Analysis of Errors in Telepathology

AIMS: The routine use of telepathology depends on the exclusion of errors, which are caused by the telepathological technique itself. In this sense telepathology has to be compared with the conventional histological diagnosis. Several studies have been published on this topic. The conditions of these studies are quite different. Our aim is to present a study that especially focuses on error analysis in telepathlogy. MATERIAL AND METHODS: We performed a study on routine frozen sections. Two different telepathology systems have been used: Broadband video-conferencing based on ATM and the TPS telepathology system. We compared conventional frozen section diagnosis and telepathological diagnosis with the paraffin diagnosis. After a first trial we analysed the error sources and improved the set-up of the systems and the workflow. In a second trial half a year later we investigated how the improvements influenced the performance. RESULTS: For frozen section diagnostic false positive errors are most critical. We had one false positive case using the ATM-system. The error analysis showed that more than a half of the errors could not be attributed to telepathology. Most of the errors were sampling errors. The errors, which could be attributed to telepathology concerned mostly the image quality. While analysing this, we found a few things that could be improved in the workflow and in the set-up of the systems, e.g. microscope set-up (TPS); frame rate (ATM). CONCLUSIONS: Several authors compared telepathology with conventional microscopy. The results are different with respect to various technical solutions, different study designs and standard diagnoses. Unfortunately, the reasons for errors and deferrals are rarely given in detail and have not been analysed sufficiently. The error sources we found in our study are comparable to error sources reported by other authors. The correct sampling on the microscopic level and a guaranteed sufficient image quality are the key for a high quality telepathology solution. By an improvement of the settings of the telepathology systems, the microscope and the workflow, it is possible to avoid some wrong diagnoses and deferrals. As a consequence of study, we suggest to monitor the image quality permanently, to sent always an overview image of the whole specimen and to set up the microscope very carefully.