Validation of Remote Digital Pathology based diagnostic reporting of Frozen Sections from home

BACKGROUND: Despite the promising applications of whole-slide imaging (WSI) for frozen section (FS) diagnosis, its adoption for remote reporting is limited. OBJECTIVE: To assess the feasibility and performance of home-based remote digital consultation for FS diagnosis. MATERIAL & METHOD: Cases accessioned beyond regular working hours (5 pm–10 pm) were reported simultaneously using optical microscopy (OM) and WSI. Validation of WSI for FS diagnosis from a remote site, i.e. home, was performed by 5 pathologists. Cases were scanned using a portable scanner (Grundium Ocus®40) and previewed on consumer-grade computer devices through a web-based browser (http://grundium.net). Clinical data and diagnostic reports were shared through a google spreadsheet. The diagnostic concordance, inter- and intra-observer agreement for FS diagnosis by WSI versus OM, and turnaround time (TAT), were recorded. RESULTS: The overall diagnostic accuracy for OM and WSI (from home) was 98.2% (range 97%–100%) and 97.6% (range 95%–99%), respectively, when compared with the reference standard. Almost perfect inter-observer (k = 0.993) and intra-observer (k = 0.987) agreement for WSI was observed by 4 pathologists. Pathologists used consumer-grade laptops/desktops with an average screen size of 14.58 inches (range = 12.3–17.7 inches) and a network speed of 64 megabits per second (range: 10–90 Mbps). The mean diagnostic assessment time per case for OM and WSI was 1:48 min and 5:54 min, respectively. Mean TAT of 27.27 min per case was observed using WSI from home. Seamless connectivity was observed in approximately 75% of cases. CONCLUSION: This study validates the role of WSI for remote FS diagnosis for its safe and efficient adoption in clinical use.