Virtual microscopy using whole-slide imaging as an enabler for teledermatopathology: A paired consultant validation study

Abstract

Background:There is a need for telemedicine, particularly in countries with large geographical areas and widely scattered low-density communities as is the case of the Canadian system, particularly if equality of care is to be achieved or the difference gap is to be narrowed between urban centers and more peripheral communities.Aims:1. To validate teledermatopathology as a diagnostic tool in under-serviced areas; 2. To test its utilization in inflammatory and melanocytic lesions; 3. To compare the impact of 20× (0.5 μm/pixel) and 40× (0.25 μm/pixel) scans on the diagnostic accuracy.Materials and Methods:A total of 103 dermatopathology cases divided into three arms were evaluated by two pathologists and results compared. The first arm consisted of 79 consecutive routine cases (n=79). The second arm consisted of 12 inflammatory skin biopsies (n=12) and the third arm consisted of 12 melanocytic lesions (n=12). Diagnosis concordance was used to evaluate the first arm. Whereas concordance of preset objective findings were used to evaluate the second and third arms.Results:The diagnostic concordance rate for the first arm was 96%. The concordance rates of the objective findings for the second and third arms were 100%. The image quality was deemed superior to light microscopy for 40× scans.Conclusion:The current scanners produce high-resolution images that are adequate for evaluation of a variety of cases of different complexities.

Interinstitutional Whole Slide Imaging Teleconsultation Service Development: Assessment Using Internal Training and Clinical Consultation Cases

“…Massone et al 20 reported, in 2007, significant problems with a WSI system for inflammatory cases; they noted that further system and technology development and additional training might improve accuracy. In 2012, Al Habeeb et al 15 reported concordance rates of 96% (76 of 79) and 100% (12 of 12) in a multiple-armed study, and they concluded modern WSI systems were adequate for diagnosis of challenging dermatopathology cases; our results agree with those findings. The feedback from the participating dermatopathologists in our study was entirely positive regarding image quality; their only concern was with speed of diagnosis in a subspecialty known for large workloads.…”

“…Other possible explanations for that result include changes related to practice behavior, such as spending more time on the WSI, novelty-induced interest, or, potentially, viewing cases at higher magnifications. Studies of nonconsult-grade cases among multiple subspecialties, [7][8][9]13,14 and consult-grade cases among a single subspecialty 3,15,16 have been published previously. The only other study 12 that addresses consult-grade cases of multiple subspecialties, to our knowledge, showed a 91% agreement rate (48 of 53) between WSI and GS interpretation for a population of cases selected for difficulty from an outside institution.…”

Telemedicine Use in International Relief Efforts

“…Given the limitations of the videoconferencing equipment, a thorough physical exam cannot be completed. Some studies have validated the use of videoconferencing by demonstrating high rates of concordance between diagnoses given after remote and face-to-face consultations [12][13][14]. However, these studies do not take into account the varying levels of health education and communication ability of patients who need humanitarian services.…”

Validation of Whole-Slide Imaging for Histolopathogical Diagnosis: Current State

“…Although both studies included a small number of cases (100 and 79, respectively), the intraobserver agreement was high (94% for WSI and 96% for CLM, respectively) [30,56]. A study limited to tumor and tumor-like skin lesions showed agreement in the diagnosis by WSI and CLM, with a κ value of 0.93 for both methods [57].…”