Sergio González, Ignacio Duarte, Martha Pruyas, Eva Nielsen, José Badía, Beltrán Mena and the Telemedicine Project Group.
Department of Pathology, Catholic University of Chile School of Medicine and Dr. Sotero del Rio Hospital, Santiago, Chile.
Purpose: To assess diagnostic accuracy of a real time telepathology system. Methods: Sixty eight slides of historical cases were selected randomly from routinely processed and HE-stained samples. Then were shown to participant pathologists through a telepathology system. The actual diagnoses were unknown to them. Telediagnoses were then compared to the actual diagnoses. The telepathology system worked as follows: Images were captured with a Sony DXC-C1 high resolution video camera mounted on an Olympus BH-2 light microscope. A composed video signal was digitized (20fps, 640x480 and 24bits), JPEG compresssed (5:1) and transmited over a 30 Mbps channel of a 155 Mbps ATM-OC3 via optic fiber. Two Silicon Graphics workstations were also connected to provide video-conferencing capabilities. Results: A diagnostic match was obtained in 61 out of 68 cases; partial agreement in 6 cases and complete disagreement in 1 case (1.5% diagnostic error). The latter corresponded to a ductal carcinoma of the breast interpreted as sclerosing adenosis. Partial agreement ocurred in: colonic adenoma as hamartomatous polyp, hyperplastic colonic polyp as inflammatory polyp, dermatofibroma as haemangioma, astrocytoma as oligodendroglioma, colonic adenoma as hyperplastic polyp, and Hashimoto's thyroiditis as hyperplastic goiter with lymphocytic infiltrates. Conclusion: A correct diagnosis of malignant and/or benign lesion was obtained in 98.5% of the cases. The diagnostic error cannot be attributed to the transmission and displaying qualities, but to the standard interobserver error. This system is a suitable and accurate solution for histhopathology telediagnosis.