Skip to main content

Teleconsultation

  • Chapter
Digital Pathology

Abstract

This chapter covers the spectrum of teleconsultations as a tool to improve the quality of care. After an historical background review, this chapter explains how the introduction of digital pathology revolutionized the practice of pathology but raised new challenges. In this century of increasing diagnostic complexity, personalized medicine and molecular pathology, obtaining the opinion of an expert may significantly impact on patient management. Expert opinions may be required as part of either intraoperative consultation (frozen section), macroscopic examination, autopsy and cytology. Therefore, digital pathology allows obtaining a quick expert opinion, regardless of the physical distance. With the increase in knowledge and complexity of pathology, teleconsultations are expected to expand and the efficiency of technological tools will need to improve.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 84.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Weinstein RS. Prospects for telepathology. Hum Pathol. 1986;17(5):433–4.

    Article  PubMed  CAS  Google Scholar 

  2. Williams S, Henricks WH, Becich MJ, Toscano M, Carter AB. Telepathology for patient care: what am i getting myself into? Adv Anat Pathol. 2010;17(2):130–49.

    Article  PubMed  Google Scholar 

  3. O’Malley DP. Practical applications of telepathology using morphology-based anatomic pathology. Arch Pathol Lab Med. 2008;132(5):743–4.

    PubMed  Google Scholar 

  4. Dunn BE, Almagro UA, Choi H, Sheth NK, Arnold JS, Recla DL, et al. Dynamic-robotic telepathology: department of veterans affairs feasibility study. Hum Pathol. 1997;28(1):8–12.

    Article  PubMed  CAS  Google Scholar 

  5. Dunn BE, Choi H, Recla DL, Kerr SE, Wagenman BL. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs medical centers: a twelve year experience. Semin Diagn Pathol. 2009;26(4):187–93.

    Article  PubMed  Google Scholar 

  6. Mullick FG, Fontelo P, Pemble C. Telemedicine and telepathology at the Armed Forces Institute of Pathology: history and current mission. Telemed J. 1996;2(3):187–93.

    Article  PubMed  CAS  Google Scholar 

  7. Ho J, Aridor O, Glinski DW, Saylor CD, Pelletier JP, Selby DM, et al. Needs and workflow assessment prior to implementation of a digital pathology infrastructure for the US Air Force Medical Service. J Pathol Inform. 2013;4:32.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Pantanowitz L, Dickinson K, Evans AJ, Hassell LA, Henricks WH, Lennerz JK, et al. American Telemedicine Association clinical guidelines for telepathology. Telemed J E Health. 2014;20(11):1049–56.

    Article  PubMed  Google Scholar 

  9. Kim B, Chhieng DC, Crowe DR, Jhala D, Jhala N, Winokur T, et al. Dynamic telecytopathology of on site rapid cytology diagnoses for pancreatic carcinoma. Cytojournal. 2006;3:27.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Delta Mea V, Cataldi P, Pertoldi B, Beltrami CA. Dynamic robotic telepathology: a preliminary evaluation on frozen sections, histology and cytology. J Telemed Telecare. 1999;5 Suppl 1:S55–6.

    Article  PubMed  Google Scholar 

  11. Kerr SE, Bellizzi AM, Stelow EB, Frierson Jr HF, Policarpio-Nicolas ML. Initial assessment of fine-needle aspiration specimens by telepathology: validation for use in pathology resident-faculty consultations. Am J Clin Pathol. 2008;130(3):409–13.

    Article  PubMed  Google Scholar 

  12. Alsharif M, Carlo-Demovich J, Massey C, Madory JE, Lewin D, Medina AM, et al. Telecytopathology for immediate evaluation of fine-needle aspiration specimens. Cancer Cytopathol. 2010;118(3):119–26.

    Article  PubMed  Google Scholar 

  13. Heimann A, Maini G, Hwang S, Shroyer KR, Singh M. Use of telecytology for the immediate assessment of CT guided and endoscopic FNA cytology: diagnostic accuracy, advantages, and pitfalls. Diagn Cytopathol. 2012;40(7):575–81.

