Abstract
Purpose of Review
In this review, we will cover definitions of relevant terms, present need, technologic requirements, regulation, validation, and current and emerging applications of teledermatopathology.
Recent Findings
Numerous studies have found no significant diagnostic discordance between teledermatopathology and glass microscopy in evaluation of melanocytic, non-melanocytic, and inflammatory diagnoses. Teledermatopathology has led to a significant difference in patient management in low-resource settings. Furthermore, studies using static images acquired using smartphones and microscope adapters have high diagnostic concordance with conventional glass slide review.
Summary
Teledermatopathology is a new method to address healthcare disparity in access to dermatopathology services on a local and international level, reduce costs, and further physician education. Adoption of teledermatopathology remains limited by regulatory and remuneration barriers and high cost and storage requirements of initiation.
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References
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Weinstein RS, Holcomb MJ, Krupinski EA. Invention and early history of telepathology (1985-2000). J Pathol Inform. 2019;10:1. https://doi.org/10.4103/jpi.jpi_71_18.
Nakayama I, Matsumura T, Kamataki A, Uzuki M, Saito K, Hobbs J, et al. Development of a teledermatopathology consultation system using virtual slides. Diagn Pathol. 2012;7:177. https://doi.org/10.1186/1746-1596-7-177.
Brauchli K, O'Mahony D, Banach L, Oberholzer M. iPath - a telemedicine platform to support health providers in low resource settings. Stud Health Technol Inf. 2005;114:11–7.
•• Mukhopadhyay S, Feldman MD, Abels E, Ashfaq R, Beltaifa S, Cacciabeve NG, et al. Whole slide imaging versus microscopy for primary diagnosis in surgical pathology: a multicenter blinded randomized noninferiority study of 1992 cases (pivotal study). Am J Surg Pathol. 2018;42(1):39–52. https://doi.org/10.1097/PAS.0000000000000948A blinded randomized non-inferiority study across all organ systems in surgical pathology where WSI was found non-inferior to microscopy in primary diagnosis of surgical pathology.
Hassell LA, Fung KM, Chaser B. Digital slides and ACGME resident competencies in anatomic pathology: an altered paradigm for acquisition and assessment. J Pathol Inform. 2011;2:27. https://doi.org/10.4103/2153-3539.82052.
Lee P, Chen CF, Wan HT, Jian WS, Hsu MH, Syed-Abdul S, et al. iSlide: a 'big picture' interactive teledermatopathology e-learning system. Br J Dermatol. 2015;172(3):692–9. https://doi.org/10.1111/bjd.13274.
Onega T, Reisch LM, Frederick PD, Geller BM, Nelson HD, Lott JP, et al. Use of digital whole slide imaging in Dermatopathology. J Digit Imaging. 2016;29(2):243–53. https://doi.org/10.1007/s10278-015-9836-y.
Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: history, rationale, and current practice. J Am Acad Dermatol. 2015;72(4):563–74; quiz 75-6. https://doi.org/10.1016/j.jaad.2014.07.061.
Saleh J. Practice of teledermatopathology: a systematic review. Am J Dermatopathol. 2018;40(9):667–70. https://doi.org/10.1097/DAD.0000000000001148.
Pantanowitz L, Sharma A, Carter AB, Kurc T, Sussman A, Saltz J. Twenty years of digital pathology: an overview of the road travelled, what is on the horizon, and the emergence of vendor-neutral archives. J Pathol Inform. 2018;9:40. https://doi.org/10.4103/jpi.jpi_69_18.
Meyer J, Pare G. Telepathology impacts and implementation challenges: a scoping review. Arch Pathol Lab Med. 2015;139(12):1550–7. https://doi.org/10.5858/arpa.2014-0606-RA.
Yeung H, Sargen MR, Luk KM, Berry EG, Gurnee EA, Heuring E, et al. Teledermatology and teledermatopathology as educational tools for international dermatology: a virtual grand rounds pilot curriculum. Int J Dermatol. 2018;57(11):1358–62. https://doi.org/10.1111/ijd.14014.
