ORIGINAL ARTICLE

Transcontinental communication and quantitative digital histopathology via the Internet; with special reference to prostate neoplasia

R Montironi¹, D Thompson², M Scarpelli¹, H G Bartels², P W Hamilton³, V D Da Silva⁴, W A Sakr⁵, B Weyn⁶, A Van Daele⁶, P H Bartels²

¹ Institute of Pathological Anatomy and Histopathology, University of Ancona, 60020 Torrette, Ancona, Italy
² Optical Sciences Center, University of Arizona, Tucson, Arizona 85721, USA
³ Department of Pathology, Royal Victoria Hospital, The Queen's University, Belfast BT12 6BL, Northern Ireland, UK
⁴ Federal University of Rio Grande do Sul, 91330-260 Porto Alegre, Brazil
⁵ Department of Pathology, Harper Hospital, Wayne State University, Detroit, MI 48230, Michigan, USA
⁶ Centre of Electron Microscopy, University of Antwerp, B-2610 Antwerp, Belgium

Correspondence to:
Correspondence to:
Professor R Montironi, Institute of Pathological Anatomy and Histopathology, School of Medicine, University of Ancona, Azienda Ospedaliera Umberto I°, Via Conca (snc), 60020 Torrette, Ancona, Italy;
r.montironi{at}popcsi.unian.it

Objective: To describe practical experiences in the sharing of very large digital data bases of histopathological imagery via the Internet, by investigators working in Europe, North America, and South America.

Materials: Experiences derived from medium power (sampling density 2.4 pixels/µm) and high power (6 pixels/µm) imagery of prostatic tissues, skin shave biopsies, breast lesions, endometrial sections, and colonic lesions. Most of the data included in this paper were from prostate. In particular, 1168 histological images of normal prostate, high grade prostatic intraepithelial neoplasia (PIN), and prostate cancer (PCa) were recorded, archived in an image format developed at the Optical Sciences Center (OSC), University of Arizona, and transmitted to Ancona, Italy, as JPEG (joint photographic experts group) files. Images were downloaded for review using the Internet application FTP (file transfer protocol). The images were then sent from Ancona to other laboratories for additional histopathological review and quantitative analyses. They were viewed using Adobe Photoshop, Paint Shop Pro, and Imaging for Windows. For karyometric analysis full resolution imagery was used, whereas histometric analyses were carried out on JPEG imagery also.

Results: The three applications of the telecommunication system were remote histopathological assessment, remote data acquisition, and selection of material. Typical data volumes for each project ranged from 120 megabytes to one gigabyte, and transmission times were usually less than one hour. There were only negligible transmission errors, and no problem in efficient communication, although real time communication was an exception, because of the time zone differences. As far as the remote histopathological assessment of the prostate was concerned, agreement between the pathologist's electronic diagnosis and the diagnostic label applied to the images by the recording scientist was present in 96.6% of instances. When these images were forwarded to two pathologists, the level of concordance with the reviewing pathologist who originally downloaded the files from Tucson was as high as 97.2% and 98.0%. Initial results of studies made by researchers belonging to our group but located in others laboratories showed the feasibility of making quantitative analysis on the same images.

Conclusions: These experiences show that diagnostic teleconsultation and quantitative image analyses via the Internet are not only feasible, but practical, and allow a close collaboration between researchers widely separated by geographical distance and analytical resources.

Keywords: teleconsultation; internet; digital histopathology; prostate; prostate cancer; prostatic intraepithelial neoplasia

Abbreviations: DIT, digital image technology; FTP, file transfer protocol; JPEG, joint photographic experts group; LAN, local area network; NP, normal appearing prostate; NPadj, normal appearing adjacent to prostate cancer; Npdist, normal appearing distant from cancer; OSC, Optical Sciences Center, Arizona, USA; PCa, prostate cancer; PIN, prostatic intraepithelial neoplasia; POTS, plain old telephone service; ISDN, integrated services digital network; TIFF, tagged image file format

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