    Article  PubMed  Google Scholar 

  14. Kaplan KJ. Telecytopathology for immediate evaluation of fine-needle aspiration specimens. Cancer Cytopathol. 2010;118(3):115–8.

    Article  PubMed  Google Scholar 

  15. Khurana KK, Swati I, Kasturi R, Lambert R, Izquierdo R. Telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine-needle aspiration of thyroid nodules. Telemed J E Health. 2011;17(10):763–7.

    Article  PubMed  Google Scholar 

  16. Khurana KK, Kovalovsky A, Masrani D. Feasibility of telecytopathology for rapid preliminary diagnosis of ultrasound-guided fine needle aspiration of axillary lymph nodes in a remote breast care center. J Pathol Inform. 2012;3:36.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gerhard R, Teixeira S, Gaspar da Rocha A, Schmitt F. Thyroid fine-needle aspiration cytology: is there a place to virtual cytology? Diagn Cytopathol. 2013;41(9):793–8.

    Article  PubMed  Google Scholar 

  18. Pantanowitz L, Wiley CA, Demetris A, Lesniak A, Ahmed I, Cable W, et al. Experience with multimodality telepathology at the University of Pittsburgh Medical Center. J Pathol Inform. 2012;3:45.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sawai T, Uzuki M, Kamataki A, Tofukuji I. The state of telepathology in Japan. J Pathol Inform. 2010;1:13.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Slodkowska J, Pankowski J, Siemiatkowska K, Chyczewski L. Use of the virtual slide and the dynamic real-time telepathology systems for a consultation and the frozen section intra-operative diagnosis in thoracic/pulmonary pathology. Folia Histochem Cytobiol. 2009;47(4):679–84.

    PubMed  Google Scholar 

  21. McKenna JK, Florell SR. Cost-effective dynamic telepathology in the Mohs surgery laboratory utilizing iChat AV videoconferencing software. Dermatol Surg. 2007;33(1):62–8. discussion 8.

    PubMed  CAS  Google Scholar 

  22. Horbinski C, Hamilton RL. Application of telepathology for neuropathologic intraoperative consultations. Brain Pathol. 2009;19(2):317–22.

    Article  PubMed  Google Scholar 

  23. Evans AJ, Chetty R, Clarke BA, Croul S, Ghazarian DM, Kiehl TR, et al. Primary frozen section diagnosis by robotic microscopy and virtual slide telepathology: the University Health Network experience. Hum Pathol. 2009;40(8):1070–81.

    Article  PubMed  Google Scholar 

  24. Evans AJ, Kiehl TR, Croul S. Frequently asked questions concerning the use of whole-slide imaging telepathology for neuropathology frozen sections. Semin Diagn Pathol. 2010;27(3):160–6.

    Article  PubMed  Google Scholar 

  25. Gould PV, Saikali S. A comparison of digitized frozen section and smear preparations for intraoperative neurotelepathology. Anal Cell Pathol (Amst). 2012;35(2):85–91.

    Article  Google Scholar 

  26. Pantanowitz L, Valenstein PN, Evans AJ, Kaplan KJ, Pfeifer JD, Wilbur DC, et al. Review of the current state of whole slide imaging in pathology. J Pathol Inform. 2011;2:36.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Fallon MA, Wilbur DC, Prasad M. Ovarian frozen section diagnosis: use of whole-slide imaging shows excellent correlation between virtual slide and original interpretations in a large series of cases. Arch Pathol Lab Med. 2010;134(7):1020–3.

    PubMed  Google Scholar 

  28. Ribback S, Flessa S, Gromoll-Bergmann K, Evert M, Dombrowski F. Virtual slide telepathology with scanner systems for intraoperative frozen-section consultation. Pathol Res Pract. 2014;210(6):377–82.

