title: Offline telepathology diagnosis of colorectal polyps: a study of interobserver agreement and comparison with glass slide diagnoses.
abstract: OBJECTIVE
  Technological advances have produced telepathology systems with high quality colour images and reasonable transmission times. Most applications of telepathology have centred on the remote diagnosis of frozen sections or remote real time expert opinions. This study investigates the reproducibility and accuracy of offline telepathology as a primary diagnostic medium for routine histopathology specimens.
  
  
  METHODS
  One hundred colorectal polyps (50 hyperplastic, 50 adenomatous) were presented in a randomised order to five histopathologists as offline images on a telepathology workstation. Six images of each case were used: the slide label, a low power scan of all material on the slide, and four higher magnification views. The times taken to prepare the images, and to make the diagnoses, were recorded. Interobserver agreement was measured with kappa statistics and compared with the glass slide diagnoses.
  
  
  RESULTS
  The kappa statistics for the interobserver agreement on the telepathology images lay in the range of 0.90-1.00, which is interpreted as excellent agreement, and were significantly higher than those for the glass slide diagnoses (range, 0.84-0.98; p = 0.001). The median time taken to capture the images for a case was 210 seconds. The median time taken to make a diagnosis from the telepathology images was five seconds, which was significantly shorter than for the glass slide diagnoses (median, 13 seconds; p < 0.0005).
  
  
  CONCLUSIONS
  Offline telepathology has the potential to be a primary diagnostic medium for routine histopathology with a high degree of reproducibility and short diagnosis times. Further studies are required to validate offline telepathology for different types of specimens and different operators of the image capture system.
authors.affiliation: Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, School of Medicine and Biological Science, University of Sheffield, Beech Hill Road, South Yorkshire S10 2RX, UK. s.s.cross@sheffield.ac.uk
authors.forename: S S
authors.initials: SS
authors.lastname: Cross
authors.forename: J L
authors.initials: JL
authors.lastname: Burton
authors.forename: A K
authors.initials: AK
authors.lastname: Dubé
authors.forename: K M
authors.initials: KM
authors.lastname: Feeley
authors.forename: P D
authors.initials: PD
authors.lastname: Lumb
authors.forename: T J
authors.initials: TJ
authors.lastname: Stephenson
authors.forename: R D
authors.initials: RD
authors.lastname: Start
mesh_terms: D000236:Adenoma / Q000473:pathology; D018253:Adenoma, Villous / Q000473:pathology; D002983:Clinical Competence; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D007417:Intestinal Polyps / Q000473:pathology*; D015588:Observer Variation; D015203:Reproducibility of Results; D019113:Telepathology / Q000379:methods*; D013997:Time Factors