title: Better resource utilisation and quality of care for ovarian cancer patients using internet-based pathology review.
abstract: The current literature indicates that a considerable number of patients in ovarian carcinoma clinical trials have histopathological diagnoses in conflict with inclusion criteria. It has been suggested that specialised pathology review prior to randomisation should become the standard procedure in study protocols. We hypothesised that our new, internet-based high-throughput infrastructure would be capable of providing specialised pathology review within 10 working days (w.d.).
  
  
  
  Patients scheduled for the AGO OVAR17 ovarian carcinoma chemotherapy trial were registered for expert pathologic case review using a new internet-based central pathology review platform prior to randomisation. All original slides were requested from local pathologists. Slides were scanned and uploaded to a secured internet server. A network of experienced gynaecological pathologists was connected to the server through a custom-designed software platform. If deemed necessary by the expert pathologists, immunohistochemistry was available through a collaborating pathology lab.
  
  
  
  A total of 880 patients with an original diagnosis of ovarian epithelial carcinoma were registered for expert pathology review from October 2011 to July 2013. For case review, five gynaecopathologists from Austria, Switzerland and Germany were available online. Median number of w.d. required to complete the whole process from patient registration to transmission of final review diagnoses was 4 (range 2-31) (w.d.), and in 848 out of 880 (97.5%) cases, it amounted to ⩽10 w.d. In 2.5% (n=22) of cases, a major diagnostic discrepancy of potential clinical relevance was found leading to exclusion from the chemotherapy trial.
  
  
  
  Our results show that the use of a new internet-based infrastructure makes timely specialised case review, prior to patient randomisation feasible within ⩽10 w.d. Our new approach helped to protect against overtreatment with chemotherapy of patients with ovarian borderline tumours and inadequate treatment of patients with ovarian metastases, as a result of their inappropriate entry into a clinical trial designed for patients with primary ovarian carcinoma.
authors.affiliation: Department of Women's Health, Tübingen University Hospital, Calwer Street 7, 72076 Tübingen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kommoss
authors.affiliation: Institute of Pathology, Referral Centre for Gynecopathology, A2/2, 68159 Mannheim, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Kommoss
authors.affiliation: Luzerner Kantonsspital, Institute of Pathology, 6000 Lucerne, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Diebold
authors.affiliation: LKH Graz West, Institute of Pathology, Göstinger Street 22, 8020 Graz, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Lax
authors.affiliation: Institute of Pathology, Referral Centre for Gynecopathology, A2/2, 68159 Mannheim, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Schmidt
authors.affiliation: Tübingen University Hospital, Institute of Pathology, Liebermeister Street 8, 72076 Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Staebler
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Henrici Street 92, 45136 Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: du Bois
authors.affiliation: Gynecologic Oncology Center Kiel, Herzog-Friedrich-Street 21, 24103 Kiel, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pfisterer
mesh_terms: D005260:Female; D006295:Health Resources / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000628:therapy*; D010338:Pathology, Clinical / Q000379:methods* / Q000458:organization & administration; D018579:Patient Selection; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D012107:Research Design