    Article  PubMed  Google Scholar 

  29. Bernard C, Chandrakanth SA, Cornell IS, Dalton J, Evans A, Garcia BM, et al. Guidelines from the Canadian Association of Pathologists for establishing a telepathology service for anatomic pathology using whole-slide imaging. J Pathol Inform. 2014;5:15.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Khurana KK. Telecytology and its evolving role in cytopathology. Diagn Cytopathol. 2012;40(6):498–502.

    Article  PubMed  Google Scholar 

  31. Thrall M, Pantanowitz L, Khalbuss W. Telecytology: clinical applications, current challenges, and future benefits. J Pathol Inform. 2011;2:51.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Eichhorn JH, Buckner L, Buckner SB, Beech DP, Harris KA, McClure DJ, et al. Internet-based gynecologic telecytology with remote automated image selection: results of a first-phase developmental trial. Am J Clin Pathol. 2008;129(5):686–96.

    Article  PubMed  Google Scholar 

  33. Kern I, Gabric S, Triller N, Pozek I. Telecytology for rapid assessment of cytological specimens. J Telemed Telecare. 2012;18(2):86–9.

    Article  PubMed  Google Scholar 

  34. Marotti JD, Johncox V, Ng D, Gonzalez JL, Padmanabhan V. Implementation of telecytology for immediate assessment of endoscopic ultrasound-guided fine-needle aspirations compared to conventional on-site evaluation: analysis of 240 consecutive cases. Acta Cytol. 2012;56(5):548–53.

    Article  PubMed  Google Scholar 

  35. Jialdasani R, Desai S, Gupta M, Kothari A, Deshpande R, Shet T, et al. An analysis of 46 static telecytology cases over a period of two years. J Telemed Telecare. 2006;12(6):311–4.

    Article  PubMed  Google Scholar 

  36. Pantanowitz L, Hornish M, Goulart RA. The impact of digital imaging in the field of cytopathology. Cytojournal. 2009;6:6.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sharma G, Sharma G, Shah A, Monaco S, Khalbuss W, Parwani A, et al. Evaluation of web based streaming as a tool in telecytology. J Pathol Inform. 2011;2(43):S40–1.

    Google Scholar 

  38. Syed M, Parwani AV, Khalbuss W, Arya P, Ahmed I, Cocoran I, et al. VisionTek® live robotic digital telecytology validation at UPMC. J Pathol Inform. 2014;5:S25–6.

    Article  Google Scholar 

  39. Cai G, Teot LA, Khalbuss WE, Yu J, Monaco SE, Jukic DM, et al. Cytologic evaluation of image-guided fine needle aspiration biopsies via robotic microscopy: a validation study. J Pathol Inform. 2010;1:4.

    Article  PubMed  Google Scholar 

  40. Monaco SE, Pantanowitz L. Telecytology. In: Pantanowitz L, Parwani AV, editors. Practical informatics for cytopathology. New York, NY: Springer; 2014. p. 157–66.

    Chapter  Google Scholar 

  41. Almagro US, Dunn BE, Choi H, Recla DL, Weinstein RS. The gross pathology workstation: an essential component of a dynamic-robotic telepathology system. Cell Vision. 1996;3:470–3.

    Google Scholar 

  42. Hutarew G, Moser K, Dietze O. Comparison of an auto-stereoscopic display and polarized stereoscopic projection for macroscopic pathology. J Telemed Telecare. 2004;10(4):206–13.

    Article  PubMed  Google Scholar 

  43. Têtu B, Paré G, Trudel M-C, Meyer J, Gould PV, Saikali S, et al. Whole-slide imaging-based telepathology in geographically dispersed Healthcare Networks. The Eastern Québec Telepathology project. Diagn Histopathol. 2014;20(12):462–9.

    Article  Google Scholar 

  44. Syed M, Ahmed I, Parwani AV, Anderson R, Balatincz K, Hartman D, et al. Evaluation of the SPOT pathStation2 for gross telepathology. J Pathol Inform. 2014;5:S24–S5.

    Article  Google Scholar 

  45. Syed M, Nine J, Ahmed I, Parwani AV, Saylor C, McHugh J, et al. Applications of Google Glass [GLΛSSTM] in autopsy pathology. J Pathol Inform. 2014;5:S43–S4.

