Pantanowitz Liron, Wiley Clayton A, Demetris Anthony, Lesniak Andrew, Ahmed Ishtiaque, Cable William, Contis Lydia, Parwani Anil V
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA.
J Pathol Inform. 2012;3:45. doi: 10.4103/2153-3539.104907. Epub 2012 Dec 20.
Several modes of telepathology exist including static (store-and-forward), dynamic (live video streaming or robotic microscopy), and hybrid technology involving whole slide imaging (WSI). Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC) for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision(®) system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections). Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal (https://pathconsult.upmc.com/) was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience. Early and continued adoption of telepathology has promoted additional digital pathology resources that are now being leveraged for other clinical, educational, and research purposes.
远程病理学存在多种模式，包括静态（存储转发）、动态（实时视频流或机器人显微镜检查）以及涉及全玻片成像（WSI）的混合技术。在匹兹堡大学医学中心（UPMC），远程病理学已在本地、国内和国际站点应用了十多年。所有远程病理学模式均已成功用于发挥我们机构的亚专业专长，并在病理学服务方面展开竞争。本文讨论了UPMC在每种远程会诊方法上积累的经验。静态和WSI远程病理学系统已在移植病理学中使用多年，采用的是专用网络和客户端 - 服务器架构。记录在案的临床意义重大的意见分歧很少。在血液病理学中，CellaVision®系统用于通过电子邮件传输外周血涂片血细胞的静态图像，以供远程解读。虽然实时视频流一直是通过远程细胞学对细胞学标本进行即时充分性评估所选择的模式，但其他方法如机器人显微镜检查也已得到验证并证明是有效的。机器人远程病理学已广泛用于远程解读术中神经病理学会诊（冰冻切片）。采用更新的技术和病理学家经验的增加提高了远程神经病理学的准确性和延期率。我们机构最近创建了一个数字病理学会诊门户（https://pathconsult.upmc.com/），以促进数字病理学二次意见会诊，特别是针对WSI。这个基于网络的工具的成功之处在于能够处理与供应商无关的数字化玻片的大图像文件，并持续为客户和远程会诊人员进行用户友好型定制。很明显，我们机构的远程病理学实践已随着技术和用户体验的进步而发展。早期并持续采用远程病理学促进了更多数字病理学资源的产生，这些资源现在正被用于其他临床、教育和研究目的。
