Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a twelve year experience

Since mid-1996 we have operated a diagnostic robotic telepathology (TP) system at the Iron Mountain, Michigan, Department of Veterans Affairs Medical Center (VAMC) from the Milwaukee, Wisconsin VAMC, located some 220 miles away. No on-site pathologist is present in Iron Mountain. Instead, an experienced, well-trained pathologist assistant, under direction of pathologists located in Milwaukee, is responsible for tissue grossing and sectioning. The pathologist assistant places slides onto the stage of the robotic microscope, which is then controlled by pathologists in Milwaukee. Each case read by TP is subsequently read by light microscopy (LM) by the same pathologist. Three distinct phases of TP have been recognized. Our experience during Phase I (mid-1996 through early 1999) has been published previously. During Phase II (early 1999 through mid-2004), one of the two senior telepathologists in Phase I retired and three junior pathologists were hired. During Phase III (mid-2004 though June 2008), two new junior pathologists were hired and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was implemented. The number of TP case opportunities in Phases I, II and III was 2,200; 5,841 and 3,512; respectively resulting in a total of 11,553. A total of 1,834 cases were deferred to LM for a variety of reasons. The number of TP diagnoses rendered in Phases I, II and III was 2,144; 4,636 and 2,939; respectively, for a total of 9,719. The major discordance rates in Phases I, II and III were 0.33%, 0.45% and 0.20%, respectively with an overall rate of 0.35%. Pathologist-specific discordance rates were not significantly different and ranged from a low of 0.12% to a high of 0.77%, while case deferral rates were significantly different (P < 0.0001) and ranged from 2.5% to 28.7%. In general, no relationship between deferral rate and discordance rate was noted. Iron Mountain clinicians have expressed great satisfaction with the services provided by their off-site pathologist colleagues.

Keywords: Telepathology, Robotic telepathology, Hybrid dynamic/store-and-forward telepathology, Surgical pathology, Diagnostic discordance