Zhao Chengquan, Wu Tao, Ding Xiangdong, Parwani Anil V, Chen Hualin, McHugh Jeffrey, Piccoli Anthony, Xie Qinling, Lauro Gonzalo Romero, Feng Xiaodong, Hartman Douglas J, Seethala Raja R, Wu Shangwei, Yousem Samuel, Liang Yaoming, Pantanowitz Liron
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Pathology, KingMed Diagnostics, Guangzhou, Guangdong, China.
J Pathol Inform. 2015 Nov 27;6:63. doi: 10.4103/2153-3539.170650. eCollection 2015.
Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service.
This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014.
A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases.
These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated pathologists who understood the language and culture on both sides. Lack of clinical information, missing gross pathology descriptions, and insufficient tissue sections submitted for evaluation were the main reasons for indefinite diagnoses. The overall experience encourages international telepathology practice for second opinions.
远程病理学越来越多地被用于支持诊断咨询服务。先前的出版物已经探讨了远程病理学的技术方面，而本文将阐述中国最大的独立病理医学实验室金域医学的临床远程病理学经验。从2012年开始，匹兹堡大学医学中心（UPMC）与金域医学合作建立了一项国际远程病理学咨询服务。
这是一项回顾性研究，总结了2012年1月至2014年12月期间UPMC与金域医学之间3年的远程病理学经验和诊断咨询结果。
总共提交了1561例进行远程病理学咨询，其中2012年有144例，2013年有614例，2014年有803例。提交的大多数病例（61.4%）由病理学家转诊，36.9%由临床医生转诊，1.7%由中国患者转诊。血液病理学接收的病例最多（23.7%），其次是骨/软组织（21.0%）和妇科/乳腺（20.2%）亚专业。每个病例的平均周转时间（TAT）为5.4天，从2012年的6.8天降至2014年的5.0天。大多数病例需要进行免疫染色。对于一些疑难病例，需要进行一轮以上的免疫染色，这延长了周转时间。在中国当地转诊医院提供初步诊断或印象的855例病例（54.7%）中，UPMC病理学家给出的最终诊断在25.6%的病例中是相同的，在50.8%的病例中被显著修改（治疗方案改变）。
这些结果表明，国际远程病理学咨询可以通过促进获得病理学专业知识显著改善患者护理。这项国际数字咨询服务的成功取决于领导层的坚定承诺和支持、信息技术专业知识以及理解双方语言和文化的敬业病理学家。缺乏临床信息、大体病理学描述缺失以及提交评估的组织切片不足是诊断不明确的主要原因。总体经验鼓励进行国际远程病理学实践以获取二次诊断意见。
