Fifth generation telepathology systems. Workflow analysis of the robotic dynamic telepathology Component

Background Fifth generation telepathology systems are dual-modality systems (i.e., digital pathology systems) that combine whole slide imaging (WSI) and real-time dynamic robotic telepathology. Hybrid robotic dynamic/static image telepathology systems were the precursors of fifth generation telepathology systems and can be used as surrogates for fifth generation systems in workflow studies [1-4]. Variability in human performance was identified as a pathology issue in the first scientific paper on telepathology, published in 1987 [5]. In a study performed under highly controlled conditions, it was shown that individual pathologists had a range of thresholds for diagnosing breast cancer on frozen sections. The use of the “equivocal for malignancy” diagnostic category varied significantly among the six pathologists enrolled in an Receiver Operating Characteristic (ROC) video microscopy human performance study. Surprisingly, use of this category was essentially the same for both conventional light microscopy and video microscopy for each pathologist [5]. In another early study, Dunn et al., using a hybrid dynamic robotic/static image telepathology system, documented patterns of telepathology primary diagnoses case deferrals for seven telepathologists over a 12-year period of time. These seven telepathologists rendered provisional primary surgical pathology diagnoses on over 11,000 surgical pathology cases. Case deferral rates among the telepathologists varied from 2.5% to 32.7% [6,7]. In this workflow study, we compared the QA case deferral rates of general pathologists and subspecialty surgical pathologists staffing a telepathology-based QA program. Fifth generation telepathology systems are an extension of the hybrid dynamic robotic/static image system concept, replacing the gallery of individual static images with a single large whole slide imaging (WSI) file.