Yamashiro K, Kawamura N, Matsubayashi S, Dota K, Suzuki H, Mizushima H, Wakao F, Azumi N
Department of Pathology and Clinical Laboratory, Sapporo National Hospital, Sapporo, Japan.
Cytopathology. 2004 Aug;15(4):221-7. doi: 10.1111/j.1365-2303.2004.00147.x.
In 1997, an Internet-based static image telepathology system was built at Sapporo National Hospital, Japan. We can exchange high-resolution microscopical images through a file transfer protocol server and discuss cytological findings and diagnosis on an electronic mailing list. We applied the system to primary telecytodiagnosis. From May 1997 to April 1999 we have made diagnoses of 614 daily cases only by looking at the video monitor images transmitted from the cytotechnologist of Wakkanai Municipal Hospital 300 km distant from Sapporo. The concordance between telecytodiagnosis and glass slide diagnosis was 88.6%. Kappa statistics for cervical smears was 0.919 and that for specimens other than uterine cervix was 0.810. The accuracy of telecytodiagnosis was 91.4%, and was not substantially different from that of the conventional mail-based cytology in a previous year. We had five cases with a severely inappropriate diagnosis in telecytology, all of which however were quickly corrected by follow-up histological or cytological specimens. With the use of an electronic mailing list the participants had quick and sufficient discussions. We conclude that telecytology is very useful for primary cytodiagnosis in regional medicine and that it may raise the accuracy of cytodiagnosis in future, if we make consistent efforts to reflect the benefits of telecytology in daily practices. This is the first report of clinical results of telecytology from Japan.
1997年，日本札幌国立医院建立了一个基于互联网的静态图像远程病理学系统。我们可以通过文件传输协议服务器交换高分辨率显微镜图像，并在电子邮件列表上讨论细胞学检查结果和诊断。我们将该系统应用于原发性远程细胞诊断。从1997年5月到1999年4月，我们仅通过查看从距离札幌300公里的稚内市立医院细胞技术人员传输来的视频监视器图像，就对614例日常病例进行了诊断。远程细胞诊断与玻片诊断之间的一致性为88.6%。宫颈涂片的kappa统计值为0.919，子宫颈以外标本的kappa统计值为0.810。远程细胞诊断的准确率为91.4%，与上一年基于传统邮件的细胞学诊断准确率相比没有显著差异。我们在远程细胞学诊断中有5例诊断严重不当，但所有这些病例都通过后续的组织学或细胞学标本迅速得到了纠正。通过使用电子邮件列表，参与者进行了快速而充分的讨论。我们得出结论，远程细胞学对地区医学中的原发性细胞诊断非常有用，如果我们不断努力在日常实践中体现远程细胞学的优势，它可能会提高未来细胞诊断的准确性。这是来自日本的关于远程细胞学临床结果的第一份报告。
