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PURPOSE: To investigate the use of super-resolution imaging techniques to enable telepathology using low-cost commercial cameras. DESIGN: Experimental study. PARTICIPANTS: A total of 139 ophthalmic pathology slides obtained from the Ophthalmic Pathology service at the University of California, Irvine. METHODS: Denoising Diffusion Probabilistic Model (DDPM) was developed to predict super-resolution pathology slide images from low-resolution inputs. The model was pretrained using 150 000 images randomly sampled from the ImageNet dataset. Patch aggregation was used to generate large images with DDPM. The performance of DDPM was evaluated against that of generative adversarial networks (GANs) and Robust UNet, which were also trained on the same dataset. MAIN OUTCOME MEASURES: The performance of models trained to generate super-resolution output images from low-resolution input images can be evaluated by using the mean squared error (MSE) and Structural Similarity Index Measure (SSIM), as well as subjective grades provided by expert pathologist graders. RESULTS: In total, our study included 110 training images, 9 validation images, and 20 testing images. The objective performance scores were averaged over patches generated from 20 test images. The DDPM-based approach with pretraining produced the best results, with an MSE score of 1.35e-5 and an SSIM score of 0.8987. A qualitative analysis of super-resolution images was conducted by expert 3 pathologists and 1 expert ophthalmic microscopist, and the average accuracy of identifying the correct ground truth images ranged from 25% to 70% (with an average accuracy of 46.5%) for widefield images and 25% to 60% (with an average accuracy of 38.25%) for individual patches. CONCLUSIONS: The DDPM-based approach with pretraining is assessed to be effective at super-resolution prediction for ophthalmic pathology slides both in terms of objective and subjective measures. The proposed methodology is expected to decrease the reliance on costly slide scanners for acquiring high-quality pathology slide images, while also streamlining clinical workflow and expanding the scope of ophthalmic telepathology. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Telecytology (TC) has the advantage of allowing cytopathologists to remotely support multiple sites rapid on-site evaluation (ROSE) concurrently and represents a potential solution for an increased clinical demand for ROSE. In this study, we share our comparative experience of using TC versus conventional (in-person) ROSE for endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA). We evaluated 475 consecutive cases of EBUS-FNA that underwent TC-ROSE from May 2020 to August 2021 along with 475 consecutive cases which had conventional ROSE from November 2019 to August 2021 at the University of Michigan. Concordant rates of preliminary and final diagnoses were calculated and compared between TC and conventional methods. While there was no significant difference in preliminary diagnostic rates of nondiagnostic, benign, atypical, and malignant categories between the TC and conventional cohorts, a significantly lower proportion of TC cases received a preliminary suspicious for malignancy diagnosis (2%) compared to the conventional group (4%) (P = 0.03). The concordance rate of preliminary and final diagnoses in TC and conventional ROSE was 96% and 94%, respectively. The average total number of passes per procedure did not differ significantly between TC and conventional ROSE (4.9 versus 4.7). While a relatively higher number of TC-ROSE cases collected dedicated passes compared with conventional ROSE (49% versus 40%), the difference was not statistically significant. The performance of TC-ROSE for EBUS-FNA is comparable to that of conventional ROSE with similar performance metrics and therefore can be used as a feasible substitute. • Real-time feedback during endobronchial ultrasound-guided fine needle aspiration (EBUS-FNA) provided by rapid on-site evaluation (ROSE), is invaluable for optimizing specimen collection and triage. • However, EBUS-FNA can be time-consuming, posing challenges in time management of cytopathologists, especially in academic centers where demand for ROSE is high and cytopathologists may need to cover multiple procedure sites. • TC-ROSE has the potential to address this challenge. • Nevertheless, concerns have arisen regarding an increased discordance rate between preliminary diagnosis and final diagnosis when using TC-ROSE. • Our study demonstrates that the performance of TC ROSE for EUS-FNA is comparable to that of conventional ROSE, with similar performance metrics and therefore can be used as a feasible substitute. [ABSTRACT FROM AUTHOR]

