Dunn B E, Choi H, Almagro U A, Recla D L, Krupinski E A, Weinstein R S
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Telemed J. 1999 Winter;5(4):323-37. doi: 10.1089/107830299311899.
To determine whether diagnostic concordance, case deferral rate, and/or time required to review slides changed significantly as telepathologists gained additional experience using a hybrid dynamic/store-and-forward (HDSF) telepathology (TP) system on the 2000 cases following an initial 200 consecutive surgical cases, previously reported.
Gross surgical pathology specimens were prepared by specially trained personnel in Iron Mountain, Michigan. For TP, glass slides were placed on the stage of a robotic microscope at the Iron Mountain VAMC (remote site); control of the motorized microscope was then transferred to a pathologist located 220 miles away at the Milwaukee, Wisconsin, VAMC (host site). For each case, a telepathologist had the option of either rendering a diagnosis or deferring the case for later analysis by conventional light microscopy (LM). After the slides were read by TP and a surgical pathology report had been generated (for nondeferred cases), the slides were transported to Milwaukee, where they were reexamined by the same pathologist, now using LM. When there was disagreement between the TP and LM diagnosis, a supplemental or revised report was issued, and the referring physician was notified by telephone immediately. All supplemental and revised reports were reviewed by a third pathologist in the group. The slides were then reviewed by the pathology group practice or, when there was no consensus, by the Armed Forces Institute of Pathology to establish a "truth" diagnosis. To determine changes in telepathologist performance with experience after the initial start-up of the service, their performance in handling 10 consecutive sets of 200 surgical pathology cases was analyzed.
Concordance rates for clinically significant TP and LM diagnoses were high for all 10 sets, ranging from 99% to 100%. Comparing the first set (Cases 201-400) with the last set (Cases 2001-2200), viewing times per case were reduced from 10.26 min to 3. 58 min. Viewing times per slide were reduced from 3.44 min to 1.13 min per slide, comparing the first and last sets. Case turnaround times (TAT) decreased from 2.46 days to < or =1.5 days.
Thes results demonstrate that improvements in TP services occur over time as the result of additional experience using the TP system. The high diagnostic concordance and low rate of case deferral lend additional support to the proposal that a host-site pathologist using HDSF TP can substitute effectively for an on-site pathologist as a service provider.
在先前报告的连续200例手术病例之后，对2000例病例使用混合动态/存储转发（HDSF）远程病理学（TP）系统，以确定随着远程病理学家获得更多经验，诊断一致性、病例延期率和/或阅片所需时间是否发生显著变化。
密歇根州铁山经过专门培训的人员制备大体外科病理标本。对于TP，玻片放置在铁山退伍军人事务医疗中心（远程站点）的机器人显微镜载物台上；然后将电动显微镜的控制权转移给位于220英里外威斯康星州密尔沃基退伍军人事务医疗中心（主站点）的病理学家。对于每个病例，远程病理学家可以选择做出诊断或延期病例以便稍后通过传统光学显微镜（LM）分析。在通过TP阅片并生成手术病理报告（针对非延期病例）后，玻片被运送到密尔沃基，由同一位病理学家现在使用LM重新检查。当TP诊断与LM诊断存在分歧时，发布补充或修订报告，并立即通过电话通知转诊医生。所有补充和修订报告均由该组的第三位病理学家审核。然后由病理科集体阅片，或者在没有达成共识时，由武装部队病理研究所阅片以确定“真实”诊断。为了确定服务初始启动后远程病理学家的表现随经验的变化，分析了他们处理连续10组每组200例手术病理病例的表现。
所有10组中具有临床意义的TP和LM诊断的一致性率都很高，范围从99%到100%。将第一组（病例201 - 400）与最后一组（病例2001 - 2200）进行比较，每例的阅片时间从10.26分钟减少到3.58分钟。比较第一组和最后一组，每张玻片的阅片时间从3.44分钟减少到1.13分钟。病例周转时间（TAT）从2.46天减少到≤1.5天。
这些结果表明，随着使用TP系统获得更多经验，TP服务会随着时间推移而得到改善。高诊断一致性和低病例延期率进一步支持了这样的提议，即使用HDSF TP的主站点病理学家可以有效地替代现场病理学家作为服务提供者。
