Leong F J W-M, Nicholson A G, McGee J O'D
Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Headington, Oxford, UK.
J Pathol. 2002 Jun;197(2):211-7. doi: 10.1002/path.1112.
Robotic telepathology is well established in the USA as a method of case referral, but is less frequently used in the UK. Using cases covering a broad spectrum of pulmonary pathology, this study assessed its application in primary diagnosis and its functionality in terms of accuracy of diagnosis and time per case, for both small biopsies and open lung biopsies/resections. Forty cases (20 bronchoscopic and 20 surgical lung biopsy/resection specimens) were reviewed in blinded fashion by a single pathologist using robotic telepathology. Connection between the John Radcliffe and Royal Brompton Hospitals was via 10 Mb/s LAN to the Internet (supported by the Joint Academic Network). The cases were then randomized and reviewed a second time with conventional light microscopy. Diagnosis, initial time to reach diagnosis, and overall time per case were recorded. In two bronchoscopic biopsy cases, there were clinically significant differences between telepathology and conventional light microscopy, one probably attributable to user inexperience and the other to either speed of image capture or digital image quality. In the surgical lung biopsies and resections, there was one variation of opinion: with telepathology a case was considered to be probably mesothelioma, whereas this was thought less likely on light microscopy. In both instances, immunohistochemistry was requested prior to clinical management. Telepathology was 14 times slower than conventional light microscopy when examining bronchoscopic biopsies. The average time spent per slide was 7 min 21 s, compared with 32 s per slide with conventional light microscopy. When assessing open lung biopsies and resections, telepathology was five times slower, at 6 min 13 s compared with 1 min 10 s with conventional light microscopy. This study showed that robotic telepathology is accurate for primary diagnosis in pulmonary histopathology, but modifications in both laboratory protocols and telepathology hardware are needed to decrease the time difference between telepathology and conventional light microscopy, for telepathology to be usable within the framework of a busy referral practice.
机器人远程病理学在美国作为一种病例转诊方法已得到广泛应用，但在英国的使用频率较低。本研究利用涵盖广泛肺部病理学类型的病例，评估了其在原发性诊断中的应用以及在诊断准确性和每例诊断时间方面的功能，涉及小活检和开胸肺活检/切除术。一名病理学家以盲法通过机器人远程病理学对40例病例（20例支气管镜活检和20例手术肺活检/切除标本）进行了复查。约翰·拉德克利夫医院和皇家布朗普顿医院之间通过10 Mb/s局域网连接到互联网（由联合学术网络支持）。然后将病例随机分组，并使用传统光学显微镜进行第二次复查。记录诊断结果、初步诊断时间和每例病例的总时间。在两例支气管镜活检病例中，远程病理学和传统光学显微镜之间存在临床显著差异，一例可能归因于用户经验不足，另一例可能归因于图像采集速度或数字图像质量。在手术肺活检和切除术中，有一例存在意见分歧：通过远程病理学认为一例可能是间皮瘤，而在光学显微镜下则认为可能性较小。在这两种情况下，在临床处理前均要求进行免疫组织化学检查。检查支气管镜活检时，远程病理学比传统光学显微镜慢14倍。每张玻片平均用时7分21秒，而传统光学显微镜每张玻片用时32秒。在评估开胸肺活检和切除术时，远程病理学慢5倍，用时6分13秒，而传统光学显微镜用时1分10秒。本研究表明，机器人远程病理学在肺部组织病理学原发性诊断中是准确的，但需要对实验室规程和远程病理学硬件进行改进，以减少远程病理学与传统光学显微镜之间的时间差异，使远程病理学能够在繁忙的转诊实践框架内得到应用。