Postmortem examination of deceased production animals with appropriate ancillary testing is fundamental to determining causes of morbidity and mortality. Reaching a definitive diagnosis is crucial to evidence-based herd management and treatment decisions that safeguard animal health and welfare, food safety, and human health. However, for a range of reasons, carcasses sometimes cannot be examined in a veterinary diagnostic laboratory. As a result, postmortem examinations of farmed animals, including cattle, are often performed on-farm by the referring veterinarian (rVet) with tissue samples submitted to a veterinary diagnostic laboratory for ancillary testing. For various reasons, field postmortems can be associated with lower diagnostic rates. We investigated real-time pathologist-assisted field postmortem examination (rtPAP) assistance to beef cattle rVets to gauge any improvement in attaining a final diagnosis. We found that rtPAPs improved the success of reaching a final diagnosis compared to unassisted field postmortem examinations. Both the participating bovine rVets and the pathologists saw benefits to the rtPAPs, with bovine rVets indicating that they would utilize this service in the future if available. Our proof-of-concept study demonstrated the positive role of rtPAPs in diagnosing beef cattle disease and speaks to the need for telepathology services supporting food animal rVets and producers. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic in 2020 posed significant communication challenges, especially in the healthcare sector. Telepathology provides a valuable means for healthcare providers to communicate. This study investigated the key challenges and benefits of telepathology in education through a systematic review of relevant studies conducted during this period. Methods This systematic review was conducted in 2022. We utilized databases, including PubMed, Google Scholar and ScienceDirect. Our search was performed from 7 February 2022 to 13 February 2022. We selected articles based on inclusion criteria and used the Critical Appraisal Skills Program checklist to assess study strengths and limitations. We extracted data using a checklist and synthesized the results narratively. Results We initially identified 125 articles, and after screening, 15 were included in the study. These studies reported various challenges, including cost, technology, communication problems, educational difficulties, time wasting, legal issues and family distraction problems. Conversely, studies mentioned benefits, such as care improvement, better education, time efficiency, proper communication, cost and technology advancement. Conclusions The results of this study will help future efforts and investigations to implement and set up telepathology. Based on our review, despite the challenges, the benefits of telepathology in education are greater than these obstacles, indicating its potential for future use. [ABSTRACT FROM AUTHOR]

Telepathology and digital pathology, enhanced with artificial intelligence (AI), represent groundbreaking technology advancements. These entities offer information exchange, enhanced teaching and research, and automated diagnosis with high precision through a computerized approach. Machine learning in pathology shows promise for both human and veterinary medicine, yielding favorable results and in some cases, surpassing the accuracy of human pathologists. This study aimed to highlight the significance of integrated AI with telepathology and digital pathology, outlining both its advantages and limitations while emphasizing the crucial role of pathologists in its implementation. A literature review was conducted to uncover publications and data on telepathology and AI, and their implementation in human and veterinary medicine. This approach has facilitated information exchange, enhancing both teaching and research. In addition, it facilitates the creation of innovative methods and offers more precise patient diagnoses, adhering to ethical and legal standards. This study delivers valuable and comparable data on telepathology, digital pathology, and AI integration. Given the continually emerging nature of these technologies, further studies are essential for their application to human and veterinary medicine.

Telepathology and digital pathology, enhanced with artificial intelligence (AI), represent groundbreaking technology advancements. These entities offer information exchange, enhanced teaching and research, and automated diagnosis with high precision through a computerized approach. Machine learning in pathology shows promise for both human and veterinary medicine, yielding favorable results and in some cases, surpassing the accuracy of human pathologists. This study aimed to highlight the significance of integrated AI with telepathology and digital pathology, outlining both its advantages and limitations while emphasizing the crucial role of pathologists in its implementation. A literature review was conducted to uncover publications and data on telepathology and AI, and their implementation in human and veterinary medicine. This approach has facilitated information exchange, enhancing both teaching and research. In addition, it facilitates the creation of innovative methods and offers more precise patient diagnoses, adhering to ethical and legal standards. This study delivers valuable and comparable data on telepathology, digital pathology, and AI integration. Given the continually emerging nature of these technologies, further studies are essential for their application to human and veterinary medicine. [ABSTRACT FROM AUTHOR]

