title: Use of telepathology for routine surgical pathology review in a test bed in the Department of Veterans Affairs.
abstract: BACKGROUND
  Routine surgical pathology review by telepathology could be an important service component of multi-institutional pathology laboratory systems. Such service networks would increase access for rural hospitals without on-site pathologists to a broader range of pathology services on a daily basis.
  
  
  METHODS
  In this clinical trial, we analyzed the diagnostic accuracy, deferral rates, and viewing times of two generalist pathologists using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system to render diagnoses in real time on 200 consecutive surgical cases. The objective was to assess the efficacy of TP in providing diagnostic surgical pathology services to a remote hospital without an onsite pathologist. Surgical pathology specimens underwent gross preparation by specially trained personnel. When appropriate, this was done under the video supervision of a telepathologist. For TP, glass slides were placed on the stage of a robotic microscope at the Iron Mountain (MI) Department of Veterans Affairs Medical Center (VAMC) (remote site); control of the motorized microscope was then transferred to a pathologist located 220 miles away at the Milwaukee VAMC (host site). For each case, the telepathologist had the option of rendering a diagnosis or deferring the case for later analysis by conventional light microscopy (LM). After the slides were read by TP and a surgical pathology report had been generated, the slides were transported to Milwaukee, where they were reexamined by the telepathologist using LM and then by the pathology group practice or, when there was no consensus, by an outside consultant to establish a "truth" diagnosis.
  
  
  RESULTS
  Compared with the consensus ("truth") diagnosis, clinically important and overall concordance were 99.0% and 97.4%, respectively, by TP, and clinically important and overall concordance were 100.0% and 98.5%, respectively, by LM. The deferral rate was 2.5%. Examining glass slides by HDSF telepathology took an average of 4.43 minutes per slide and 12.09 minutes per case.
  
  
  CONCLUSIONS
  The high diagnostic accuracy and low rate of case deferral support the proposal that an offsite pathologist using HDSF telepathology can substitute effectively for an onsite pathologist as a service provider.
authors.affiliation: Department of Pathology, Medical College of Wisconsin, Milwaukee, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Dunn
authors.forename: U A
authors.initials: UA
authors.lastname: Almagro
authors.forename: H
authors.initials: H
authors.lastname: Choi
authors.forename: D L
authors.initials: DL
authors.lastname: Recla
authors.forename: R S
authors.initials: RS
authors.lastname: Weinstein
mesh_terms: D001706:Biopsy; D006801:Humans; D015588:Observer Variation; D019114:Remote Consultation; D013514:Surgical Procedures, Operative; D019113:Telepathology