological findings in the images, proved useful. Standardized findings forms facilitate orientation during interpretation of the cases and should be used generally to avoid misunderstandings in telepathological communication. Conclusions: In general it is possible to obtain an effective and reliable diagnosis of congenital heart malformations by means of telepathology. It is far quicker to get a second opinion by this means than by conventional means. Show more

Keywords: Congenital cardiac malformation, post‐mortem examination, telepathology, second opinion

Citation: Analytical Cellular Pathology, vol. 21, no. 3-4, pp. 229-235, 2000