Parathyroid Frozen Section Interpretation via Desktop Telepathology Systems: A Validation Study.

BACKGROUND

Telepathology can potentially be utilized as an alternative to having on-site pathology services for rural and regional hospitals. The goal of the study was to validate two small-footprint desktop telepathology systems for remote parathyroid frozen sections.

SUBJECTS AND METHODS

Three pathologists retrospectively diagnosed 76 parathyroidectomy frozen sections of 52 patients from three pathology services in Australia using the "live-view mode" of MikroScan D2 and Aperio LV1 and in-house direct microscopy. The final paraffin section diagnosis served as the "gold standard" for accuracy evaluation. Concordance rates of the telepathology systems with direct microscopy, inter-pathologist and intra-pathologist agreement, and the time taken to report each slide were analyzed.

RESULTS

Both telepathology systems showed high diagnostic accuracy (>99%) and high concordance (>99%) with direct microscopy. High inter-pathologist agreement for telepathology systems was demonstrated by overall kappa values of 0.92 for Aperio LV1 and 0.85 for MikroScan D2. High kappa values (from 0.85 to 1) for intra-pathologist agreement within the three systems were also observed. The time taken per slide by Aperio LV1 and MicroScan D2 within three pathologists was about 3.0 times ( < 0.001, 95% confidence interval [CI]: 2.8-3.2) and 7.7 times ( < 0.001, 95% CI: 7.1-8.3) as long as direct microscopy, respectively, while MikroScan D2 took about 2.6 times as long as Aperio LV1 ( < 0.001, 95% CI: 2.4-2.7). All pathologists evaluated Aperio LV1 as being more user-friendly.

CONCLUSIONS

Telepathology diagnosis of parathyroidectomy frozen sections through small-footprint desktop systems is accurate, reliable, and comparable with in-house direct microscopy. Telepathology systems take longer than direct microscopy; however, the time taken is within clinically acceptable limits. Aperio LV1 takes shorter time than MikroScan D2 and is more user-friendly.