Application of virtual microscopy in consultation practice of gastrointestinal and liver pathology
Shriram M. Jakate · Journal of Pathology Informatics · 2010
For several years now, virtual microscopy has been utilized in medical teaching, research, proficiency testing, American Board of Pathology examinations, pathology meetings and conferences, and quality assurance programs. In diagnostic practice, it is most widely and routinely used in image analysis. Some practices are beginning to use it internally (within their group) for frozen section intraoperative consultations and subspecialty consultations due to geographic and time constrains. Although diagnostic consultation for expert second opinion is a well-established practice in pathology for glass slides, similar consultation via virtual microscopy poses multiple controversial issues such as licensing, liability, security, reimbursement, and scanning quality and its validation. Regulations and standardization are not yet in place that pathologists can use to allay these fears. Nevertheless, if the virtual microscopy scans are of optimal quality, these can be simply substituted for glass slides and a microscope while maintaining all other practice guidelines for second opinion consultation. Additionally, the cost and maintenance of scanning equipment is not currently affordable to most practitioners and consultants. A practice model that offers tertiary consultation in gastrointestinal (GI) and liver pathology is presented that eliminates the cost and maintenance of scanners by the consultants and clients, minimizes the need for review of glass slides, facilitates clinicopathological and radiological correlation and serves the need of clients who need timely help with challenging liver and GI cases and to obtain expert opinion for dysplasia in Barrett’s and ulcerative colitis surveillance biopsies required by the American Gastroenterology Association (AGA). This model has been practiced for 3 years and applied to over 2000 cases by small pathology practices in the 50 United States and a single consultant GI and liver pathologist.