Holten-Rossing Henrik, Larsen Lise Grupe, Toft Birgitte Grønkær, Loya Anand, Vainer Ben
Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Pathology, Næstved Hospital, Region Zealand, Næstved, Denmark.
J Pathol Inform. 2016 Mar 1;7:11. doi: 10.4103/2153-3539.177689. eCollection 2016.
Centralization of cancer treatment entails a reassessment of the diagnostic tissue specimens. Packaging and shipment of glass slides from the local to the central pathology unit means that the standard procedure is time-consuming and that it is difficult to comply with governmental requirements. The aim was to evaluate whether real-time digital microscopy for urological cancer specimens during the primary diagnostic process can replace subsequent physical slide referral and reassessment without compromising diagnostic safety.
From May to October 2014, tissue specimens from 130 patients with urological cancer received at Næstved Hospital's Pathology Department, and expected to be referred for further treatment at cancer unit of a university hospital, were diagnosed using standard light microscopy. In the event of diagnostic uncertainty, the VisionTek digital microscope (Sakura Finetek) was employed. The Pathology Department at Næstved Hospital was equipped with a digital microscope and three consultant pathologists were stationed at Rigshospitalet with workstations optimized for digital microscopy. Representative slides for each case were selected for consultation and live digital consultation took place over the telephone using remote access software. Time of start and finish for each case was logged. For the physically referred cases, time from arrival to sign-out was logged in the national pathology information system, and time spent on microscopy and reporting was noted manually. Diagnosis, number of involved biopsies, grade, and stage were compared between digital microscopy and conventional microscopy.
Complete data were available for all 130 cases. Standard procedure with referral of urological cancer specimens took a mean of 8 min 56 s for microscopy, reporting and sign-out per case. For live digital consultations, a mean of 18 min 37 s was spent on each consultation with 4 min 43 s for each case, depending on the number of digital slides included. Only in two cases could a consensus regarding the diagnosis not be reached during live consultation; this did not, it should be noted, affect patient treatment. Complete agreement between conventional and digital histopathology diagnosis was reached in all the 53 patients referred to central pathology units. The participating pathologists were in general comfortable using live digital microscopy, but they emphasized that a fast internet connection was essential for a smooth consultation.
An almost perfect agreement between live digital and conventional microscopy was observed in this study. Live digital consultation allowed cases to be referred from local hospitals to central cancer units without the standard delay caused by shipment. Only a few preselected specimen slides for each patient were presented in live consultation, which reduced the time spent on diagnosis compared to using the conventional method. Implementation of real-time digital microscopy would result in quicker turnaround and patient referral time, and with careful selection of relevant specimen slides for consultation, diagnostic safety would not be compromised.
癌症治疗的集中化需要对诊断组织标本进行重新评估。将玻片从当地病理科包装并运送到中心病理科，意味着标准流程耗时较长，且难以符合政府要求。本研究旨在评估在原发性诊断过程中，对泌尿系统癌症标本进行实时数字显微镜检查是否能够替代后续的实体玻片送检和重新评估，同时不影响诊断安全性。
2014年5月至10月期间，纳斯特维德医院病理科接收的130例泌尿系统癌症患者的组织标本，预计将被转诊至大学医院的癌症科接受进一步治疗，这些标本采用标准光学显微镜进行诊断。若诊断存在不确定性，则使用VisionTek数字显微镜（樱花精技公司）。纳斯特维德医院病理科配备了一台数字显微镜，三名顾问病理学家驻扎在哥本哈根大学医院，其工作站针对数字显微镜进行了优化。为每例病例挑选代表性玻片以供会诊，并使用远程访问软件通过电话进行实时数字会诊。记录每个病例的开始和结束时间。对于实体转诊的病例，从标本送达至报告发出的时间记录在国家病理信息系统中，显微镜检查和报告所花费的时间则手动记录。比较数字显微镜检查和传统显微镜检查的诊断结果、活检累及数量、分级和分期。
130例病例均获得了完整数据。泌尿系统癌症标本转诊的标准流程中，每例病例的显微镜检查、报告和发出报告平均耗时8分56秒。对于实时数字会诊，每次会诊平均耗时18分37秒，每例病例平均耗时4分43秒，具体取决于包含的数字玻片数量。仅在两例病例中，实时会诊期间未就诊断达成共识；需要注意的是，这并未影响患者的治疗。转诊至中心病理科的53例患者中，传统组织病理学诊断和数字组织病理学诊断完全一致。参与研究的病理学家总体上对使用实时数字显微镜感到满意，但他们强调快速的网络连接对于顺利会诊至关重要。
本研究观察到实时数字显微镜检查与传统显微镜检查之间几乎完全一致。实时数字会诊使得病例能够从当地医院转诊至中心癌症科，而不会出现因运输导致的标准延迟。实时会诊中仅为每位患者展示了少数预先选定的标本玻片，与传统方法相比，这减少了诊断所花费的时间。实施实时数字显微镜检查将缩短周转时间和患者转诊时间，并且通过仔细挑选相关标本玻片进行会诊，诊断安全性不会受到影响。
