title: Interinstitutional whole slide imaging teleconsultation service development: assessment using internal training and clinical consultation cases.
abstract: BACKGROUND
  Assessment of accuracy and feasibility of whole slide imaging (WSI) for interinstitutional consultation in surgical pathology.
  
  
  OBJECTIVE
  To train technical and pathologist staff in WSI technology, establish and evaluate a WSI workflow using training cases and second-opinion consultations, and assess diagnostic accuracy.
  
  
  METHODS
  First, WSI training and evaluation using selected subspecialty service cases were performed and compared with the clinical glass slide (GS) diagnosis. Second, WSI and GS diagnoses of consecutive, second-opinion consultation cases were compared. Discrepancies underwent adjudication to determine a reference diagnosis. Participant observations on WSI initiation to practice were gathered.
  
  
  RESULTS
  There were 130 cases evaluated, with 123 correlations (94.6%) and 6 minor (4.6%) and 1 major (0.8%) discrepancies. The 74 consultation cases interpreted had 52 correlations (70.3%), and 18 minor (24.3%) and 4 major (5.4%) discrepancies. The WSI and GS adjusted major discrepancy rates in second-opinion consultations were 2.7% (2 of 74) and 4.1% (3 of 74), respectively. Statistical analysis showed that WSI was not inferior to GS interpretation. Pathologists agreed the software was easy to use and the images were adequate, but more time was spent rendering WSI interpretations.
  
  
  CONCLUSIONS
  A significant learning curve was observed in the transition from the training set to clinical consultation cases associated both with WSI interpretation and adjustments to the digital analogs of routine GS workflow. Results from second-opinion consultations indicated that WSI interpretation was as accurate as GS interpretation among properly trained and experienced users. Overall, WSI-based practice appears feasible for second-opinion consultations.
authors.affiliation: From the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (Mr Jones and Drs Nazarian, Duncan, Kamionek, Lauwers, Tambouret, Wu, Nielsen, Brachtel, Mark, Sadow, Grabbe, and Wilbur); and the Department of Pathology, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Grabbe). Dr Kamionek is now with the Department of Pathology, Carolinas Pathology Group, Charlotte, North Carolina.
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Jones
authors.forename: Rosalynn M
authors.initials: RM
authors.lastname: Nazarian
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Duncan
authors.forename: Michal
authors.initials: M
authors.lastname: Kamionek
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: Lauwers
authors.forename: Rosemary H
authors.initials: RH
authors.lastname: Tambouret
authors.forename: Chin-Lee
authors.initials: CL
authors.lastname: Wu
authors.forename: G Petur
authors.initials: GP
authors.lastname: Nielsen
authors.forename: Elena F
authors.initials: EF
authors.lastname: Brachtel
authors.forename: Eugene J
authors.initials: EJ
authors.lastname: Mark
authors.forename: Peter M
authors.initials: PM
authors.lastname: Sadow
authors.forename: John P
authors.initials: JP
authors.lastname: Grabbe
authors.forename: David C
authors.initials: DC
authors.lastname: Wilbur
mesh_terms: D000293:Adolescent; D003952:Diagnostic Imaging / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008853:Microscopy / Q000295:instrumentation / Q000379:methods; D015588:Observer Variation; D010338:Pathology, Clinical / Q000193:education / Q000379:methods*; D010340:Pathology, Surgical / Q000193:education / Q000379:methods*; D019114:Remote Consultation; D015203:Reproducibility of Results; D012984:Software; D019113:Telepathology / Q000379:methods*; D057188:Workflow