A study assessing the feasibility and diagnostic accuracy of real-time teledermatopathology

Smartphone adapter time trial analysis: A low-cost, time-efficient method to disseminate quality photomicrographs at the microscope

BACKGROUND

Within the field of pathology there is a need for a uniform low-cost option for securing high-quality photomicrographs. Advances in smartphone photography and 3D-printing technology allow for custom adapters to be designed for the purpose of photomicrograph capture.

METHODS

Photomicrograph acquisition was performed using four core modalities: a novel 3D-printed smartphone-to-microscope adapter, freehand smartphone-to-microscope technique, a commercial adaptor (LabCam Pro), and a microscope-mounted digital camera. Eight skin diagnoses were photographed using each of the modalities and time to image capture was measured. The photomicrographs were blindly reviewed by two academic dermatopathologists and one pathologist using a side-by-side comparison technique to determine the image quality. Cost assessments were evaluated by obtaining free pricing information on manufacturer websites.

RESULTS

The 3D-printed adapter was the most efficient method of capturing a high-quality photomicrograph in addition to being budget neutral. The microscope-mounted camera produced the highest quality photomicrographs followed by the 3D-printed adapter.

CONCLUSIONS

The 3D-printed smartphone-to-microscope adapter offers a low-cost, time-efficient method of capturing high-quality photomicrographs.

Utility of international store-and-forward teledermatopathology among a cohort of mostly female patients at a tertiary referral center in Afghanistan

Background

The variety and complexity of dermatologic diseases in Afghanistan and the associated diagnostic resource constraints have not been previously studied. Moreover, the utility of store-and-forward teledermatopathology in this resource-limited setting has not been investigated.

Methods

A retrospective analysis was conducted of 150 store-and-forward teledermatopathology cases that were composed of a clinical history, clinical images, and histologic images that were sent from an academic teaching hospital in Kabul to a dermatology-trained dermatopathologist at Emory University in the United States between November 2013 and June 2017. For each case, the histologic impression of the Emory dermatopathologist was compared with that of the Kabul-based general pathologist and the clinical differential diagnosis and histologic impression of the Kabul-based dermatologist.

Results

Eighty-one of the cases that were analyzed were from female patients. The diagnosis after telepathology consultation differed from the first entity in the clinical differential diagnosis in 34.7% of cases. The telepathology consultation refined the Afghan general pathologist’s histologic impression 45.5% of the time and the Kabul-based dermatologist’s histologic impression 24.3% of the time. A clinically significant difference in care was made in 19.3% of cases for which an analysis could take place between the histologic impressions of the Emory dermatopathologist and U.S.-trained dermatologist. The most common resource constraints that limited a definitive diagnosis were the inability to perform infectious stains and cultures to identify specific pathogens (19.3% of cases) and immunofluorescence studies to confirm autoimmune bullous disease (6.7% of cases).

Conclusions

These results highlight the important diagnostic role that teledermatopathology can serve in resource-limited settings such as in Afghanistan.

Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology

BACKGROUND

Teledermatopathology has evolved from static images to whole slide imaging (WSI), which allows for remote viewing and manipulation of tissue sections. Previous studies of WSI in teledermatopathology predated College of American Pathologists (CAP) telepathology validation guidelines.

OBJECTIVE

We conducted a comprehensive retrospective WSI validation study of routine dermatopathology cases, adhering to CAP guidelines.

METHOD

In all, 181 consecutive cases arranged into 3 categories (inflammatory, melanocytic, nonmelanocytic proliferations) were reviewed by 3 board-certified dermatopathologists via traditional microscopy (TM) and WSI. Intraobserver (TM vs WSI), TM intraobserver and interobserver (TM vs TM), and WSI interobserver (WSI vs WSI) concordance was interpreted using a 3-tier system.

RESULTS

TM versus WSI intraobserver concordance (86.9%; 95% confidence interval [CI] 83.7-89.6) did not differ from TM versus TM intraobserver concordance (90.3%; 95% CI 86.7-93.1) or interobserver concordance (WSI: 89.9%; 95% CI 87.0-92.2, and TM: 89.5%; 95% CI 86.5-91.9). Melanocytic proliferations had the lowest TM versus WSI intraobserver concordance (75.6%; 95% CI 68.5-81.5), whereas inflammatory lesions had the highest TM versus WSI intraobserver concordance (96.1%; 95% CI 91.8-98.3). Nonmelanocytic proliferations had an intraobserver concordance of 89.1% (95% CI 83.4-93.0).

LIMITATIONS

Efficiency and other logistical WSI parameters were not evaluated.

CONCLUSION

Intraobserver and interobserver diagnostic concordance between WSI and TM was equivalent. Therefore, WSI appears to be a reliable diagnostic modality for dermatopathology.

iSlide: a 'big picture' interactive teledermatopathology e-learning system

BACKGROUND

Dermatopathology training is often limited by facilities and a dearth of specialists. Advancements in information and communication technologies have made possible the adoption of innovative learning techniques, especially in places where specialists are lacking.

OBJECTIVES

To implement and evaluate the performance of the iSlide system, which is an interactive dermatopathology training platform (http://scope.tmu.edu.tw/islide2/).

METHODS

Fifty-two cases representing a variety of dermatopathology conditions and complications were used to set up the iSlide system, and virtual slides of these cases were produced. Medical students from the Dermatology Department of Taipei Medical University were taught to use the system. Performance of the system was evaluated and validated using questionnaires, the first comprising 20 questions and the second a shorter, six-question telephone-based survey on 15 of the 96 interns. Twenty cases prepared by the iSlide system were also presented at an international dermatopathology conference and evaluated by conference participants.

RESULTS

Ninety-six students and 72 experts participated in the study. Ninety-two per cent of the students and 98% of the experts found the iSlide system to be a useful tool for learning dermatopathology. Of these, 82% of the students and 63% of the experts felt that iSlide was easy to use.

CONCLUSIONS

iSlide is useful for dermatopathology. As only 82% of the student evaluators and 63% of the expert evaluators found the system easy to use, further work has to be done to improve the iSlide interface to make the system more user friendly.