title: Telepathology in a routine clinical environment: implementation and accuracy of diagnosis by robotic microscopy in a one-stop breast clinic.
abstract: The concept of using telepathology as a way of increasing the efficiency of pathologists is not new. There have been many studies attempting to evaluate the role of telepathology diagnosis, predominantly using transmission of still digital images. This study evaluates the potential value of remote diagnosis using robotic microscopy in the setting of a one-stop breast clinic. A Zeiss Axiopath telepathology system was used. The aim was to identify deficiencies in software and the minimum specifications for the computer hardware and network capability needed for reproducible pathological diagnosis with a view to developing a system that can preclude the need for an on-site pathologist. Forty-seven fine needle aspiration smears were diagnosed simultaneously by a pathologist in the breast clinic and by a different pathologist operating a robotic microscope situated in the clinic in a different wing of the hospital from the pathology department. The diagnoses, the time taken for clinic and remote diagnosis, and difficulties in using the system were recorded. Absolute correlation was achieved in 80.9% of cases. There was one false-positive diagnosis of cancer and no false negatives. The mean time taken for diagnosis per case was 2.39 min in clinic and 10.81 min by remote control robotic microscopy. However, as the pathologist did not have to leave the department, remote diagnosis was overall more economical of pathologists' time. Image quality was generally found to be good and not an obstacle to diagnosis. There were operational and technical problems that made remote diagnosis tedious and lengthy. Although at present the system is not capable of replacing an on-site pathologist, the results were encouraging and suggest that remote control remote diagnosis has the potential to increase the efficiency of pathologists.
authors.affiliation: Department of Histopathology, Barts and the London NHS Trust, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK. n.singh@mds.qmw.ac.uk
authors.forename: Naveena
authors.initials: N
authors.lastname: Singh
authors.forename: Nuzhat
authors.initials: N
authors.lastname: Akbar
authors.forename: Chris
authors.initials: C
authors.lastname: Sowter
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Lea
authors.forename: Clive A
authors.initials: CA
authors.lastname: Wells
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology*; D003199:Computer Systems; D005260:Female; D006801:Humans; D008853:Microscopy; D009367:Neoplasm Staging; D010338:Pathology, Clinical; D012371:Robotics / Q000379:methods*; D012680:Sensitivity and Specificity; D012984:Software; D019113:Telepathology / Q000379:methods*; D013997:Time Factors