ORIGINAL ARTICLE

Offline telepathology diagnosis of colorectal polyps: a study of interobserver agreement and comparison with glass slide diagnoses

S S Cross¹, J L Burton¹, A K Dubé³, K M Feeley³, P D Lumb², T J Stephenson³, R D Start⁴

¹ Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, School of Medicine and Biological Science, University of Sheffield, Beech Hill Road, South Yorkshire S10 2RX, UK
² Academic Unit of Forensic Pathology, University of Sheffield
³ Department of Histopathology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield S10 2UL, UK
⁴ Department of Histopathology, Chesterfield Royal Hospital NHS Trust, Calow, Chesterfield S44 5BL, UK

Correspondence to:
Correspondence to:
Dr S S Cross, Academic Unit of Pathology, Section of Oncology and Pathology, Division of Genomic Medicine, School of Medicine and Biological Science, University of Sheffield, Beech Hill Road, South Yorkshire S10 2RX, UK;
s.s.cross{at}sheffield.ac.uk

Background/Aims: Technological advances have produced telepathology systems with high quality colour images and reasonable transmission times. Most applications of telepathology have centred on the remote diagnosis of frozen sections or remote real time expert opinions. This study investigates the reproducibility and accuracy of offline telepathology as a primary diagnostic medium for routine histopathology specimens.

Methods: One hundred colorectal polyps (50 hyperplastic, 50 adenomatous) were presented in a randomised order to five histopathologists as offline images on a telepathology workstation. Six images of each case were used: the slide label, a low power scan of all material on the slide, and four higher magnification views. The times taken to prepare the images, and to make the diagnoses, were recorded. Interobserver agreement was measured with statistics and compared with the glass slide diagnoses.

Results: The statistics for the interobserver agreement on the telepathology images lay in the range of 0.90–1.00, which is interpreted as excellent agreement, and were significantly higher than those for the glass slide diagnoses (range, 0.84–0.98; p = 0.001). The median time taken to capture the images for a case was 210 seconds. The median time taken to make a diagnosis from the telepathology images was five seconds, which was significantly shorter than for the glass slide diagnoses (median, 13 seconds; p < 0.0005).

Conclusions: Offline telepathology has the potential to be a primary diagnostic medium for routine histopathology with a high degree of reproducibility and short diagnosis times. Further studies are required to validate offline telepathology for different types of specimens and different operators of the image capture system.

Keywords: telepathology; colorectal polyps; diagnosis; interobserver agreement

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