This paper explores the role of teledermatology (TD) in Mohs micrographic surgery (MMS) at various stages of patient care. The study aims to assess the benefits, limitations, and patient experiences surrounding TD integration into MMS practices. We conducted a PubMed search using keywords related to TD and MMS, categorizing selected articles into pre-operative, intra-operative, and post-operative stages of MMS. TD reduced waiting times (26.10 days for TD compared to 60.57 days for face-to-face [FTF]) and consultation failure rates (6% for TD vs. 17% for FTF) for MMS preoperative consultations. It also shortened time to treatment by two weeks and led to notable travel savings (162.7 min, 144.5 miles, and $60.00 per person). Telepathology facilitated communication and decision-making during MMS, improving accuracy and efficiency, especially in challenging cases requiring collaboration where physical presence of another surgeon or pathologist is not feasible. Telepathology definitively diagnosed benign lesions and malignant tumors in 81.8% of cases (18/22). Additionally, there was a 95% agreement between conventional light microscopy diagnosis and telepathology in tumors (19/20), and 100% agreement for all 20 Mohs frozen section consultations. For post-operative follow-up, telephone follow-up (TFU) and text messaging proved effective, cost-efficient alternatives with high patient satisfaction (94% in New Zealand and 96% in the U.K.) and early complication identification. This study underscores TD's multifaceted benefits in MMS: enhanced patient experience preoperatively, improved communication during surgery, and cost-effective postoperative follow-up. Limitations include the financial expense and technical issues that can arise with TD (connectivity problems, delays in video/audio transmission, etc.). Further studies are needed to explore emerging TD modalities in post-operative patient management. The integration of TD into MMS signifies a progressive step in dermatological care, offering convenient, cost-effective, and better solutions with the potential to enhance patient experiences and outcomes. [ABSTRACT FROM AUTHOR]

Telepathology, as a subset of teleconsulting, is pathology interpretation performed at a distance. Telepathology is not a new phenomenon, but since ~2015, significant advances in information technology and telecommunications coupled with the pandemic have led to unprecedented sophistication, accessibility, and use of telepathology in human and veterinary medicine. Furthermore, telepathology can connect veterinary practices to distant laboratories and provide support for underserved animals and communities. Through our scoping review, we provide an overview of how telepathology is being used in veterinary medicine, identify gaps in the literature, and highlight future areas of research and service development. We searched MEDLINE, CAB Abstracts, and the gray literature, and included all relevant literature. Despite the widespread use of digital microscopy in large veterinary diagnostic laboratories, we identified a paucity of literature describing the use of telepathology in veterinary medicine, with a significant gap in studies addressing the validation of whole-slide imaging for primary diagnosis. Underutilization of telepathology to support postmortem examinations conducted in the field was also identified, which indicates a potential area for service development. The use of telepathology is increasing in veterinary medicine, and pathologists must keep pace with the changing technology, ensure the validation of innovative technologies, and identify novel uses to advance the profession. [ABSTRACT FROM AUTHOR]

Telepathology facilitates histological diagnoses through sharing expertise between pathologists. However, the associated costs are high and frequently prohibitive, especially in low-resource settings, where telepathology would paradoxically be of paramount importance due to a paucity of pathologists. We have constructed a telepathology system (TelePi) with a budget of < €120 using the small, single-board computer Raspberry Pi Zero and its High-Quality Camera Module in conjunction with a standard microscope and open-source software. The system requires no maintenance costs or service contracts, has a small footprint, can be moved and shared across several microscopes, and is independent from other computer operating systems. TelePi uses a responsive and high-resolution web-based live stream which allows remote consultation between two or more locations. TelePi can serve as a telepathology system for remote diagnostics of frozen sections. Additionally, it can be used as a standard microscope camera for teaching of medical students and for basic research. The quality of the TelePi system compared favorable to a commercially available telepathology system that exceed its cost by more than 125-fold. Additionally, still images are of publication quality equal to that of a whole slide scanner that costs 800 times more. In summary, TelePi is an affordable, versatile, and inexpensive camera system that potentially enables telepathology in low-resource settings without sacrificing image quality. [ABSTRACT FROM AUTHOR]

