实时远程病理诊断与亲临现场的术中冰冻切片诊断基本相同。

IF 3.7 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Joseph M Rohr, Kevin Ginnebaugh, Mark Tuthill, Jason Pimentel, Rodney Markin
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引用次数: 0

摘要

背景:通过冰冻切片进行术中诊断是外科病理实践的主流,可为手术团队提供即时反馈。尽管现代方法具有良好的准确性,但对于小型或偏远地区的外科中心来说,在适当的周转时间(TAT)内获得术中手术病理诊断一直是一个限制因素,对成本和患者护理产生了负面影响。远程病理学为没有内部病理学家或亚专科病理学家的医疗机构提供即时的解剖病理专家会诊:评估实时远程病理学在冷冻切片实践中的实用性:通过远程显微镜对 2 家三级医疗中心和 3 家附属医院的冷冻切片诊断进行了查询,内容包括解剖部位、每块 TAT、病理学家以及与石蜡诊断的一致性。将 TAT 和一致性与同期的玻璃诊断进行比较:在 748 例远程显微镜术中诊断中,有 694 例的平均 TAT 为 18 分 56 秒 ± 8 分 45 秒,慢于玻璃诊断(14 分 25 秒 ± 7 分 8 秒,P < .001)。有 22 例(占现有病例的 2.89%)不一致,与玻璃上的比率(P = .44)或分类分布(P = .31)无显著差异。两例(0.27%)出现技术故障:尽管从统计学角度看,面对面诊断的速度更快,但绝大多数远程显微镜诊断都能在 20 分钟内完成。这种情况在不同医院的众多病理学家、病理助理和/或技术人员的共同努力下,在长达 6 年的时间里依然如此。不一致的诊断结果集中在相对较少的病理学家中,这表明每个人对远程病理和/或冷冻切片诊断都很满意。在极少数情况下,技术问题阻碍了远程显微诊断。总体而言,这证明远程显微镜服务在术中主要诊断中的持续使用和扩展是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Real-Time Telepathology Is Substantially Equivalent to In-Person Intraoperative Frozen Section Diagnosis.

Context.—: Intraoperative diagnosis by frozen section is a mainstay of surgical pathology practice, providing immediate feedback to the surgical team. Despite good accuracy with modern methods, access to intraoperative surgical pathology with an appropriate turnaround time (TAT) has been a limiting factor for small or remote surgical centers, with negative impacts on cost and patient care. Telepathology offers immediate expert anatomic pathology consultation to sites without an in-house or subspecialized pathologist.

Objective.—: To assess the utility of live telepathology in frozen section practice.

Design.—: Frozen section diagnoses by telemicroscopy from 2 tertiary care centers with a combined 3 satellite hospitals were queried for anatomic site, TAT per block, pathologist, and concordance with paraffin diagnosis. TAT and concordance were compared to glass diagnoses in the same period.

Results.—: For 748 intraoperative diagnoses by telemicroscopy, 694 had TATs with a mean of 18 minutes 56 seconds ± 8 minutes 45 seconds, which was slower than on glass (14 minutes 25 seconds ± 7 minutes 8 seconds, P < .001). Twenty-two (2.89% of available) were discordant, which was not significantly different from the on-glass rate (P = .44) or categorical distribution (P = .31). Two cases (0.27%) had technical failures.

Conclusions.—: Although in-person diagnoses were statistically faster, the great majority of telemicroscopic diagnoses were returned in less than 20 minutes. This remained true through numerous pathologists, pathology assistants and/or technicians, different hospitals, and during a combined 6 years. The concentration of discordant diagnoses among relatively few pathologists suggests individual comfort with telepathology and/or frozen section diagnosis. In rare cases, technical issues prevented telemicroscopic diagnosis. Overall, this justifies continued use and expansion of telemicroscopic services in primary intraoperative diagnoses.

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来源期刊
CiteScore
9.20
自引率
2.20%
发文量
369
审稿时长
3-8 weeks
期刊介绍: Welcome to the website of the Archives of Pathology & Laboratory Medicine (APLM). This monthly, peer-reviewed journal of the College of American Pathologists offers global reach and highest measured readership among pathology journals. Published since 1926, ARCHIVES was voted in 2009 the only pathology journal among the top 100 most influential journals of the past 100 years by the BioMedical and Life Sciences Division of the Special Libraries Association. Online access to the full-text and PDF files of APLM articles is free.
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