RESUMO
Digital pathology has made great strides in recent years culminating with the approval to market devices from the Food and Drug Administration. The pathology community is now poised to begin using these systems for diagnostic purposes. This article will discuss the preparatory steps needed to implement digital pathology as well as some implementation styles that may be sufficient for a pathology department.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Patologia/métodos , Patologia/organização & administração , Telepatologia/métodos , Telepatologia/organização & administração , Fluxo de Trabalho , HumanosRESUMO
INTRODUCTION: There is an emerging need for telecytology in Colombia as the demand for cytopathology has increased. However, due to economic and technological constraints telecytology services are limited. Our aim was to evaluate the diagnostic feasibility of using whole slide imaging with and without Z-stacking for telecytology in Colombia, South America. METHODS: Archival glass slides from 17 fine needle aspiration smears were digitized employing whole slide imaging (WSI) (Nanozoomer 2.0 HT, Hamamatsu) in one Z-plane at 40x, and panoramic digital imaging (Panoptiq system, ViewsIQ) combining low-magnification digital maps with embedded 40x Z-stacks of representative regions of interest. Fourteen Colombian pathologists reviewed both sets of digital images. Diagnostic concordance, time to diagnosis, image quality (scale 1-10), usefulness of Z-stacking, and technical difficulties were recorded. RESULTS: Image quality scored by pathologists was on average 8.3 for WSI and 8.7 for panoramic images with Z-stacks (P = .03). However, diagnostic concordance was not impacted by image quality ranking. In the majority of cases (72.4%) pathologists deemed Z-stacking to be diagnostically helpful. Technical issues related to Z-stack video performance constituted only a minor proportion of technical problems reported. Slow downloads and crashing of files while viewing were mostly experienced with larger WSI files. CONCLUSION: This study demonstrated that international telecytology for diagnostic purposes is feasible. Panoramic images had to be acquired manually, but were of suitable diagnostic quality and generated smaller image files associated with fewer technical errors. Z-stacking proved to be useful in the majority of cases and is thus recommended for telecytology.
Assuntos
Consulta Remota/métodos , Telepatologia/métodos , Colômbia , Citodiagnóstico/métodos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Patologia Clínica/métodos , Reprodutibilidade dos Testes , Estados UnidosRESUMO
BACKGROUND: Rapid on-site evaluation is a great tool for optimizing the adequacy and quality of cytologic samples. The objective of the current study was to analyze a low-cost telecytopathology method for the remote assessment of thyroid fine-needle aspiration biopsies (FNABs), with comparison of the primarily rendered adequacy and diagnosis with the final conventional analysis. METHODS: Material collected from thyroid FNABs was immediately smeared onto glass slides and stained with Diff-Quik. A conventional microscope attached to a smart device was operated on-site by either a medical student or a pathology resident for Wi-Fi transmission of the images by Skype. The cytopathologist would remotely guide the screening of the slides, zooming in and out of areas of interest. Remote assessment included an analysis of material adequacy and a preliminary diagnosis. The quality of the transmission and the number of slides also were recorded. After a washout period of 3 weeks, final diagnosis and adequacy were assigned by conventional microscopy. RESULTS: The final agreement rate for adequacy between remote and conventional analysis was 90.5%. For diagnosis, the final agreement rate was 83.3%. The diagnosis agreement rate varied, depending on the quality of transmission: there was 88% agreement when the quality was excellent, 77.8% agreement when it was good, and 62.5% agreement when it was poor. CONCLUSIONS: Low-cost telecytopathology is an efficient method for the remote assessment of thyroid FNAB adequacy and diagnosis. The wide use of such technology in low-resource or remote centers may have a positive impact on the number of adequate or satisfactory samples, optimizing the management of patients who have thyroid nodules.
Assuntos
Citodiagnóstico/economia , Citodiagnóstico/métodos , Telepatologia/economia , Telepatologia/métodos , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/economia , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Citodiagnóstico/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Telepatologia/instrumentação , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/economiaRESUMO
Recently, several technological advances have been introduced to mobile phones leading some people to refer to them as "smartphones." These changes have led to widespread consumer adoption. A similar adoption has occurred within the medical field and this revolution is changing the practice of medicine, including pathology. Several mobile applications have been published for dermatology, orthopedics, ophthalmology, neurosurgery, and clinical pathology. The applications are wide ranging, including mobile technology to increase patient engagement, self-monitoring by patients, clinical algorithm calculation, facilitation between experts to resource-poor environments. These advances have been received with mixed reviews. For anatomic pathology, mobile technology applications can be broken into 4 broad categories: (a) educational uses, (b) microscope with mobile phone, (c) mobile phone as microscope/acquisition device, and (d) miscellaneous. Using a mobile phone as an acquisition device paired with a microscope seems to be the most interesting current application because of the need for expert consultation with resource-poor environments. However, several emerging uses for mobile technology may become more prominent as the technology matures including image analysis, alternative light sources, and increased opportunities for clinician and patient engagement. The flexibility represented by mobile technology represents a burgeoning field in pathology informatics.
