@article {941, title = {Computational Pathology and Telepathology: SY05-1 TELECYTOLOGY TC AND TELEPATHOLOGY TP IN UNDERSERVED COUNTRIES TOY OR TOOL?}, journal = {Pathology}, volume = {46 Suppl 2}, year = {2014}, month = {2014 Oct}, pages = {S7}, abstract = {

BACKGROUND: Pathologic anatomic practice is an essential part of medical practice even in low-income countries. It is an extraordinarily helpful tool in finding therapeutic decisions, monitoring therapeutic processes and in academic teaching students and residents in understanding aetiology and morphology of infectious and neoplastic diseases. However, all countries worldwide are suffering from a shortage of experienced surgical pathologists providing an adequate service to the clinics. Training pathologists is a time-consuming procedure and it takes more than one decade. Therefore new techniques have to be utilized to overcome the gap of human resources in medical fields in these countries. Telepathology and telecytology may be effective tools to transfer both knowledge and experience to any place in the world with simple technical equipment using the Internet. We evaluate the benefit of TP and TC on three projects, with different educational levels of the local pathologists.

MATERIAL AND APPROACH: In 2002 Cambodian pathologists started off with telepathology using iPath Network as an open-source system. Up to now more than 5600 cases have been submitted to experts. In 2007 a Tanzanian hospital started telepathology and solved more than 3600 cases. In 2010 an Afghan group of medical experts started using TP and submitted more than 1600 cases. The latest 100 cases of each group were analysed with respect to (1) the organs concerned; (2) the diagnostic techniques used such as histology vs cytology; (3) complexity of the diagnostic question; (4) information quality and quantity; (5) diagnostic concordance between primary diagnosis and the experts opinion; and (6) diagnostic accuracy of the experts diagnoses in order to evaluate the benefit of the projects.

RESULTS AND CONCLUSION: Telepathology services are ranging from a triage of diagnostic assessment of benign vs malignant to academic-scientific services including teaching and research facilities. Breast pathology is predominant in Afghanistan, whereas cervix pathology is the leading issue in Tanzania, and in Cambodia soft tissue/bone pathology plays the major role. In more than 50\% cytology was applied in Afghanistan and only 10\% and 5\% in Cambodia and Tanzania respectively. The complexity of diagnostic questions differs from Cambodia using TP for confirmation in most cases, to Tanzania and Afghanistan using TP mostly for primary diagnosis. Diagnostic concordance depending on both the experience of local pathologists and the technical facilities of the laboratory was high in Cambodia, followed by Tanzania and Afghanistan. Diagnostic accuracy corresponding with the quantity and quality of information followed the same pattern. The success of TP projects can be measured by the number of TP sessions and by the sustainability of projects. Our TP/TC projects in those countries with limited resources are effective tools in improving medical health care.

}, keywords = {iPath, open source software, telepathology}, issn = {1465-3931}, doi = {10.1097/01.PAT.0000454068.32934.09}, author = {Stauch, Gerhard and Miringa, Angelica and Raoufi, Rokai and Vathana, Cchut Serey and Hetzmann, Sophia and Hinsch, Nora and Dalquen, Peter and Voelker, Ullrich and Kunze, Dietmar} } @article {1033, title = {Making cytological diagnoses on digital images using the iPath network.}, journal = {Acta Cytol}, volume = {58}, year = {2014}, month = {2014}, pages = {453-60}, abstract = {

BACKGROUND: The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool.

AIM: To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set.

METHOD: Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant.

RESULTS: For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93\%, respectively; the overall accuracy was 88-90\%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions.

CONCLUSION: Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90\%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.

}, keywords = {Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Computers, Handheld, Cytodiagnosis, Diagnosis, Differential, Female, Humans, Hyperplasia, Infant, Male, Metaplasia, Middle Aged, Neoplasms, Observer Variation, Reproducibility of Results, Sensitivity and Specificity, Telemedicine}, issn = {0001-5547}, doi = {10.1159/000369241}, author = {Dalquen, Peter and Savic Prince, Spasenija and Spieler, Peter and Kunze, Dietmar and Neumann, Heinrich and Eppenberger-Castori, Serenella and Adams, Heiner and Glatz, Katharina and Bubendorf, Lukas} } @article {1034, title = {Telecytological diagnosis of space-occupying lesions of the liver.}, journal = {Acta Cytol}, volume = {58}, year = {2014}, month = {2014}, pages = {174-81}, abstract = {

OBJECTIVE: In this study, the efficiency of telemedical consulting with regard to fine needle aspirates from space-occupying lesions (SOLs) of the liver is investigated for the first time.

STUDY DESIGN: The study includes fine needle aspirations from 62 patients, 33 with hepatocellular carcinoma (HCC) and 29 with non-hepatic tumors. Using the Internet-based iPath system, the initial pathologist submitted 1-8 images from smears and cell block sections. One consultant assessed the cytological and another one the histological images. Both made their diagnoses independent of each other. A final diagnosis was made by immunochemistry of cell block sections. The cytological images were analyzed retrospectively for the occurrence of the most typical HCC indicators. The number of these indicators was related to the initial diagnoses of the three pathologists, and possible reasons for diagnostic errors were analyzed based on this analysis.

RESULTS: The accuracy of the preliminary telemedical diagnoses regarding HCC was 82.0\% for the cytological images and 87.7\% for the histological images. Most of the false diagnoses occurred in tumors with unusual cytological and histological patterns.

CONCLUSIONS: Telemedical consulting is a valuable tool to obtain a second opinion. However, for improvement of the diagnosis of HCC, supplementary immunochemical tests are necessary.

}, keywords = {Adult, Aged, Aged, 80 and over, Carcinoma, Hepatocellular, Female, Humans, Image-Guided Biopsy, Liver, Liver Neoplasms, Male, Middle Aged, Retrospective Studies, Telemedicine}, issn = {0001-5547}, doi = {10.1159/000357195}, author = {Mostafa, Mohammad Golam and Dalquen, Peter and Kunze, Dietmar and Terracciano, Luigi} }