Simple Summary: Due to the fast changes in the availability of new technologies, partially accelerated by COVID-19, veterinarians and veterinary students faced the challenges of digital learning technologies embedded in practical laboratories. In particular, veterinary pathology courses transitioned from traditional methods to digital pathology, the viewing of slides on a computer screen. The aims of this study are to evaluate and compare the personal effectiveness and satisfaction, as well as the advantages and disadvantages of digital pathology, specifically digital cytology, as a teaching method among European veterinary students at the undergraduate and postgraduate level who attended digital pathology courses during and before the pandemic. Digital cytology refers to the visualisation of cytological samples on a screen. A Google Form survey consisting of 11 multiple-choice questions was emailed to pathology teachers and distributed to their students. From our results, the main differences emerged in training, the disadvantages of digital cytology, and the preferred method of learning cytology. Finally, all students consider digital cytology as a satisfactory primary teaching methodology; however, the importance of not completely replacing light microscopy, a common tool in everyday veterinary practice, emerged, especially from postgraduate students. The COVID-19 pandemic accelerated technological changes in veterinary education, particularly in clinical pathology and anatomic pathology courses transitioning from traditional methods to digital pathology (DP). This study evaluates the personal effectiveness and satisfaction, as well as the advantages and disadvantages, of DP, in particular digital cytology (DC), as a teaching method among European veterinary students, both at the undergraduate and postgraduate level, who attended digital pathology courses during and before the pandemic. A further aim is to discuss the differences between the two student groups. A Google Form survey consisting of 11 multiple-choice questions was emailed to pathology teachers and distributed to their students. Results indicated that undergraduate students showed greater digital pathology training, favouring DC as the most effective learning modality. In contrast, postgraduate students reported less digital slide training, and their preference for learning cytology was split between DC alone and DC integrated with traditional microscopy. All students experienced whole slide imaging for learning cytology slides prevalently, and they stated that DC enhanced their learning experience. While DC demonstrates personal effectiveness and satisfaction as a teaching method, it is important to not replace pathology training with light microscopy completely, as almost a third of the students indicated. [ABSTRACT FROM AUTHOR]

Backgroundhistopathology plays a pivotal role in clinical diagnosis, research, and medical education. In recent years, whole slide imaging (wsi) has emerged as a potential alternative to traditional microscopy for pathological examination. This study aims to provide a comprehensive comparison of wsi and traditional microscopy(tm) in various aspects of histopathology practice. Materials and MethodsIn this study, total of 30 cases comprising of oral premalignant and malignant cases which were diagnostically challenging was considered from the archives of the institute for validation. The slides were scanned with slide scanner and were evaluated by histopathologists. The comparative parameters which were noted were diagnostic discordances, number of fields observed to reach the diagnosis and time taken. ResultsThe mean time taken by the pathologists to reach the diagnosis was significantly less in whole slide imaging technique. The average number of fields observed was higher by using wsi that too in a lesser time compared to tm, the results were found to be statistically significant with p=0.001.however the diagnostic disparity were seen to be maximum for verrucous lesions both in wsi and tm. Conclusionwsi has facilitated the specialty with rapid mode of diagnosis in a more efficient and error less manner. It has also aided in case banking as well as research possibilities. Hence with the advent of telepathology it is very much necessary to get trained with wsi as early as possible so that the professionals can render correct diagnosis.

The most widely accepted and used type of digital pathology (DP) is whole-slide imaging (WSI). The USFDA granted two WSI system approvals for primary diagnosis, the first in 2017. In Latin America, DP has the potential to reshape healthcare by enhancing diagnostic capabilities through artificial intelligence (AI) and standardizing pathology reports. Yet, we must tackle regulatory hurdles, training, resource availability, and unique challenges to the region. Collectively addressing these hurdles can enable the region to harness DP’s advantages—enhancing disease diagnosis, medical research, and healthcare accessibility for its population. Americas Health Foundation assembled a panel of Latin American pathologists who are experts in DP to assess the hurdles to implementing it into pathologists’ workflows in the region and provide recommendations for overcoming them. Some key steps recommended include creating a Latin American Society of Digital Pathology to provide continuing education, developing AI models trained on the Latin American population, establishing national regulatory frameworks for protecting the data, and standardizing formats for DP images to ensure that pathologists can collaborate and validate specimens across the various DP platforms.

