Adachi H, Inoue J, Nozu T, Aoki H, Ito H
First Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Japan.
Pathol Int. 1996 Jun;46(6):436-41. doi: 10.1111/j.1440-1827.1996.tb03634.x.
The early experience is reported here of the use of intra-operative frozen-section service by telepathology using the integrated Service Digital Network (ISDN), a commercially available system that is being connected between the Department of Pathology of Tottori University and Matsue City Hospital, a distance of 30 km. The transfer rate is currently 64 kbit/s. The frozen-section service was conducted for a total of 117 tissue specimens (organs) from 100 patients between August 1993 and May 1995. The average time taken for examination of each specimen of frozen section was 13 min, ranging between 2 and 42 min. The average number of transmitted images was 6.2. Six cases necessitated more than 11 transmitted images to make a diagnosis, while 13 cases could be diagnosed from two images only. Correct and permissible diagnoses were obtained in 109 (93.2%) out of 117 specimens when comparing the telepathology diagnosis with that of direct microscopy. Improper or misdiagnosis was made for eight cases (specimens), which were misinterpreted as papillary carcinoma in Basedow's disease, adenoma and hyperplasia in two pheochromocytomas, solid-tubular carcinoma in phyllodes tumor, mastopathy in invasive carcinoma, metastatic carcinoma in astrocytoma, follicular lymphoma in reactive hyperplasia, and lymphadenitis in follicular lymphoma. In retrospect, diagnosis of these cases should have been deferred. From the results, it was concluded that the intraoperative frozen-section service by telepathology may be a worthwhile substitute for hospitals with limited accessibility to local pathology service, in spite of pitfalls in some cases. Well prepared, high-quality frozen section, sufficient verbal communication with surgeons, and a rather conservative attitude on the part of a well-trained pathologist seem to be the essential ingredients for reaching an accurate decision when using telepathology.
本文报道了利用综合业务数字网（ISDN）进行远程病理学术中冰冻切片服务的早期经验，ISDN是一种市售系统，连接鸟取大学病理学系和松江城市医院，相距30公里。目前的传输速率为64千比特/秒。1993年8月至1995年5月期间，共对100例患者的117个组织标本（器官）进行了冰冻切片服务。每个冰冻切片标本的平均检查时间为13分钟，范围在2至42分钟之间。平均传输图像数量为6.2张。6例需要超过11张传输图像才能做出诊断，而13例仅通过2张图像即可诊断。将远程病理学诊断与直接显微镜诊断进行比较时，117个标本中有109个（93.2%）获得了正确和可接受的诊断。有8例（标本）诊断不当或误诊，包括在巴塞多氏病中误诊为乳头状癌、在两个嗜铬细胞瘤中误诊为腺瘤和增生、在叶状肿瘤中误诊为实性管状癌、在浸润性癌中误诊为乳腺病、在星形细胞瘤中误诊为转移性癌、在反应性增生中误诊为滤泡性淋巴瘤以及在滤泡性淋巴瘤中误诊为淋巴结炎。回顾起来，这些病例的诊断本应推迟。从结果来看，可以得出结论，尽管在某些情况下存在缺陷，但远程病理学术中冰冻切片服务对于当地病理学服务获取有限的医院可能是一种值得的替代方法。精心准备、高质量的冰冻切片、与外科医生充分的口头沟通以及训练有素的病理学家采取相当保守的态度，似乎是使用远程病理学做出准确决策的关键要素。
