Diagnosing minimal adenocarcinoma on prostate needle biopsy by real-time dynamic telepathology through the internet: evaluation of an economic technology for remote consultation.
Computer-aided telepathology was introduced about 10 years ago, but has not yet met with worldwide acceptance. Recently, the internet has been used for image transmission in telepathology. We set up an easily assembled system comprising a common microscope, a charge-coupled device (CCD) camera, a personal computer, and a commercial internet surveillance program with internet accessibility. The consultant then views the real-time images using a common web browser at the remote site. The purpose of the study was to assess the ability of the system to transmit images of sufficient quality to achieve high concordance between the diagnoses made at the home base and at the remote site. We chose cases of minimal adenocarcinoma on prostate needle biopsy, because these lesions are liable to be overlooked and, even if discovered, are subject to differences in interpretation due to their limited size and subtle histologic changes. One hundred prostate needle biopsy specimens, including 45 minimal adenocarcinoma, 11 atypical small acinar proliferation, and 44 benign lesions, were tested. Two pathologists, unaware of the final diagnoses, were recruited to provide intra- and interinstitutional consultation. The overall concordance rates between telepathology diagnoses and final diagnoses were 97% and 94% for the two pathologists, respectively. Our results demonstrate that this method is effective for teleconsultation. Similar systems using the internet can be easily set up by ordinary pathology laboratories to facilitate remote consultation.