Background Whole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data. Objective The main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits. Methods Details of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS. Results From 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year. Conclusions The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.

BACKGROUND Telepathology is a potent strategy to overcome the shortage of senior pathologists, whole slid imaging (WSI) is the most advanced means and has been widely used in telepathology owning to its complete scanning of glass slides, but WSI occupies large storage space and computing resource, and the WSI retrieval is time-consuming. To compensate for these shortcomings of WSI, we have established a cloud-based telepathology system and conducted detailed evaluation of its implementation effects. OBJECTIVE The cloud-based telepathology system in China has been running for more than four years, and a large number of cases were submitted. The main purpose of this study is to evaluate the operation effect of this system based on a large sample, including the overview of the submitted cases, timeliness of telepathology reports, diagnostic accuracy, and economic benefits. METHODS A total of 23,167 cases submitted to the cloud-based telepathology system of the National Telemedicine Center of China from January 2016 to December 2019 were collected as subjects. The variation tendency of the report-timeliness from the system were analyzed for years. 564 patients who also directly visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the system. RESULTS The amounts of participated hospitals and submitted cases rose year by year. Most samples were captured from uterus, gastrointestinal tract, bone or soft tissue, breast, and esophagus. 17,495 cases were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions, the proportion of malignant lesions in esophagus, lung/mediastinum, urinary and thoracic cavity/pleura was higher than that in benign lesions, which was different from other 22 anatomic sites. The median turnaround time was 16.93 hours and shortened yearly (between 2018 and 2019 adjusted P= .012, other groups adjusted P＜ .001), 82.88% cases were diagnosed in 48 hours. The telepathological diagnosis of 11 cases were discrepant with the final diagnosis, and the diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in hospital(P= .549). 300,000 dollars were saved for patients every year with this system. CONCLUSIONS The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals and simultaneously reduced the high medical costs for patients in China. It should be therefore promoted further to enhance the efficiency, quantity and quality of telepathological diagnoses.