Trudel MC, Pare G, Tetu B, Sicotte C. The effects of a regional telepathology project: a study protocol. BMC Health Serv Res. 2012;12:64. https://doi.org/10.1186/1472-6963-12-64.
Global Health Observatory data repository [database on the Internet]. World Health Organization. 2019. Available from: http://apps.who.int/gho/data/node.main.HWFGRP_0020?lang=en. Accessed 10/03/2019.
Hitchcock CL. The future of telepathology for the developing world. Arch Pathol Lab Med. 2011;135(2):211–4. https://doi.org/10.1043/1543-2165-135.2.211.
Tsang MW, Kovarik CL. Global access to dermatopathology services: physician survey of availability and needs in sub-Saharan Africa. J Am Acad Dermatol. 2010;63(2):346–8. https://doi.org/10.1016/j.jaad.2009.09.038.
Fischer MK, Kayembe MK, Scheer AJ, Introcaso CE, Binder SW, Kovarik CL. Establishing telepathology in Africa: lessons from Botswana. J Am Acad Dermatol. 2011;64(5):986–7. https://doi.org/10.1016/j.jaad.2010.05.032.
Nguyen A, Tran D, Uemura M, Bardin RL, Shitabata PK. Practical and sustainable teledermatology and teledermatopathology: specialty care in Cameroon Africa. J Clin Aesthet Dermatol. 2017;10(1):47–56.
Tsang MW, Kovarik CL. The role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African teledermatology project. Int J Dermatol. 2011;50(2):150–6. https://doi.org/10.1111/j.1365-4632.2010.04790.x.
Morenz AM, Wescott S, Mostaghimi A, Sequist TD, Tobey M. Evaluation of barriers to telehealth programs and dermatological care for American Indian individuals in rural communities. JAMA Dermatol. 2019. https://doi.org/10.1001/jamadermatol.2019.0872.
Riedl E, Asgari M, Alvarez D, Margaritescu I, Gottlieb GJ. A study assessing the feasibility and diagnostic accuracy of real-time teledermatopathology. Dermatol Pract Concept. 2012;2(2):202a02. https://doi.org/10.5826/dpc.0202a02.
Ho J, Ahlers SM, Stratman C, Aridor O, Pantanowitz L, Fine JL, et al. Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization. J Pathol Inform. 2014;5(1):33. https://doi.org/10.4103/2153-3539.139714.
Isaacs M, Lennerz JK, Yates S, Clermont W, Rossi J, Pfeifer JD. Implementation of whole slide imaging in surgical pathology: a value added approach. J Pathol Inform. 2011;2:39. https://doi.org/10.4103/2153-3539.84232.
Abels E, Pantanowitz L. Current state of the regulatory trajectory for whole slide imaging devices in the USA. J Pathol Inform. 2017;8:23. https://doi.org/10.4103/jpi.jpi_11_17.
• Gutman DA, Khalilia M, Lee S, Nalisnik M, Mullen Z, Beezley J, et al. The digital slide archive: a software platform for management, integration, and analysis of histology for cancer research. Cancer Res. 2017;77(21):e75–e8. https://doi.org/10.1158/0008-5472.CAN-17-0629The Digital Slide Archive is an open-source digital pathology platform developed to help investigators to manage large collections of histologic images and their associate clinical and genomic metadata.
Singh R, Chubb L, Pantanowitz L, Parwani A. Standardization in digital pathology: supplement 145 of the DICOM standards. J Pathol Inform. 2011;2:23. https://doi.org/10.4103/2153-3539.80719.
Auguste L, Palsana D. Mobile whole slide imaging (mWSI): a low resource acquisition and transport technique for microscopic pathological specimens. BMJ Innov. 2015;1(3):137–43. https://doi.org/10.1136/bmjinnov-2015-000040.
