title: A pilot study investigating the minimum requirements necessary for grading astrocytomas remotely.
abstract: OBJECTIVE
  To investigate the minimum requirements necessary for remote grading astrocytomas in terms of selected static images and descriptive histologic characteristics.
  
  
  METHODS
  A histopathologist examined 106 formalin-fixed, paraffin-embedded tissue samples of low- and high-grade astrocytomas. Interobserver-checked cases were reviewed under a microscope to estimate the accuracy of the conventional glass slide diagnoses. Then cases based on 5 static-digitized images from each patient were diagnosed. Next, the grade of each tumor was assessed based on the set of 5 images and the World Health Organization (WHO) description of 8 histologic characteristics defined as crucial in grading astrocytomas. Finally, an evaluation was made using a custom-designed decision support system.
  
  
  RESULTS
  Conventional glass slide diagnosis was 93.9%. Diagnosis based only on the set of 5 images dropped to 81.6%. Diagnosis based on the set of 5 images and the WHO characteristics boosted accuracy to 88.8%. Accuracy improved to 91.8% with the addition of the decision support system.
  
  
  CONCLUSIONS
  Our findings suggest that a telepathology system might be valuable for accurate grade diagnosis of astrocytomas-providing a means for avoiding diagnostic errors-without blocks or slides having to leave the department. This could significantly reduce the overall time and cost of diagnosis.
authors.affiliation: Department of Medical Instruments Technology, Technological Educational Institute of Athens, Athens, Greece. dimglo@teiath.gr
authors.forename: Dimitris
authors.initials: D
authors.lastname: Glotsos
authors.forename: Pantelis
authors.initials: P
authors.lastname: Georgiadis
authors.forename: Spiros
authors.initials: S
authors.lastname: Kostopoulos
authors.forename: Antonis
authors.initials: A
authors.lastname: Daskalakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kalatzis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Ravazoula
authors.forename: Dionisis
authors.initials: D
authors.lastname: Cavouras
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000473:pathology* / Q000628:therapy; D001932:Brain Neoplasms / Q000473:pathology* / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D003663:Decision Trees; D003951:Diagnostic Errors / Q000517:prevention & control; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D010865:Pilot Projects; D015203:Reproducibility of Results; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000628:therapy; D019113:Telepathology / Q000379:methods*; D014944:World Health Organization; D055815:Young Adult