Journal Article
. 2021 Jul; 23(7):e23799.
doi: 10.2196/23799.

Effectiveness of a Cloud-Based Telepathology System in China: Large-Sample Observational Study

Xianying He 1 Linlin Wang 1 Li Wang 2 Jinghong Gao 1 Fangfang Cui 1 Qianqian Ma 1 Wenjie Zhang 1 Lin Wang 1 Yunkai Zhai 3 Jie Zhao 1 
Affiliations
  • PMID: 34326037
  •     37 References

Abstract

Background: Whole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data.

Objective: The main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits.

Methods: Details of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS.

Results: From 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year.

Conclusions: The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.

Keywords: cloud-based system; diagnostic accuracy; economic benefits; telepathology; turnaround time; whole-slide imaging.

A nationwide telepathology consultation and quality control program in China: implementation and result analysis.
Je Chen, Yahui Jiao, +3 authors, Chen Zhou.
Diagn Pathol, 2015 Jan 08; 9 Suppl 1. PMID: 25565398    Free PMC article.
Evaluation of panoramic digital images using Panoptiq for frozen section diagnosis.
Dinesh Pradhan, Sara E Monaco, +3 authors, Liron Pantanowitz.
J Pathol Inform, 2016 May 25; 7. PMID: 27217976    Free PMC article.
Performance evaluation of a dynamic telepathology system (Panoptiq™) in the morphologic assessment of peripheral blood film abnormalities.
R Goswami, D Pi, +2 authors, M Hudoba De Badyn.
Int J Lab Hematol, 2014 Sep 18; 37(3). PMID: 25227659
Overview of Telepathology.
Navid Farahani, Liron Pantanowitz.
Clin Lab Med, 2016 Feb 07; 36(1). PMID: 26851668
Review.
A hybrid approach to telepathology in Cambodia.
Varsha Kadaba, Tho Ly, +4 authors, James Gollogly.
J Telemed Telecare, 2013 Nov 08; 19(8). PMID: 24197402
Frozen section evaluation via dynamic real-time nonrobotic telepathology system in a university cancer center by resident/faculty cooperation team.
Aram Vosoughi, Paul Taylor Smith, +10 authors, Oleksandr N Kryvenko.
Hum Pathol, 2018 May 04; 78. PMID: 29723604
Design and Validation of a Low-Cost Telepathology System.
Bernardo Meléndez-Álvarez, Omar Robayo, Vicente Gil-Guillén, María Carratalá-Munuera.
Telemed J E Health, 2017 May 26; 23(12). PMID: 28537789
Comparative and cost effectiveness of telemedicine versus telephone counseling for smoking cessation.
Kimber P Richter, Theresa I Shireman, +9 authors, Leah Lambart.
J Med Internet Res, 2015 May 10; 17(5). PMID: 25956257    Free PMC article.
Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations.
Kai Ivar Müller, Karl Bjørnar Alstadhaug, Svein Ivar Bekkelund.
J Med Internet Res, 2016 Jun 01; 18(5). PMID: 27241876    Free PMC article.
Development and evaluation of the virtual pathology slide: a new tool in telepathology.
Sean S P Costello, Daniel J Johnston, Peter A Dervan, Daniel G O'Shea.
J Med Internet Res, 2003 Jul 15; 5(2). PMID: 12857667    Free PMC article.
Whole-slide imaging at primary pathological diagnosis: Validation of whole-slide imaging-based primary pathological diagnosis at twelve Japanese academic institutes.
Kazuhiro Tabata, Ichiro Mori, +13 authors, Junya Fukuoka.
Pathol Int, 2017 Oct 06; 67(11). PMID: 28980740
Systematic Review of the Use of Telepathology During Intraoperative Consultation.
Robin L Dietz, Douglas J Hartman, Liron Pantanowitz.
Am J Clin Pathol, 2019 Oct 17; 153(2). PMID: 31618416    Free PMC article.
Systematic Review.
Image Montaging for Creating a Virtual Pathology Slide: An Innovative and Economical Tool to Obtain a Whole Slide Image.
Spoorthi Ravi Banavar, Prashanthi Chippagiri, +2 authors, Premalatha Bidadi Rajashekaraiah.
Anal Cell Pathol (Amst), 2016 Oct 18; 2016. PMID: 27747147    Free PMC article.
Digital pathology is a practical alternative to on-site intraoperative frozen section diagnosis in thoracic surgery.
Jonathan M R French, Daniel T Betney, +5 authors, Douglas G West.
Histopathology, 2018 Dec 12; 74(6). PMID: 30537290
Telepathology overview: from concept to implementation.
R S Weinstein, M R Descour, +9 authors, B E Dunn.
Hum Pathol, 2002 Jan 05; 32(12). PMID: 11774159
Review.
[Ten years of telepathology for a mission hospital in Tanzania].
H-U Völker, H-K Müller-Hermelink, +3 authors, G Stauch.
Pathologe, 2019 Jul 25; 40(5). PMID: 31338564