Hiemenz MC, Leung ST, Park JY. Crossing boundaries: a comprehensive survey of medical licensing laws and guidelines regulating the interstate practice of pathology. Am J Surg Pathol. 2014;38(3):e1–5. https://doi.org/10.1097/PAS.0000000000000168.
Interstate Medical Licensure Compact. Online. https://imlcc.org/. Accessed 10/19/2019.
State Telehealth Laws & Reimbursement Laws. The Center for Connected Health Policy, Online. https://www.cchpca.org. Accessed 10/01/2019.
Authority of Health Care Providers To Practice Telehealth. Federal Register, Online. 2018. https://www.federalregister.gov/documents/2018/05/11/2018-10114/authority-of-health-care-providers-to-practice-telehealth. Accessed 10/19/2019.
Giambrone D, Rao BK, Esfahani A, Rao S. Obstacles hindering the mainstream practice of teledermatopathology. J Am Acad Dermatol. 2014;71(4):772–80. https://doi.org/10.1016/j.jaad.2014.04.043.
Marsch AF, Feinberg JS. State restrictions on the interstate practice of dermatopathology are unconstitutional: the tissue is the issue. J Cutan Pathol. 2015;42(10):669–73. https://doi.org/10.1111/cup.12505.
Cornish TC, McClintock DS. Medicolegal and regulatory aspects of whole slide imaging-based telepathology. Diagn Histopathol. 2014;20(12):475–81. https://doi.org/10.1016/j.mpdhp.2014.10.004.
Marsch A, High WA. Teledermatology, teledermatopathology, interstate dermatopathology and the law. Semin Cutan Med Surg. 2013;32(4):224–9.
Leinweber B, Massone C, Kodama K, Kaddu S, Cerroni L, Haas J, et al. Teledermatopathology: a controlled study about diagnostic validity and technical requirements for digital transmission. Am J Dermatopathol. 2006;28(5):413–6. https://doi.org/10.1097/01.dad.0000211523.95552.86.
Al Habeeb A, Evans A, Ghazarian D. Virtual microscopy using whole-slide imaging as an enabler for teledermatopathology: a paired consultant validation study. J Pathol Inform. 2012;3:2. https://doi.org/10.4103/2153-3539.93399.
Shah KK, Lehman JS, Gibson LE, Lohse CM, Comfere NI, Wieland CN. Validation of diagnostic accuracy with whole-slide imaging compared with glass slide review in dermatopathology. J Am Acad Dermatol. 2016;75(6):1229–37. https://doi.org/10.1016/j.jaad.2016.08.024.
Fertig RM, Gaudi S, Cervantes J, Maddy A, Sangueza O, Vu J, et al. Feasibility study in teledermatopathology: an examination of the histopathologic features of mycosis fungoides and spongiotic dermatitis. J Cutan Pathol. 2017;44(11):919–24. https://doi.org/10.1111/cup.13018.
Sargen MR, Luk KM, Stoff BK, MacKelfresh J, Patrawala S, Zhang C, et al. Diagnostic accuracy of whole slide imaging for cutaneous, soft tissue, and melanoma sentinel lymph node biopsies with and without immunohistochemistry. J Cutan Pathol. 2018;45(8):597–602. https://doi.org/10.1111/cup.13268.
• Lee JJ, Jedrych J, Pantanowitz L, Ho J. Validation of digital pathology for primary histopathological diagnosis of routine, inflammatory dermatopathology cases. Am J Dermatopathol. 2018;40(1):17–23. https://doi.org/10.1097/DAD.0000000000000888This is a prospective side-by-side validation study comparing WSI and traditional microscopy with a focus on inflammatory dermatopathology. Both modalities could adequately identify over 300 microscopic features important for diagnosis.
Piccolo D, Soyer HP, Burgdorf W, Talamini R, Peris K, Bugatti L, et al. Concordance between telepathologic diagnosis and conventional histopathologic diagnosis: a multiobserver store-and-forward study on 20 skin specimens. Arch Dermatol. 2002;138(1):53–8. https://doi.org/10.1001/archderm.138.1.53.
