International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China.
International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China.
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DOI：
10.4103/2153-3539.170650
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发表时间：
2015
影响因子：
--
通讯作者：
Pantanowitz L
中科院分区：
文献类型：
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作者：
Zhao C;Wu T;Ding X;Parwani AV;Chen H;McHugh J;Piccoli A;Xie Q;Lauro GR;Feng X;Hartman DJ;Seethala RR;Wu S;Yousem S;Liang Y;Pantanowitz L
远程病理学正越来越多地用于支持诊断咨询服务。以前的出版物已经解决了远程病理学的技术方面，而本文将讨论中国最大的独立病理医学实验室KingMed Diagnostics的临床远程病理学经验。从2012年开始，匹兹堡大学医学中心（UPMC）和KingMed Diagnostics合作建立了国际远程病理咨询服务。这是一项回顾性研究，总结了2012年1月至2014年12月3年期间UPMC和KingMed之间的远程病理学经验和诊断会诊结果。共有1 561例病例提交进行远程病理学咨询，包括2012年的144例、2013年的614例和2014年的803例。提交的大多数病例（61.4%）由病理学家转诊，36.9%由临床医生转诊，1.7%由中国患者转诊。血液病理学收到的病例最多（23.7%），其次是骨/软组织（21.0%）和妇科/乳腺（20.2%）亚专业。每个案件的平均周转时间为5.4天，从2012年的6.8天减少到2014年的5.0天。大多数病例需要免疫染色。对于一些疑难病例，需要进行一轮以上的免疫染色，从而延长了达特。在中国当地转诊医院提供初步诊断或印象的855例病例（54.7%）中，UPMC病理学家给出的最终诊断在25.6%的病例中是相同的，在50.8%的病例中有显着修改（治疗计划改变）。这些结果表明，国际远程病理学咨询可以显着改善病人的护理，促进获得病理学专业知识。这项国际数字咨询服务的成功取决于领导层的坚定承诺和支持，信息技术专业知识，以及了解双方语言和文化的专业病理学家。缺乏临床信息、缺少大体病理学描述和提交用于评价的组织切片不足是诊断不明确的主要原因。整体经验鼓励国际远程病理学实践的第二意见。
Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service. This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases. These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated pathologists who understood the language and culture on both sides. Lack of clinical information, missing gross pathology descriptions, and insufficient tissue sections submitted for evaluation were the main reasons for indefinite diagnoses. The overall experience encourages international telepathology practice for second opinions.