Assuntos
Telepatologia/tendências , Dermatologia/tendências , Patologia Clínica , Telepatologia/métodos , TelerradiologiaRESUMO
BACKGROUND: Telemedicine refers to the use of technology as improvement of healthcare delivery to places where distance becomes an obstacle. Its use represents a great potential for dermatology, a specialty whose visual analysis phase is essential in diagnosis. OBJECTIVES: To analyze the compatibility index of skin cancer diagnoses between primary care and teledermatology, and to validate a protocol for standardization of digital imaging to obtain the reports in teledermatology. METHODS: An observational cross-sectional study developed through the census of 333 examination requests, received between January/2012 and July/2012, in the Center for Telemedicine and Telehealth of SES-SC. We used a protocol for photographic lesion standardization, consisting of three steps (panoramic photo, close-up with ruler and dermoscopy). After collection, the data were sent to a virtual site on the Internet, and recorded with the use of an electronic health record containing the images, the skin phototype and demographic characteristics. RESULTS: The level of compatibility between the diagnosis of skin cancer in Santa Catarina's primary care and the diagnosis proposed by teledermatology was 19.02%. Proportionally, it was 21.21% for BCC, 44.44% for SCC and 6.98% for MM. The protocol was statistically significant (p <0.05), with an OR of 38.77. CONCLUSION: The rate of diagnostic compatibility of skin cancer was low and the use of the protocol optimized the chance of validating requests for examination.
Assuntos
Dermatologia/normas , Interpretação de Imagem Assistida por Computador/normas , Atenção Primária à Saúde/normas , Neoplasias Cutâneas/diagnóstico , Telemedicina/normas , Adulto , Idoso , Estudos Transversais , Dermatologia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Atenção Primária à Saúde/métodos , Reprodutibilidade dos Testes , Telemedicina/métodos , Telepatologia/métodos , Telepatologia/normasRESUMO
BACKGROUND: Telemedicine refers to the use of technology as improvement of healthcare delivery to places where distance becomes an obstacle. Its use represents a great potential for dermatology, a specialty whose visual analysis phase is essential in diagnosis. OBJECTIVES: To analyze the compatibility index of skin cancer diagnoses between primary care and teledermatology, and to validate a protocol for standardization of digital imaging to obtain the reports in teledermatology. METHODS: An observational cross-sectional study developed through the census of 333 examination requests, received between January/2012 and July/2012, in the Center for Telemedicine and Telehealth of SES-SC. We used a protocol for photographic lesion standardization, consisting of three steps (panoramic photo, close-up with ruler and dermoscopy). After collection, the data were sent to a virtual site on the Internet, and recorded with the use of an electronic health record containing the images, the skin phototype and demographic characteristics. RESULTS: The level of compatibility between the diagnosis of skin cancer in Santa Catarina's primary care and the diagnosis proposed by teledermatology was 19.02%. Proportionally, it was 21.21% for BCC, 44.44% for SCC and 6.98% for MM. The protocol was statistically significant (p <0.05), with an OR of 38.77. CONCLUSION: The rate of diagnostic compatibility of skin cancer was low and the use of the protocol optimized the chance of validating requests for examination. .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatologia/normas , Interpretação de Imagem Assistida por Computador/normas , Atenção Primária à Saúde/normas , Neoplasias Cutâneas/diagnóstico , Telemedicina/normas , Estudos Transversais , Dermatologia/métodos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Atenção Primária à Saúde/métodos , Reprodutibilidade dos Testes , Telemedicina/métodos , Telepatologia/métodos , Telepatologia/normasRESUMO
Real integration of Virtual Microscopy with the pathologist service workflow requires the design of adaptable strategies for any hospital service to interact with a set of Whole Slide Images. Nowadays, mobile devices have the actual potential of supporting an online pervasive network of specialists working together. However, such devices are still very limited. This article introduces a novel highly adaptable strategy for streaming and visualizing WSI from mobile devices. The presented approach effectively exploits and extends the granularity of the JPEG2000 standard and integrates it with different strategies to achieve a lossless, loosely-coupled, decoder and platform independent implementation, adaptable to any interaction model. The performance was evaluated by two expert pathologists interacting with a set of 20 virtual slides. The method efficiently uses the available device resources: the memory usage did not exceed a 7% of the device capacity while the decoding times were smaller than the 200 ms per Region of Interest, i.e., a window of 256×256 pixels. This model is easily adaptable to other medical imaging scenarios.