Okada DH, Binder SW, Felten CL, Strauss JS, Marchevsky AM. "Virtual microscopy" and the internet as telepathology consultation tools: diagnostic accuracy in evaluating melanocytic skin lesions. Am J Dermatopathol. 1999;21(6):525–31. https://doi.org/10.1097/00000372-199912000-00004.
Vyas NS, Markow M, Prieto-Granada C, Gaudi S, Turner L, Rodriguez-Waitkus P, et al. Comparing whole slide digital images versus traditional glass slides in the detection of common microscopic features seen in dermatitis. J Pathol Inform. 2016;7:30. https://doi.org/10.4103/2153-3539.186909.
Berman B, Elgart GW, Burdick AE. Dermatopathology via a still-image telemedicine system: diagnostic concordance with direct microscopy. Telemed J. 1997;3(1):27–32. https://doi.org/10.1089/tmj.1.1997.3.27.
Velez N, Jukic D, Ho J. Evaluation of 2 whole-slide imaging applications in dermatopathology. Hum Pathol. 2008;39(9):1341–9. https://doi.org/10.1016/j.humpath.2008.01.006.
Massone C, Soyer HP, Lozzi GP, Di Stefani A, Leinweber B, Gabler G, et al. Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system. Hum Pathol. 2007;38(4):546–54. https://doi.org/10.1016/j.humpath.2006.10.006.
Williams BJ, DaCosta P, Goacher E, Treanor D. A systematic analysis of discordant diagnoses in digital pathology compared with light microscopy. Arch Pathol Lab Med. 2017;141(12):1712–8. https://doi.org/10.5858/arpa.2016-0494-OA.
Morgan MB, Tannenbaum M, Smoller BR. Telepathology in the diagnosis of routine dermatopathologic entities. Arch Dermatol. 2003;139(5):637–40. https://doi.org/10.1001/archderm.139.5.637.
Della Mea V, Puglisi F, Forti S, Delendi M, Boi S, Mauri F, et al. Expert pathology consultation through the internet: melanoma versus benign melanocytic tumours. J Telemed Telecare. 1997;3(Suppl 1):17–9. https://doi.org/10.1258/1357633971930841.
Koch LH, Lampros JN, Delong LK, Chen SC, Woosley JT, Hood AF. Randomized comparison of virtual microscopy and traditional glass microscopy in diagnostic accuracy among dermatology and pathology residents. Hum Pathol. 2009;40(5):662–7. https://doi.org/10.1016/j.humpath.2008.10.009.
Weinstein LJ, Epstein JI, Edlow D, Westra WH. Static image analysis of skin specimens: the application of telepathology to frozen section evaluation. Hum Pathol. 1997;28(1):30–5. https://doi.org/10.1016/s0046-8177(97)90275-6.
Nielsen PS, Lindebjerg J, Rasmussen J, Starklint H, Waldstrom M, Nielsen B. Virtual microscopy: an evaluation of its validity and diagnostic performance in routine histologic diagnosis of skin tumors. Hum Pathol. 2010;41(12):1770–6. https://doi.org/10.1016/j.humpath.2010.05.015.
Mooney E, Hood AF, Lampros J, Kempf W, Jemec GB. Comparative diagnostic accuracy in virtual dermatopathology. Skin Res Technol. 2011;17(2):251–5. https://doi.org/10.1111/j.1600-0846.2010.00493.x.
Mooney E, Kempf W, Jemec GB, Koch L, Hood A. Diagnostic accuracy in virtual dermatopathology. J Cutan Pathol. 2012;39(8):758–61. https://doi.org/10.1111/j.1600-0560.2012.01931.x.
Gimbel DC, Sohani AR, Prasad Busarla SV, Kirimi JM, Sayed S, Okiro P, et al. A static-image telepathology system for dermatopathology consultation in East Africa: the Massachusetts General Hospital experience. J Am Acad Dermatol. 2012;67(5):997–1007. https://doi.org/10.1016/j.jaad.2011.12.036.