A static-image telepathology system for dermatopathology consultation in East Africa: the Massachusetts General Hospital Experience.
Devon C Gimbel, Aliyah R Sohani, +4 authors, Rosalynn M Nazarian.
J Am Acad Dermatol, 2012 Feb 22; 67(5). PMID: 22341607
The Eastern Québec Telepathology Network: a three-year experience of clinical diagnostic services.
Bernard Têtu, Émilie Perron, +3 authors, Julien Meyer.
Diagn Pathol, 2015 Jan 08; 9 Suppl 1. PMID: 25564940    Free PMC article.
Validating whole-slide imaging for consultation diagnoses in surgical pathology.
Thomas W Bauer, Renee J Slaw.
Arch Pathol Lab Med, 2014 May 21; 138(11). PMID: 24840034
Quality and practical aspects of pathological and molecular diagnostics in metastatic colorectal cancer (mCRC).
Andrzej Tysarowski, Anna Nasierowska-Guttmejer.
Contemp Oncol (Pozn), 2018 Aug 29; 22(2). PMID: 30150883    Free PMC article.
Review.
Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review.
Isabel de la Torre-Díez, Miguel López-Coronado, +2 authors, Carlos de Castro.
Telemed J E Health, 2014 Dec 05; 21(2). PMID: 25474190    Free PMC article.
Systematic Review.
Telepathology for intraoperative consultations and expert opinions: the experience of the Eastern Québec Telepathology Network.
Emilie Perron, Said Louahlia, +4 authors, Bernard Têtu.
Arch Pathol Lab Med, 2014 Aug 30; 138(9). PMID: 25171705
Pathologic Diagnosis of Pancreatic Adenocarcinoma in the United States: Its Status and Prognostic Value.
Miaozhen Qiu, Huijuan Qiu, +12 authors, Ruihua Xu.
J Cancer, 2016 Apr 15; 7(6). PMID: 27076851    Free PMC article.
ATA clinical guidelines for telepathology.
Liron Pantanowitz, Kim Dickinson, +12 authors, Jordana Bernard.
Telemed J E Health, 2014 Nov 11; 20(11). PMID: 25384254
Telepathology consultation for frozen section diagnosis in China.
Yingxin Huang, Yan Lei, +11 authors, Yongjian Deng.
Diagn Pathol, 2018 May 16; 13(1). PMID: 29759085    Free PMC article.
Digital imaging in cytopathology.
Walid E Khalbuss, Liron Pantanowitz, Anil V Parwani.
Patholog Res Int, 2011 Jul 26; 2011. PMID: 21785680    Free PMC article.
Digital pathology and artificial intelligence.
Muhammad Khalid Khan Niazi, Anil V Parwani, Metin N Gurcan.
Lancet Oncol, 2019 May 03; 20(5). PMID: 31044723
Highly Cited. Review.
Assessment of diagnostic accuracy and feasibility of dynamic telepathology in China.
Xinxia Li, Encong Gong, +5 authors, Jiang Gu.
Hum Pathol, 2007 Oct 24; 39(2). PMID: 17950781
A Trial Study of Static Telepathology in Iran.
Sadrieh Hajesmaeel Gohari, Kambiz Bahaadinbeigy, Reza Malekpour Afshar, Majid Asadi-Shekaari.
Health Care Manag (Frederick), 2018 Jun 30; 37(3). PMID: 29957660
New Technologies: Real-time Telepathology Systems-Novel Cost-effective Tools for Real-time Consultation and Data Sharing.
Gabriel Siegel, Dan Regelman, +2 authors, Abraham Nyska.
Toxicol Pathol, 2017 Dec 14; 45(8). PMID: 29233077
The California Telepathology Service: UCLA's Experience in Deploying a Regional Digital Pathology Subspecialty Consultation Network.
Thomas Chong, M Fernando Palma-Diaz, +10 authors, W Dean Wallace.
J Pathol Inform, 2019 Oct 18; 10. PMID: 31620310    Free PMC article.
Practical applications of Internet resources for cost-effective telepathology practice.
F J Leong.
Pathology, 2002 Feb 06; 33(4). PMID: 11827419
Review.
Whole slide imaging equivalency and efficiency study: experience at a large academic center.
Matthew G Hanna, Victor E Reuter, +17 authors, S Joseph Sirintrapun.
Mod Pathol, 2019 Feb 20; 32(7). PMID: 30778169
Use of mobile high-resolution device for remote frozen section evaluation of whole slide images.
Joel Ramey, Kar Ming Fung, Lewis A Hassell.
J Pathol Inform, 2011 Oct 05; 2. PMID: 21969922    Free PMC article.
Design and Application of a Telemedicine System Jointly Driven by Videoconferencing and Data Exchange: Practical Experience from Henan Province, China.
Yunkai Zhai, Jinghong Gao, +8 authors, Jie Zhao.
Telemed J E Health, 2019 May 06; 26(1). PMID: 31050599
Application of medical information system for telepathology--Georgian experience.
Ekaterina Kldiashvili, Thomas Schrader, Archil Burduli, Gocha Ghortlishvili.
Telemed J E Health, 2010 Jul 14; 16(6). PMID: 20618089
Practical Successes in Telepathology Experiences in Africa.
Nathan D Montgomery, Tamiwe Tomoka, +8 authors, Yuri Fedoriw.
Clin Lab Med, 2018 Feb 08; 38(1). PMID: 29412878    Free PMC article.
Review.