Comparing Conventional and Telepathological Diagnosis in Routine Frozen Section Service

Abstract

Aims In a prospective randomised study the diagnostic accuracy of frozen section service of conventional and telepathological procedures was compared for routine breast surgery. Material and Methods In the telepathological approach the surgeon performed the gross examination and macroscopic cutting directly supervised via videoconference by a pathologist. Then a technician prepared the frozen sections and the staining. The on-line histological diagnosis was done using a remote controlled robotic microscope. The images were transferred to the computer screen of the pathologist. In the conventional mode, the pathologist himself manually performed the gross and microscopic tissue examination in the same laboratory. The material was restricted to breast specimens and the number of participating surgeons was limited in order to obtain comparable results. All in all, 81 routine frozen sections of the breast were included in the study within seven months. Results The overall diagnostic concordance of both approaches with the definite diagnosis based upon paraffin embedded tissue was calculated to 95,1 % (77/81 cases). The telepathology arm revealed 94,3 % (33/ 35 cases), and the conventional arm 95,7% (44/46 cases). Two cases of each arm remained uncertain. The median diagnostic time was calculated to 9 minutes in the conventional mode and to 17 minutes for telepathology. Not included are median 3 minutes for transportation and 12 minutes for slide preparation. Discussion Telepathology can replace successfully conventional performance of frozen section service within the same range of diagnostic accuracy.

Keywords

• Frozen section service, Telepathology, Remote telemicroscopy, Breast surgery, Randomised study