Elsevier

Human Pathology

Volume 35, Issue 1, January 2004, Pages 129-135
Human Pathology

Original contribution
Diagnostic accuracy of second-opinion diagnoses based on still images

https://doi.org/10.1016/j.humpath.2003.08.010Get rights and content

Abstract

Second opinion of histological specimens is an important part of the daily routine in anatomic pathology practices. Today, extramural second opinion can be easily obtained by sending still images via an electronic network. The aim of this study was to examine the diagnostic accuracy of second opinion diagnosis based on still images selected from glass slides of 90 archived cases originally referred for extramural second opinion. Two pathologists together diagnosed first the still images (phase 1) and then the glass slides (phase 2). Phase 1 and phase 2 diagnoses were compared with the original second opinion diagnoses (OSODs). The pathologists achieved the same diagnostic results in phase 1 and in phase 2 measured against the OSOD, 67.8% (n = 61) and 68.9% (n = 62) complete agreement, respectively. In 29 cases in phase 1, the diagnoses were discordant with the OSOD. Three cases had incorrect benign diagnoses and 8 cases had incorrect malignant diagnoses. There were 8 false-negative diagnoses regarding malignancy, 6 false-positive diagnoses regarding malignancy, and 4 other discordant diagnoses. Eleven of the 29 discordant diagnoses could have had clinical implications. In interpreting these results, it is important to acknowledge the observer variability in diagnostic histopathology in general. In conclusion, the results support the concept of using still images to obtain second opinion diagnosis.

Section snippets

Case material

The study group comprised 100 cases of histological specimens, originally referred for extramural second opinion by the Department of Pathology, County Hospital of Nordland, consecutively retrieved from the archives.

Still image capture

Two different types of still images were captured at the sender site at the county hospital. One or two birds’ eye images (Figure 1) of the glass slides from each case were selected using a Polaroid SprintScan 35 Film Scanner (maximum resolution, 2700 dpi; Polaroid Corp.,

Case material

Of the 100 cases studied, 10 had not been referred for second opinion. Eight of these 10 cases had been requested by pathology departments at other hospitals because the patients were undergoing further treatment. Thus, 90 cases remained for analysis. Most of these 90 cases had originally been referred to one of three hospitals in Norway (29 cases to University Hospital of Northern Norway, 27 to Norwegian Radium Hospital, and 22 to Ullevål University Hospital).

The cases represented tissues from

Discussion

The importance of second opinion in diagnostic pathology has received much attention recently.14, 15, 16, 17 Access to extramural second opinion through still image communication is a valuable approach if an acceptable degree of diagnostic accuracy can be attained. Despite the existence of limited studies addressing diagnostic accuracy, the use of still images to render second opinions has grown gradually and today is offered by, for example, the Armed Forces Institute of Pathology and the

Acknowledgements

The authors thank The Research Council of Norway for a grant to the project NorTelemed, of which this study has been a part. They also thank Yngve Nyheim and Pål Reidar Fredriksen for technical support, Tormod Brenn for advice on design, and Anna Bofin for linguistically reading the manuscript.

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