    Article  Google Scholar 

  46. Burton JL, Underwood J. Clinical, educational, and epidemiological value of autopsy. Lancet. 2007;369(9571):1471–80.

    Article  PubMed  Google Scholar 

  47. Dunn BE, Choi H, Almagro UA, Recla DL. Combined robotic and nonrobotic telepathology as an integral service component of a geographically dispersed laboratory network. Hum Pathol. 2001;32(12):1300–3.

    Article  PubMed  CAS  Google Scholar 

  48. Thali MJ, Yen K, Vock P, Ozdoba C, Kneubuehl BP, Sonnenschein M, et al. Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings. Forensic Sci Int. 2003;138(1–3):8–16.

    Article  PubMed  Google Scholar 

  49. Ebert LC, Ptacek W, Furst M, Ross S, Thali MJ, Hatch G. Minimally invasive postmortem telebiopsy. J Forensic Sci. 2012;57(2):528–30.

    Article  PubMed  Google Scholar 

  50. Ruegger CM, Bartsch C, Martinez RM, Ross S, Bolliger SA, Koller B, et al. Minimally invasive, imaging guided virtual autopsy compared to conventional autopsy in foetal, newborn and infant cases: study protocol for the paediatric virtual autopsy trial. BMC Pediatr. 2014;14:15.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Perron E, Louahlia S, Nadeau L, Boilard F, Ing M, Orain M, et al. Telepathology for intraoperative consultations and expert opinions: the experience of the eastern Quebec telepathology network. Arch Pathol Lab Med. 2014;138(9):1223–8.

    Article  PubMed  Google Scholar 

  52. Wamala DS, Augustine K. A meta-analysis of telemedicine success in Africa. J Pathol Inform. 2013;4:6.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Zhao C, Wu T, Ding X, Parwani AV, Chen H, Lauro GR, et al. International telepathology consultation: two years of experience between the University of Pittsburgh Medical Center (UPMC) and Kingmed (China). J Pathol Inform. 2014;5:S33–S4.

    Article  Google Scholar 

  54. Park S, Parwani AV, Aller RD, Banach L, Becich MJ, Borkenfeld S, et al. The history of pathology informatics: a global perspective. J Pathol Inform. 2013;4:7.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Oberholzer M, Christen H, Haroske G, Helfrich M, Oberli H, Jundt G, et al. Modern telepathology: a distributed system with open standards. Curr Probl Dermatol. 2003;32:102–14.

    Article  PubMed  Google Scholar 

  56. Brauchli K, Oberholzer M. The iPath telemedicine platform. J Telemed Telecare. 2005;11 Suppl 2:S3–7.

    Article  PubMed  Google Scholar 

  57. Kayser K, Borkenfeld S, Djenouni A, Kayser G. History and structures of telecommunication in pathology, focusing on open access platforms. Diagn Pathol. 2011;6:110.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Minervini MI, Yagi Y, Marino IR, Lawson A, Nalesnik M, Randhawa P, et al. Development and experience with an integrated system for transplantation telepathology. Hum Pathol. 2001;32(12):1334–43.

    Article  PubMed  CAS  Google Scholar 

  59. Romero Lauro G, Cable W, Lesniak A, Tseytlin E, McHugh J, Parwani A, et al. Digital pathology consultations-a new era in digital imaging, challenges and practical applications. J Digit Imaging. 2013;26(4):668–77.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Saliba V, Legido-Quigley H, Hallik R, Aaviksoo A, Car J, McKee M. Telemedicine across borders: a systematic review of factors that hinder or support implementation. Int J Med Inform. 2012;81(12):793–809.

    Article  PubMed  Google Scholar 

  61. Kayser K. Introduction of virtual microscopy in routine surgical pathology—a hypothesis and personal view from Europe. Diagn Pathol. 2012;7:48.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Guzman M, Judkins AR. Digital pathology: a tool for 21st century neuropathology. Brain Pathol. 2009;19(2):305–16.

