Development of a nationwide telepathology consultation and quality control program for cancer diagnosis in China

Background China has the largest numbers of cancer patients worldwide but has limited pathology resources. According to a survey done by Chinese Pathologists Association, a large number of pathologists in clinical practice in China has only one year of formal or informal training. Only in recent year, formal pathology residency programs similar to those of Western countries are available in a couple of large medical schools, where limited numbers of welltrained and experienced pathologists are located. When having rare or complex cancer pathology cases, pathologists often have difficulty in making an accurate diagnosis. Mistakes in cancer diagnosis are not uncommon, which often leads to inadequate treatment of patients and medical legal problems. Thus, there is a great need for pathology consultation and quality control of cancer diagnosis in China. In recent years, telepathology or digital pathology has been applied in many areas of pathology, including remote consultation and quality control [1]. Difficult pathology cases can be sent through internet or intranet to remote site for consultation [2]. Quality control can be performed on digitalized image or WSI by expert pathologists at remote sites [3]. The practice of telepathology can solve the problem of healthcare system with poor pathology resource, especially in developing countries [4]. In order to use pathology resource efficiently and to improve the quality of pathology diagnosis of cancer, the Ministry of Health of China developed and launched a nationwide telepathology consultation and quality control program for cancer diagnosis in China in 2011. Designs Internet platform An internet based telepathology consultation platform (http://www.mpathology.cn) was designed to serve as the hub for the project, connecting hospitals and expert consultants. Selection an internet based platform or a website portal was due to the consideration that multiple hospitals/institutions and multiple expert pathologists from different institutions need to access the platform. A server was used for storage of images and data. Figure 1 shows the flowchart of the platform. For telepathology consultation, referring pathologists from participating hospitals sent request for consults with attached WSI and related clinical information to the internet platform, the system would alert system information technologists by e-mails. The technologists would then check out the submitted materials to make sure the requesting form is filled out appropriately with the WSI attached. The system manager would then contact the expert pathologist for consultation. For quality control, a designated expert pathologist would log into the platform, review the WSI of cancer case from specific hospitals, assesses the accuracy of the pathology diagnosis and quality of histology sections. The results would then be sent to provincial and national pathology quality control center. All of the participating hospitals were supplied with a virtual microscope, Motic Virtual Microscopic Scanner (Motic Medical Diagnostic Systems Corporation, China). The virtual microscope and related software were tested and validated previously in a study involving a variety of 600 surgical pathology specimens in China. The study showed a high concordance rate (94.2%) between WSI and H/E glass slide [5]. Bureau of Health Policy and Regulation, Ministry of Health, Beijing, China Full list of author information is available at the end of the article Zhang et al. Diagnostic Pathology 2013, 8(Suppl 1):S6 http://www.diagnosticpathology.org/content/8/S1/S6