• Ismail A, McMichael JR, Stoff BK. Utility of international store-and-forward teledermatopathology among a cohort of mostly female patients at a tertiary referral center in Afghanistan. Int J Women’s Dermatol. 2018;4(2):83–6. https://doi.org/10.1016/j.ijwd.2017.10.011This is a retrospective review of four-years of S&F TDP using static images from a tertiary referral center in Afghanistan. S&F TDP led to a significant difference in care in 19.3% (27/140) cases.
Zhao C, Wu T, Ding X, Parwani AV, Chen H, McHugh J, et al. International telepathology consultation: three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China. J Pathol Inform. 2015;6:63. https://doi.org/10.4103/2153-3539.170650.
Micheletti RG, Steele KT, Kovarik CL. Robotic teledermatopathology from an African dermatology clinic. J Am Acad Dermatol. 2014;70(5):952–4. https://doi.org/10.1016/j.jaad.2014.01.861.
Pantanowitz L, Sinard JH, Henricks WH, Fatheree LA, Carter AB, Contis L, et al. Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center. Arch Pathol Lab Med. 2013;137(12):1710–22. https://doi.org/10.5858/arpa.2013-0093-CP.
Bellina L, Missoni E. Mobile cell-phones (M-phones) in telemicroscopy: increasing connectivity of isolated laboratories. Diagn Pathol. 2009;4:19. https://doi.org/10.1186/1746-1596-4-19.
Shahriari N, Grant-Kels J, Murphy MJ. Dermatopathology education in the era of modern technology. J Cutan Pathol. 2017;44(9):763–71. https://doi.org/10.1111/cup.12980.
Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part II: emerging technologies in teledermatology, limitations and future directions. J Am Acad Dermatol. 2015;72(4):577–86; quiz 87-8. https://doi.org/10.1016/j.jaad.2014.08.014.
Speiser JJ, Hughes I, Mehta V, Wojcik EM, Hutchens KA. Mobile teledermatopathology: using a tablet PC as a novel and cost-efficient method to remotely diagnose dermatopathology cases. Am J Dermatopathol. 2014;36(1):54–7. https://doi.org/10.1097/DAD.0b013e3182863186.
Lehman JS, Gibson LE. Smart teledermatopathology: a feasibility study of novel, high-value, portable, widely accessible and intuitive telepathology methods using handheld electronic devices. J Cutan Pathol. 2013;40(5):513–8. https://doi.org/10.1111/cup.12108.
• Laggis CW, Bailey EE, Novoa R, Stewart CL, Stoff B, Wanat KA, et al. Validation of image quality and diagnostic accuracy using a mobile phone camera microscope adaptor compared with glass slide review in teledermatopathology. Am J Dermatopathol. 2019. https://doi.org/10.1097/DAD.0000000000001529Diagnostic accuracy of S&F TDP was assessed using an iPhone mobile phone microscope adapter and static images compared to conventional glass slide review for inflammatory or infectious lesions. Intraobserver concordance rate was 93.3%.
Ekong D, Liu F, Brown GT, Ghosh A, Fontelo P. Evaluation of android smartphones for telepathology. J Pathol Inform. 2017;8:16. https://doi.org/10.4103/jpi.jpi_93_16.
• Fraggetta F, Yagi Y, Garcia-Rojo M, Evans AJ, Tuthill JM, Baidoshvili A, et al. The importance of eSlide Macro Images for primary diagnosis with whole slide imaging. J Pathol Inform. 2018;9:46. https://doi.org/10.4103/jpi.jpi_70_18The authors demonstrate that inclusion of a “macro image” of the entire glass slide in TDP can act as useful internal quality control.
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Wolner, Z.J., Brahmbhatt, M. & Stoff, B.K. “Teledermatopathology: A Review”. Curr Derm Rep 9, 123–130 (2020). https://doi.org/10.1007/s13671-020-00299-x
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DOI: https://doi.org/10.1007/s13671-020-00299-x