    Article  PubMed  Google Scholar 

  63. Chang H, Fontenay GV, Han J, Cong G, Baehner FL, Gray JW, et al. Morphometic analysis of TCGA glioblastoma multiforme. BMC Bioinformatics. 2011;12:484.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Weinstein RS, Graham AR, Lian F, Braunhut BL, Barker GR, Krupinski EA, et al. Reconciliation of diverse telepathology system designs. Historic issues and implications for emerging markets and new applications. APMIS. 2012;120(4):256–75.

    Article  PubMed  Google Scholar 

  65. Tetu B, Fortin JP, Gagnon MP, Louahlia S. The challenges of implementing a “patient-oriented” telepathology network; the Eastern Quebec telepathology project experience. Anal Cell Pathol (Amst). 2012;35(1):11–8.

    Article  Google Scholar 

  66. Bauer TW, Schoenfield L, Slaw RJ, Yerian L, Sun Z, Henricks WH. Validation of whole slide imaging for primary diagnosis in surgical pathology. Arch Pathol Lab Med. 2013;137(4):518–24.

    Article  PubMed  Google Scholar 

  67. Krishnamurthy S, Mathews K, McClure S, Murray M, Gilcrease M, Albarracin C, et al. Multi-institutional comparison of whole slide digital imaging and optical microscopy for interpretation of hematoxylin-eosin-stained breast tissue sections. Arch Pathol Lab Med. 2013;137(12):1733–9.

    Article  PubMed  Google Scholar 

  68. Bauer TW, Slaw RJ. Validating whole-slide imaging for consultation diagnoses in surgical pathology. Arch Pathol Lab Med. 2014;138(11):1459–65.

    Article  PubMed  Google Scholar 

  69. Jain M, Narula N, Aggarwal A, Stiles B, Shevchuk MM, Sterling J, et al. Multiphoton microscopy: a potential “optical biopsy” tool for real-time evaluation of lung tumors without the need for exogenous contrast agents. Arch Pathol Lab Med. 2014;138(8):1037–47.

    Article  PubMed  Google Scholar 

  70. Wu X, Chen G, Lu J, Zhu W, Qiu J, Chen J, et al. Label-free detection of breast masses using multiphoton microscopy. PLoS One. 2013;8(6), e65933.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  71. Fine JL, Kagemann L, Wollstein G, Ishikawa H, Schuman JS. Direct scanning of pathology specimens using spectral domain optical coherence tomography: a pilot study. Ophthalmic Surg Lasers Imaging. 2010;41(6):S58–64.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Jain M, Narula N, Salamoon B, Shevchuk MM, Aggarwal A, Altorki N, et al. Full-field optical coherence tomography for the analysis of fresh unstained human lobectomy specimens. J Pathol Inform. 2013;4:26.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Lloyd GR, Wood J, Kendall C, Cook T, Shepherd N, Stone N. Histological imaging of a human colon polyp sample using Raman spectroscopy and self organising maps. Vib Spectrosc. 2012;60:43–9.

    Article  CAS  Google Scholar 

  74. Dierks C. Legal aspects of telepathology. Anal Cell Pathol. 2000;21(3-4):97–9.

    Article  PubMed  CAS  Google Scholar 

  75. Tetu B, Evans A. Canadian licensure for the use of digital pathology for routine diagnoses: one more step toward a new era of pathology practice without borders. Arch Pathol Lab Med. 2014;138(3):302–4.

    Article  PubMed  Google Scholar 

  76. Garcia-Rojo M, Goncalves L, Blobel B. The COST action IC0604 “Telepathology Network in Europe” (EURO-TELEPATH). Stud Health Technol Inform. 2012;179:3–12.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bernard Têtu M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Têtu, B., Wilbur, D.C., Pantanowitz, L., Parwani, A.V. (2016). Teleconsultation. In: Kaplan, K., Rao, L. (eds) Digital Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-20379-9_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-20379-9_6

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20378-2

  • Online ISBN: 978-3-319-20379-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics