Weinberg D S, Allaert F A, Dusserre P, Drouot F, Retailliau B, Welch W R, Longtine J, Brodsky G, Folkerth R, Doolittle M
Brigham and Women's Hospital, Boston, MA 02115, USA.
Hum Pathol. 1996 Feb;27(2):111-8. doi: 10.1016/s0046-8177(96)90363-9.
Telepathology affords the means to provide pathological diagnosis and consultation to remote sites. However, before telepathology can become an acceptable medical tool, it will be vital to determine the diagnostic accuracy of this technology. We report the results of a single-blind study of the accuracy of diagnosis performed using computerized still images obtained from a telepathology workstation used in a French telepathology network. Four pathologists, each working alone, reviewed a total of 200 cases of routine surgical pathology (50 cases each), and performed diagnosis based on both computer CD-ROM still images (CD) and conventional glass slides (GS). Concordance between GS and CD diagnosis, as well as accuracy, were determined. Other factors related to performance were also measured, including diagnostic certainty, reasons for uncertainty, and causes of diagnostic error. Overall, there was good agreement between CS and CD diagnosis. There was 87.5% concordance between CS and CD diagnosis, and comparison to consensus (correct) diagnosis showed accuracy of 95.5% and 88.5% for GS and CD diagnosis, respectively. Marked variability in accuracy of CD diagnosis was observed among the four pathologists, and issues related to image selection and/or quality appeared responsible for 60% of the diagnostic errors. The lack of sufficient images and clinical information were frequently cited as reasons for diagnostic uncertainty, as well as feelings of insufficient expertise. It is likely that the opportunity for interaction with the referring pathologist and the use of subspecialty consultants would likely improve the performance of telepathology.
远程病理学提供了向偏远地区提供病理诊断和会诊的手段。然而，在远程病理学成为一种可接受的医学工具之前，确定这项技术的诊断准确性至关重要。我们报告了一项单盲研究的结果，该研究使用从法国远程病理学网络中使用的远程病理学工作站获取的计算机静态图像进行诊断准确性评估。四位病理学家各自独立工作，共审查了200例常规外科病理学病例（每人50例），并基于计算机光盘静态图像（CD）和传统玻璃切片（GS）进行诊断。确定了GS和CD诊断之间的一致性以及准确性。还测量了与诊断表现相关的其他因素，包括诊断确定性、不确定性原因和诊断错误原因。总体而言，CS和CD诊断之间有良好的一致性。CS和CD诊断之间的一致性为87.5%，与共识（正确）诊断相比，GS和CD诊断的准确性分别为95.5%和88.5%。在四位病理学家中观察到CD诊断准确性存在显著差异，与图像选择和/或质量相关的问题占诊断错误的60%。缺乏足够的图像和临床信息经常被引为诊断不确定性的原因，以及专业知识不足的感觉。与转诊病理学家互动的机会以及使用专科顾问可能会提高远程病理学的表现。