Assuntos
Processamento de Imagem Assistida por Computador/métodos , Microscopia/métodos , Telepatologia/métodos , Biópsia , Bases de Dados Factuais , Humanos , Pele/patologia , Smartphone , Interface Usuário-ComputadorRESUMO
BACKGROUND: Non-melanoma skin cancer (NMSC) is one of the most common neoplasms in the world. Despite the low mortality rates, NMSC can still cause severe sequelae when diagnosed at advanced stages. Malignant melanoma, the third most common type of skin cancer, has more aggressive behavior and a worse prognosis. Teledermatology provides a new tool for monitoring skin cancer, especially in countries with a large area and unequal population distribution. This study sought to evaluate the performance of digital photography in skin cancer diagnosis in remote areas of Brazil. METHODS: A physician in a Mobile Prevention Unit (MPU) took four hundred sixteen digital images of suspicious lesions between April 2010 and July 2011. All of the photographs were electronically sent to two oncologists at Barretos Cancer Hospital who blindly evaluated the images and provided a diagnosis (benign or malignant). The absolute agreement rates between the diagnoses made by direct visual inspection (by the MPU physician) and through the use of digital imaging (by the two oncologists) were calculated. The oncologists' accuracy in predicting skin cancer using digital imaging was assessed by means of overall accuracy (correct classification rate), sensitivity, specificity and predictive value (positive and negative). A skin biopsy was considered the gold standard. RESULTS: Oncologist #1 classified 59 lesions as benign with the digital images, while oncologist #2 classified 27 lesions as benign using the same images. The absolute agreement rates with direct visual inspection were 85.8% for oncologist #1 (95% CI: 77.1-95.2) and 93.5% for oncologist #2 (95% CI: 84.5-100.0). The overall accuracy of the two oncologists did not differ significantly. CONCLUSIONS: Given the high sensitivity and PPV, Teledermatology seems to be a suitable tool for skin cancer screening by MPU in remote areas of Brazil.
Assuntos
Dermoscopia/métodos , Interpretação de Imagem Assistida por Computador/métodos , Unidades Móveis de Saúde , Fotografação , Consulta Remota/métodos , Serviços de Saúde Rural , Neoplasias Cutâneas/diagnóstico , Brasil , Detecção Precoce de Câncer/métodos , Humanos , Variações Dependentes do Observador , Telepatologia/métodosRESUMO
BACKGROUND: Telepathology is considered a good alternative for a second opinion consultation. Its implementation is desirable, but studies to confirm its practical application are required. OBJECTIVES: To evaluate the reproducibility of histopathologic diagnoses of skin diseases obtained through digital photomicrographs compared with conventional microscopy. METHODS: We evaluated the surgical specimens of 135 patients using an optical microscope. After 4 weeks, the same consultants independently evaluated a total of 1,738 digital photomicrographs obtained from the histopathological slides. We estimated the overall rate of intra and interobserver agreement, and the Kappa coefficient was obtained with the categorization of the skin diseases: neoplastic skin diseases, infectious-contagious skin diseases and non-infectious-contagious skin diseases. RESULTS: Consultant 1 obtained an agreement of 88.1% (95% CI = 81.5% - 93.1%) between conventional microscopy and images. Consultant 2 obtained an agreement of 80.7% (95% CI = 73.1% - 87%). The interobserver agreement for the microscopy analysis was 81.5% (95% CI = 73.9% - 87.6%). The same analysis using microphotography showed an agreement of 85.9% (95% CI = 78.9% - 91.3%). The Kappa coefficient, which evaluated the categorized skin diseases, was 98.6% for Consultant 1, 93.1% for Consultant 2, 95.8% for interconsultant analyses of images and 95.9% for interconsultant analyses using conventional optical microscopy. All of these values are considered optimal. CONCLUSION: The evaluation of microphotographs shows a good level of reproducibility when compared to traditional microscopy and, therefore, is a viable option for a second opinion consultation in dermatopathology.