Ramey Joel, Fung Kar Ming, Hassell Lewis A
Oklahoma University College of Medicine, Oklahoma City, OK.
J Pathol Inform. 2011;2:41. doi: 10.4103/2153-3539.84276. Epub 2011 Aug 27.
With recent advances, it is now possible to view whole slide images (WSI) on mobile, high-resolution, viewing devices (MVD). This creates a new paradigm in which MVDs may be used for consultation and/or diagnosis. Validation of the results with devices is important for practitioners and regulators. We evaluated the use of MVDs in frozen section (FS) interpretation.
A series of 72 consecutive FS cases were selected for potential inclusion in the study. A 67 case subset of these were successfully scanned at 20x magnification. Scan times were recorded. A sample of WSI FS cases, with gross and clinical information, was presented to six pathologists on an iPad MVD using the Interpath application. Times to diagnosis were recorded. Results were compared with the original reported and final diagnosis. Participants also completed a survey assessing image quality, interface, and diagnostic comfort level.
Scan times averaged two minutes and 46 seconds per slide, (standard deviation [SD] 2 minutes 46 seconds). Evaluation times averaged 4 minutes and 59 seconds per case, range to 13 minutes and 50 seconds, SD 3 minutes 48 seconds. Concordance between initial FS diagnosis and rendered through the MVD was 89%. Minor discrepancies made up 8% and major disagreements 3%. The kappa statistic for this series is 0.85. Participants rated the experience at 5 on a 10-point scale, range 3 to 7. Two-thirds found the image quality to be adequate, half were satisfied with image resolution, and 33% would be willing to make a diagnosis on the iPad, plus one only for special cases. Five of six respondents (83%) found the navigation with the study software difficult.
Image fidelity and resolution makes the iPad potentially suitable for WSI evaluation of FS. Acceptable accuracy is attainable for FS interpretation. But, although possible to obtain acceptable results, use of the iPad with Interpath to view WSI is not easy and meets user resistance. The obstacle of slide navigation at high magnification could introduce frustrations, delays, or errors.
随着近期的技术进步，现在可以在移动、高分辨率的查看设备（MVD）上查看全切片图像（WSI）。这创造了一种新的模式，即MVD可用于会诊和/或诊断。对设备结果进行验证对从业者和监管机构而言至关重要。我们评估了MVD在冰冻切片（FS）解读中的应用。
选择了连续72例FS病例以纳入本研究。其中67例成功以20倍放大率进行扫描。记录扫描时间。将一组带有大体和临床信息的WSI FS病例样本，使用Interpath应用程序在iPad MVD上呈现给六位病理学家。记录诊断时间。将结果与原始报告诊断和最终诊断进行比较。参与者还完成了一项评估图像质量、界面和诊断舒适度的调查。
每张切片的扫描时间平均为2分46秒（标准差[SD]为2分46秒）。每个病例的评估时间平均为4分59秒，范围为13分50秒，SD为3分48秒。初始FS诊断与通过MVD得出的诊断之间的一致性为89%。微小差异占8%，重大分歧占3%。本系列的kappa统计量为0.85。参与者对该体验在10分制中评分为5分，范围为3至7分。三分之二的人认为图像质量足够，一半的人对图像分辨率满意，33%的人愿意在iPad上进行诊断，仅在特殊情况下还有一人愿意。六位受访者中有五位（83%）认为使用研究软件进行导航困难。
图像保真度和分辨率使iPad有可能适用于FS的WSI评估。对于FS解读可实现可接受的准确性。但是，虽然有可能获得可接受的结果，但使用带有Interpath的iPad查看WSI并不容易，且会遇到用户阻力。高放大倍数下切片导航的障碍可能会导致挫败感、延误或错误。
