Three years of experience with routine use of telepathology in assessment of excisional and aspirate biopsies of breast lesions.

AIM To examine the applicability of routine telepathology to accurately diagnose breast lesions. METHODS During a 36 month period, a dynamic telepathology system was used to assess 315 excisional biopsies and 209 fine needle aspirates of breast lesions submitted by surgeons located 20 km from the hospital. The results of the gross and microscopic telepathology diagnoses were compared with final microscopic diagnoses. RESULTS No frozen sections were obtained in 120 of 315 cases submitted for frozen section due to lack of gross lesion (73/120), a papillary lesion or a lesion smaller than 1 cm (22/120), or a gross-only diagnosis of a benign process was given (23/120). For frozen sections, the microscopic telepathology diagnoses had a sensitivity of 81.6%, specificity of 100.0%, and diagnostic accuracy of 95.3%. For malignant tumors, the positive predictive value was 100.0% and the negative predictive value was 94.0%. For the fine needle aspirates, microscopic telepathology diagnoses agreed with conventional cytology in 163 of 209 cases. Tissue pathology was available for 109 of the fine needle aspirate specimens. For these 109 cases, telepathology diagnosis of malignancy was shown to have a sensitivity of 91.2% and specificity of 100.0%. Malignancy was identified in 8 of 16 cases with an atypia microscopic telepathology diagnosis and in 18 of 21 suspicious microscopic telepathology diagnoses. CONCLUSION This long term study demonstrates that the routine use of telepathology compares well with conventional microscopy in the assessment of both frozen sections and fine needle aspirates of breast lesions.