数字病理远程会诊相关文献

作者：Chen Zhou, Huaqiang Shi

关键字：区域调查

摘要：

Our results indicated that telepathology consultation in China has gained traction since 2010. More than 90% of consultation cases submitted during the 3 years of this study were in 2010 and the first 5 months of 2011. The main reason is the governmental support for telepathology consultations. In 2010, the Ministry of Health in China released a document encouraging the use of telepathology across the country; other reasons are the availabilities of high speed internet and 3G networks and low cost commercial virtual microscopes in China after 2009.

作者：David M. Steinberg, Syed Z. Ali

关键字：应用研究

摘要：

Virtual microscopy (VM) refers to the use of an automated microscope and digital imaging technology to scan, store, and view glass slides. VM systems allow the user to view a scanned image of the entire slide at multiple magnifications on a computer screen. We tested VM to evaluate its possible utility in diagnostic cytopathology. Ten cervical-vaginal monolayered preparations (AutoCyte™ preparation) were scanned using a BLISS™ (Bacus Laboratories Inc. Slide Scanner) system. Approximately 20–30% of the cellular area of each slide was imaged. The cases were randomly chosen to include examples ranging from benign cellular changes (BCC) to high-grade squamous intraepithelial lesions (HSIL). The computer performed image tiling and fusing of multiple JPEG images to create a high-quality VM slide. Six examiners (two each of cytopathologists, senior residents, and cytotechnologists) blindly evaluated the VM slides using an image server program (WebSlide Browser™ thin client software). The cytopathologic diagnoses made on the VM slide were then compared to the original glass slide diagnoses. BLISS™ took 36–100 min (avg. 58.4 min) to scan the selected fields in a glass slide with file sizes ranging from 23.1–83.6 MB. Time taken by the examiners to render a diagnosis ranged from 1–15 min (avg. 4.1 min) per case. The combined diagnostic accuracy was 98.3%. Only one case of LSIL was missed by one examiner. VM is a promising new tool, which gives a user the feel and simulated experience of an actual microscopic examination and provides a useful alternative to a glass slide in diagnostic cytopathology. Possible applications include: 1) second opinion consultation without transporting the glass slide, 2) education, 3) VM proficiency tests / board exams, and 4) telepathology. Shortcomings include 1) expensive initial setup, 2) inability to maintain an adequate focus in a thick smear with multiple levels, 3) large storage size of the VM slide, and 4) relatively long time needed to scan a slide.

作者：Sean SP Costello, Daniel G O Shea

关键字：应用研究

摘要：

"Objective The aim of this study was to assess the diagnostic accuracy and acceptability of the Virtual Pathology Slide. Methods Ten breast needle core biopsies were randomly selected and presented to 17 pathologists or trainee pathologists with at least 2 years experience in pathology practice. Participants were required to examine each case online and provide a diagnostic classification using online feedback forms. The recorded data permitted examination of interobserver variability and user satisfaction. Results Agreement between original glass-slide diagnosis and consensus diagnosis using the Virtual Pathology Slide was reached in 9 out of 10 slides. Percentage concordance for slides lay in the range of 35.3% to 100% with an average percentage concordance between slides of 66.5%. The average Kappa statistics for interobserver agreement was 0.75 while average percentage concordance amongst participants was 66.5%. Participants looked at an average of 22 fields of view while examining each slide. Confidence: 81.25% of the participants indicated confidence using the Virtual Pathology Slide to make a diagnostic decision, with 56.25% describing themselves as ""reasonably confident,"" 18.75% as ""confident,"" and 6.25% as ""very confident."" Ease of use: 68.75% reported the system as ""easy"" or ""very easy"" to use. Satisfaction: 87.5% of participants expressed satisfaction with image quality, with 43.75% describing the image quality as ""adequate,"" 25% describing it as ""good,"" and 18.75% describing the image quality as ""excellent."" Pathologists with a working bandwidth greater than 20 kilobits per second found the download speed of the Virtual Pathology Slide ""adequate"" or better. Conclusions Results from this study show that the Virtual Pathology Slide can be used to make a correct diagnostic decision, and that the system is a realistic alternative to dynamic telepathology."

作者：David C. Wilbur, Wolfgang Klietmann

关键字：应用研究

摘要：

CONTEXT: -Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized. OBJECTIVE: -To determine whether interpretation of whole-slide images differed from glass-slide interpretation in difficult surgical pathology cases. DESIGN: -Diagnostically challenging pathology slides from a variety of anatomic sites from an outside laboratory were scanned into whole digital format. Digital and glass slides were independently diagnosed by 2 subspecialty pathologists. 

Reference, digital, and glass-slide interpretations were compared. Operator comments on technical issues were gathered. RESULTS: -Fifty-three case pairs were analyzed. There was agreement among digital, glass, and reference diagnoses in 45 cases (85%) and between digital and glass diagnoses in 48 (91%) cases. There were 5 digital cases (9%) discordant with both reference and glass diagnoses. Further review of each of these cases indicated an incorrect digital whole-slide interpretation. Neoplastic cases showed better correlation (93%) than did cases of nonneoplastic disease (88%). Comments on discordant cases related to digital whole  technology focused on issues such as fine resolution and navigating ability at high magnification. CONCLUSIONS: -Overall concordance between digital whole-slide and standard glass-slide interpretations was good at 91%. Adjustments in technology, case selection, and technology familiarization should improve performance, making digital whole-slide review feasible for broader telepathology subspecialty consultation applications.

