Digital pathology is a practical alternative to on‐site intra‐operative frozen section diagnosis in thoracic surgery

Abstract

Introduction

Telepathology uses digitised image transfer to allow off‐site reporting of histopathology slides. This technology could facilitate the centralisation of pathology services, which may improve their quality and cost‐effectiveness. The benefits may be most apparent in frozen section reporting, where turnaround times are vital. We moved from onsite to offsite telepathology reporting of thoracic surgery frozen section specimens in 2016. This study compares turnaround times (TAT) before and after this service change.

Method

All thoracic frozen section specimens analysed 4 months prior and 4 months following the service change were included. Demographics, operation, sample type, time taken from theatre, time received by lab, time reported by lab, TAT, frozen section diagnosis, final histopathological diagnosis, and final TNM staging were recorded. Results were analysed using SPSS statistical software version 24.

Results

In total there were 65 samples from 59 patients; 34 before, and 31 after the change. Specimens included 51 lung, 6 lymph node, 3 bronchial, 3 chest wall, and 2 pleural biopsies.

Before the change, the median TAT was 25 (IQR 20‐33) minutes. No diagnoses were deferred. No diagnoses were changed on subsequent paraffin analysis.

After the change, using digital pathology, the median TAT was 27.5 (IQR 21.75‐38.5) minutes. This difference was not significant (p=0.581). Diagnosis was deferred in one case (3.23%). There was one (3.23%) mid‐case technical failure where the sample had to be transported by courier, resulting in a TAT of 106 mins. No diagnoses were changed on subsequent paraffin analysis.

Conclusion

There was no significant difference in reporting times using digital technology compared with an on‐site service, although one sample was affected by a technical failure requiring physical transportation of the specimen for analysis. Our study was underpowered to detect differences in accuracy.

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