Diagnostic accuracy of a rural live video telepathology system

被引:36
作者
Callas, PW
Leslie, KO
Mattia, AR
Weaver, DL
Cook, D
Travis, B
Stanley, DE
Rogers, LA
Mount, SL
Trainer, TD
Zarka, MA
Belding, RM
机构
[1] FLETCHER ALLEN HLTH CARE,DEPT PATHOL,BURLINGTON,VT
[2] UNIV VERMONT,COLL MED,DEPT PATHOL,BURLINGTON,VT 05405
关键词
telemedicine; telepathology; diagnostic accuracy; surgical pathology;
D O I
10.1097/00000478-199707000-00009
中图分类号
R36 [病理学];
学科分类号
100104 ;
摘要
Accuracy of diagnoses rendered using a live video telepathology network was assessed for permanent sections of surgical pathology specimens. To determine accuracy, telepathology diagnoses were compared with those obtained by directly viewing the glass slide using a standard microscope. A total of 294 cases were read via both telepathology and glass slide by attending pathologists at a tertiary care medical center. Overall accuracy was defined as exact concordance between diagnoses. Clinically insignificant differences in diagnoses were excluded to determine clinically significant accuracy. For the 285 cases with complete data, the overall accuracy for telepathology was 0.912 (95% confidence interval [CI], 0.872-0.941), whereas the overall accuracy for glass slide readings was 0.968 (95% CI, 0.939-0.985). This difference is statistically significant (p = 0.009). When focusing on clinically significant discrepancies, where the difference in diagnosis might affect therapeutic decisions, the video accuracy was only slightly less than the glass slide accuracy (0.965 [95% CI, 0.934-0.982] vs. 0.982 [95% CI, 0.957-0.994], respectively), but this difference is not statistically significant (p = 0.302). Most of the cases with clinically significant differences involved lesions with inherently high interobserver variation. Certainty of diagnosis did not differ between video and glass slide readings (p = 0.911), but there was an association between certainty of diagnosis and diagnostic accuracy for video (p = 0.003 for clinically significant accuracies). Based on these findings, we recommend when using this telepathology system that only preliminary diagnoses should be given in the following situations: for diagnostic areas with known high interobserver variability: when the consultant has any degree of uncertainty about the presence or absence of the lesion in question, and when then is insufficient experience using telepathology as a diagnostic medium.
引用
收藏
页码:812 / 819
页数:8
相关论文
共 25 条
[1]   USE OF REMOTE VIDEO MICROSCOPY (TELEPATHOLOGY) AS AN ADJUNCT TO NEUROSURGICAL FROZEN-SECTION CONSULTATION [J].
BECKER, RL ;
SPECHT, CS ;
JONES, R ;
RUEDAPEDRAZA, ME ;
OLEARY, TJ .
HUMAN PATHOLOGY, 1993, 24 (08) :909-911
[2]  
Bhattacharyya A K, 1995, Telemed J, V1, P9, DOI 10.1089/tmj.1.1995.1.9
[3]  
Black-Schaffer S, 1995, Telemed J, V1, P95, DOI 10.1089/tmj.1.1995.1.95
[4]  
BLOOM KJ, 1987, SPIE P VISUAL COMMUN, V845, P408
[5]  
CONOVER WJ, 1971, PRACTICAL NONPARAMET, P95
[6]   CURRENT STATUS OF TELEPATHOLOGY [J].
EIDE, TJ ;
NORDRUM, I .
APMIS, 1994, 102 (12) :881-890
[7]  
Eide Tor J. Vvar Nordrum, 1992, Zentralblatt fuer Pathologie, V138, P405
[8]  
Fleiss JL., 1981, STAT METHODS RATES P, P14
[9]  
*I MED, 1985, ASS MED TECHN, P85
[10]  
ITO H, 1994, MODERN PATHOL, V7, P801