Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
J Am Acad Dermatol. 2012 Nov;67(5):997-1007. doi: 10.1016/j.jaad.2011.12.036. Epub 2012 Feb 16.
The histologic diagnosis of skin lesions in the developing world is complicated by the shortage of pathologists with subspecialty training in dermatopathology, limited access to ancillary diagnostic testing, and costly referrals for expert glass slide consultation in challenging cases.
In this study we evaluate the feasibility of a static-image telepathology platform in Africa for performing accurate dermatopathology consultations.
A static-image telepathology platform using the iPath server was utilized by referring pathologists in 4 African hospitals. Diagnostic interpretations were provided by Massachusetts General Hospital dermatopathologists at no cost. The diagnostic accuracy and interobserver correlation was evaluated.
The static histopathologic images were diagnostic in 22 of 29 (76%) cases. Diagnostic accuracy between static image and glass slide diagnosis in 22 cases was 91%, ranging from 86% to 95% according to years of dermatopathology subspecialty expertise. Comparison with the glass slides showed that the telepathology diagnosis was limited by inappropriate field selection in only one case. Interobserver concordance between two pathologists was high (K = 0.86) suggesting that this platform is easy to use with minimal training of both referring and consulting pathologists.
Concordance between conventional microscopy and static image telepathology was performed in 22 of 29 cases for which glass slides were received. Interobserver concordance was performed for two pathologists.
Static-image telepathology is a feasible means of rendering diagnoses on dermatopathology cases and is a cost-effective technology for obtaining much-needed second opinions in resource-poor settings.
在发展中国家，皮肤病变的组织学诊断受到以下因素的限制：具有皮肤病理亚专科培训的病理学家短缺、辅助诊断检测的获取受限，以及在疑难病例中昂贵的专家玻片会诊转诊。
本研究旨在评估在非洲使用静态图像远程病理学平台进行准确皮肤科病理咨询的可行性。
4 家非洲医院的转诊病理学家使用了基于 iPath 服务器的静态图像远程病理学平台。马萨诸塞州总医院的皮肤科病理学家免费提供诊断解读。评估了诊断准确性和观察者间相关性。
在 29 例中的 22 例（76%）中，静态组织病理学图像具有诊断意义。在 22 例病例中，静态图像与玻片诊断的诊断准确性为 91%，根据皮肤科病理亚专科经验的年限，范围从 86%到 95%。与玻片的比较表明，仅在 1 例中，远程病理学诊断受到不合适的视野选择的限制。两位病理学家之间的观察者间一致性很高（K = 0.86），这表明该平台易于使用，转诊和咨询病理学家的培训要求都很低。
仅对收到玻片的 29 例中的 22 例进行了传统显微镜与静态图像远程病理学之间的一致性评估。仅对两位病理学家进行了观察者间一致性评估。
静态图像远程病理学是一种可行的皮肤科病理病例诊断方法，是在资源匮乏环境中获得急需的第二意见的一种具有成本效益的技术。