作者：王仪

关键字：应用体会

摘要：

传统的病理诊断是建立在一张HE切片基础上,经病理医生在光学显微镜的形态观察做出疾病诊断的,近年来随着图像数字化以及数字存储传输技术的发展,使得将病理HE切片转化为切片数字化图像(WSI)成为可能,又称数字切片(digital slides)或虚拟切片(virtual slides),通过全自动显微镜扫描切片,将病理切片上的全部信息转化成可以存储的全新的数字化切片,这张数字化切片可以不用显微镜而在个人计算机上进行阅读并做诊断,并可以方便的在网络上传输阅读并诊断,这使跨地域的远程病理会诊成为现实,对于我国这样的一个地域广阔,各地病理发展极不均衡的国家来说,这种远程会诊具有划时代意义,在卫生部的推动下,2011年10月卫生部医管司和卫生部病理质控与评价中心协同厦门麦克奥迪公司启动了覆盖全国的远程病理网络,我院有幸成为首批全国60家试点单位之一,运行一年来,对病理科的会诊工作做一总结分析,探讨数字切片在远程会诊中的应有价值及体会.

作者：朱晨雁, 施华强

关键字：区域调查

摘要：

远程医学是将计算机、图像处理和通讯技术相互整合,最终实现大数据真彩色图像异地传输的一门学科.随着网络传输技术及其医学可视化水平的不断发展,该领域为最大程度整合与共享医学资源提供了可能,已经越来越广泛地应用于医疗诊断和治疗,并日益显示出其重要性.

作者：Xinxia Li, Jianying Liu, Jiang Gu

关键字：应用研究

摘要：

China's huge territorial expanse and its imbalance of regional economic development have resulted in an uneven distribution of experienced pathologists. Developing telepathology for consultation is of special relevance to China. We developed a newly designed telepathology workstation, which includes a small file size of each slide, permitting easy transmission, storage, and manipulation, and a feedback function, and also evaluated itsfeasibility in surgical pathology in China. Four hundred cases covering a broad spectrum of surgical pathology problems were investigated in a blinded fashion by the 2 pathologists using this virtual microscope system. These cases were then randomized and re-reviewed a second time with light microscope. Diagnoses and time spent for each diagnosis were recorded for both methods. The diagnostic accuracies achieved by viewing glassslides and virtual images were 97.25% (389 of 400) and 95.5% (382 of 400) for pathologist A and 96.25% (385 of 400) and 94.75% (379 of 400) for pathologist B, respectively. There was no significant diagnostic discrepancy between the 2 methods for the 2 pathologists. The average times for viewing a virtual slide were 3.41 and 5.24 minutes for pathologists A and B, respectively, whereas the average times for viewing a glass slide were 1.16 and 3.35 minutes for pathologists A and B. There was a statistical difference between the time costs of the 2 methods. However, the slight time increase using virtual slides is less than that using dynamic telepathology and traditional consultation, and is acceptable to the pathologists. These results showed that this newly designed virtual microscope system have an acceptable diagnostic accuracy that is of practical value and may be suitable for application in China.

作者：Xinxia Li, Encong Gong, Jiang Gu

关键字：应用研究, 区域调查

摘要：

To assess the feasibility, including diagnostic accuracy and time cost, of a real-time telepathology system with pathologic slides, 600 cases covering a wide spectrum of lesions from 16 organ systems were tested. The "correct" diagnosis (gold standard) was established as a consensus by 2 experienced pathologists. The cases were first examined by 4 pathologists at different levels of experience with dynamic telepathology. Cases were then reviewed by the same pathologists using light microscopy in a blinded fashion 3 weeks to 2 months later. A diagnosis, together with reading times for telepathology and light microscopy, was recorded for each case. Diagnostic accuracy by telepathology was 94.8% (569/600), 93.3% (560/600), 91.6% (550/600), and 97% (388/400) for pathologists A, B, C, and D, respectively. Telepathologic diagnosis was concordant with the gold standard and with direct microscopy, with a mean of 94.2% and 99.26%, respectively. Most cases (510 or 85%) were diagnosed in 15 to 40 minutes by telepathology, with a mean of 17.0 minutes. The time needed to review a slide by telepathology was 3 to 4 times longer than that of standard light microscopy. All 4 pathologists were able to render a diagnosis in all cases. Our results showed that robotic telepathology is sufficiently accurate for primary diagnosis in surgical pathology, but modifications in laboratory protocols, telepathology hardware, and internet speed are needed to reduce the time necessary for diagnosis by telepathology before this method may be deemed suitable for use in a busy practice.

作者：Zhongjiu Zhang, Guangming Gao, Chen Zhou

关键字：应用研究, 区域调查

摘要：

Through this program, we believe that in near future telepathology will be widely used in China for pathology consultation and quality control. The program will not only assists pathologists in dealing with diagnostically difficult pathology cases, but also benefits patients, who do not need to travel a long distance to large hospitals for a second opinion of cancer diagnosis, thus saving time and money for patients. The program will also guaranty the quality of pathology diagnosis of cancer in China.