title: International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China.
abstract: BACKGROUND
  Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service.
  
  
  METHODS
  This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014.
  
  
  RESULTS
  A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases.
  
  
  CONCLUSIONS
  These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated pathologists who understood the language and culture on both sides. Lack of clinical information, missing gross pathology descriptions, and insufficient tissue sections submitted for evaluation were the main reasons for indefinite diagnoses. The overall experience encourages international telepathology practice for second opinions.
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Chengquan
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Ding
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Anil V
authors.initials: AV
authors.lastname: Parwani
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Hualin
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McHugh
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Piccoli
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Qinling
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Gonzalo Romero
authors.initials: GR
authors.lastname: Lauro
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Feng
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Hartman
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Raja R
authors.initials: RR
authors.lastname: Seethala
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Shangwei
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Yousem
authors.affiliation: Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
authors.forename: Yaoming
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Liron
authors.initials: L
authors.lastname: Pantanowitz
keywords: China; digital pathology; teleconsultation; telepathology; whole slide imaging