Minervini M I, Yagi Y, Marino I R, Lawson A, Nalesnik M, Randhawa P, Wu T, Fung J J, Demetris A
Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
Hum Pathol. 2001 Dec;32(12):1334-43. doi: 10.1053/hupa.2001.29655.
Rapid and accurate interpretation of allograft biopsies influences the outcome after organ transplantation. Expert histopathologic interpretation can also determine whether a donor organ should be used for transplantation or disposed. These and similar considerations in the field of Transplantation Pathology prompted us to develop a static image, store-and-forward telepathology system capable of rendering accurate, robust, and confidential communication by using readily available equipment and bandwidth capabilities for interactive real-time second opinion consultation. Between July 1999 and October 2000, 102 cases were transmitted, including 78 for second opinion and 1 for primary diagnosis with 6 (5 real-time) frozen sections. Full agreement with the original diagnosis was obtained in 67 of 78 (86%) cases; in 11 (14%) cases, teleconsultation resulted in 8 minor and 3 clinically significant differences of opinion. This led to a change in therapy in 1 case and further evaluation in 2 other cases. We conclude that static image, store-and-forward telepathology can enhance the practice of transplantation pathology, but a multidisciplinary team for ongiong support and development is required. This technology has the potential to promote case sharing, conduct continuing education, build consensus, and standardize readings of biopsies in multicenter trials in which histopathologic findings represent important outcome measures.
对同种异体移植活检进行快速准确的解读会影响器官移植后的结果。专业的组织病理学解读还能确定供体器官是否可用于移植或废弃。移植病理学领域的这些及类似考量促使我们开发一种静态图像、存储转发式远程病理学系统，该系统能够利用现成的设备和带宽能力进行交互式实时二次诊断咨询，从而实现准确、可靠且保密的通信。1999年7月至2000年10月期间，共传输了102例病例，其中78例用于二次诊断，1例用于初步诊断，还有6例（5例实时）进行了冰冻切片检查。78例病例中有67例（86%）与原诊断完全一致；11例（14%）病例中，远程会诊产生了8例轻微及3例具有临床意义的意见分歧。这导致1例病例的治疗方案改变，另外2例病例进行了进一步评估。我们得出结论，静态图像、存储转发式远程病理学可以提升移植病理学的实践水平，但需要一个多学科团队进行持续的支持和发展。这项技术有潜力促进病例共享、开展继续教育、达成共识，并在组织病理学结果作为重要疗效指标的多中心试验中规范活检解读。