Background. Whole slide imaging (WSI) represents a paradigm shift in pathology, serving as a necessary first step for a wide array of digital tools to enter the field. It utilizes virtual microscopy wherein glass slides are converted into digital slides and are viewed by pathologists by automated image analysis. Its impact on pathology workflow, reproducibility, dissemination of educational material, expansion of service to underprivileged areas, and institutional collaboration exemplifies a significant innovative movement. The recent US Food and Drug Administration approval to WSI for its use in primary surgical pathology diagnosis has opened opportunities for wider application of this technology in routine practice. Main Text. The ongoing technological advances in digital scanners, image visualization methods, and the integration of artificial intelligence-derived algorithms with these systems provide avenues to exploit its applications. Its benefits are innumerable such as ease of access through the internet, avoidance of physical storage space, and no risk of deterioration of staining quality or breakage of slides to name a few. Although the benefits of WSI to pathology practices are many, the complexities of implementation remain an obstacle to widespread adoption. Some barriers including the high cost, technical glitches, and most importantly professional hesitation to adopt a new technology have hindered its use in routine pathology. Conclusions. In this review, we summarize the technical aspects of WSI, its applications in diagnostic pathology, training, and research along with future perspectives. It also highlights improved understanding of the current challenges to implementation, as well as the benefits and successes of the technology. WSI provides a golden opportunity for pathologists to guide its evolution, standardization, and implementation to better acquaint them with the key aspects of this technology and its judicial use. Also, implementation of routine digital pathology is an extra step requiring resources which (currently) does not usually result increased efficiency or payment. [ABSTRACT FROM AUTHOR]

Telediagnosis uses information and communication technologies to support diagnosis, shortening geographical distances. It helps make decisions about various oral lesions. The objective of this scoping review was to map the existing literature on digital strategies to assist in the diagnosis of oral squamous cell carcinoma. this review was structured based on the 5-stage methodology proposed by Arksey and O'Malley, the Joanna Briggs Institute Manual for Evidence Synthesis and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The methods were registered on the Open Science Framework. The research question was: What digital strategies have been used to assist in the diagnosis of oral squamous cell carcinoma? The search was conducted on PubMed/MEDLINE, Scopus, Web of Science, Embase, and ScienceDirect. Inclusion criteria comprised studies on telediagnosis, teleconsultation or teleconsultation mediated by a professional and studies in English, without date restrictions. The search conducted in June 2023 yielded 1,798 articles, from which 16 studies were included. Telediagnosis was reported in nine studies, involving data screening through applications, clinical images from digital cameras, mobile phones or artificial intelligence. Histopathological images were reported in four studies. Both, telediagnosis and teleconsultation, were mentioned in seven studies, utilizing images and information submission services to platforms, WhatsApp or applications. One study presented teleconsultations involving slides and another study introduced teleconsultation mediated by a professional. Digital strategies telediagnosis and teleconsultations enable the histopathological diagnosis of oral cancer through clinical or histopathological images. The higher the observed diagnostic agreement, the better the performance of the strategy. [ABSTRACT FROM AUTHOR]

Objectives Leukemia diagnosis in Vietnam is limited by a lack of hematopathology training and expert consultation as well as the cost of high-magnification digitization of hematology slides. Screen-sharing software allows international collaboration with experienced hematopathologists for improved diagnostic accuracy. Methods A hematopathology education and consultation program was proposed for Vietnam hospitals. By appointment, pathologists in Vietnam with access to a microscope camera, imaging software, and high-speed internet were invited to review slides and data with a volunteer board-certified hematopathologist in the United States using secure videoconferencing software. A single hospital in southern Vietnam assigned a pathologist proficient in English to access this service. All consultations from this site with clinicopathologic information were logged. After a 2-year period of online consultation, case slides for selected diagnoses were reviewed under the microscope in Vietnam to assess concordance. Results In total, 135 consultations were logged, 53 of which were for blood and bone marrow. T-cell large granular lymphocytic leukemia (T-LGLL) was 1 of the most frequent bone marrow consultation-related diagnoses; all diagnoses of this entity were confirmed by in-person microscopy (100% concordance). A records search and physician surveys found no prior documented diagnoses of T-LGLL made in Vietnam before this education and consultation program. Conclusions Our virtual consultation model has improved patient care in Vietnam by providing correct diagnoses to inform best practices in treatment. As a result of our program, the first Vietnam diagnoses of T-LGLL were made and may help expand on the literature in this area. This model could provide cost-effective, real-time consultation and education services for pathologists in underserved communities. [ABSTRACT FROM AUTHOR]

Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a rare tumor of low malignant potential that occurs most often in young females. Imaging and histopathology are necessary to confirm the diagnosis as most have no symptoms. Lack of access to these technologies in sub-Saharan Africa contributes to the difficulty in making an early and accurate diagnosis, and hence, impedes treatment. We present two cases of SPEN of the pancreas in young female patients at a rural, teaching hospital in Cameroon. The diagnosis was made only with histopathology. Computed tomography scan with intravenous contrast was essential to planning a safe surgical resection. Both patients had complete surgical resection with good results. [ABSTRACT FROM AUTHOR]

Objectives Intrapathology consultation is recommended for complex cases during frozen section (FS) as routine practice. In our institution, solicited second opinions were traditionally provided by in-person consultation (IPC). Whole-slide imaging (WSI) was implemented in 2018 as an alternative but replaced by videoconferencing in 2020. Here, we assess the accuracy of remote FS consultation using these digital modalities vs IPC. Methods Gynecologic FS cases over a 4-year period overseen by 2 intraoperative consultants were grouped by consultation method: (1) IPC, (2) WSI, and (3) videoconferencing. Accuracy was determined by concordance between the FS and final report diagnoses. Turnaround time between the 3 groups was analyzed using SPSS statistical software (IBM). Results Using WSI and videoconferencing, 100% concordance was observed, while the IPC group had a 98.5% concordance rate. Videoconferencing, however, showed longer turnaround times (mean, 45.59 minutes) than IPC (mean, 33.36 minutes). Although turnaround time positively correlated with the number of FS specimens, blocks, and H&E slides per case, no statistically significant differences in the number of specimens, blocks, and H&E slides generated were found among the consultation methods. Conclusions Even though turnaround time using videoconferencing is longer, the accuracy of WSI and videoconferencing for remote FS consultation is equivalent to IPC. It is therefore a safe method for conducting intrapathology FS consultation in challenging surgical cases. [ABSTRACT FROM AUTHOR]

Simple Summary: The quality of care available to cancer patients is highly constrained by the presence of comprehensive pathology services. However, pathology infrastructure is severely lacking in most resource-scarce medical systems. In recent years, progress made in the digitalization of pathology workflows and the advent of clinical-grade AI tools for pathology have offered pathologists new ways to increase their efficiency and offer better care to more patients. In this review, we aim to provide an overview of the current state of digitalization and AI in pathology and how it impacts the practice of oncology. We also identify the main challenges of implementing digital pathology and AI in resource-poor settings and point out the different approaches needed to tackle these challenges. The application of artificial intelligence to improve the access of cancer patients to high-quality medical care is one of the goals of modern medicine. Pathology constitutes the foundation of modern oncologic treatment, and its role has expanded far beyond diagnosis into predicting treatment response and overall survival. However, the funding of pathology is often an afterthought in resource-scarce medical systems. The increased digitalization of pathology has paved the way towards the potential use of artificial intelligence tools for improving pathologist efficiency and extracting more information from tissues. In this review, we provide an overview of the main research directions intersecting with artificial intelligence and pathology in relation to oncology, such as tumor classification, the prediction of molecular alterations, and biomarker quantification. We then discuss examples of tools that have matured into clinical products and gained regulatory approval for clinical use. Finally, we highlight the main hurdles that stand in the way of the digitalization of pathology and the application of artificial intelligence in pathology while also discussing possible solutions. [ABSTRACT FROM AUTHOR]

Purpose: Although axillary dissection is no longer indicated for many breast cancer patients with 1–2 positive axillary sentinel lymph nodes (ASLN), intraoperative ASLN assessment is still performed in many institutions for patients undergoing mastectomy or neoadjuvant therapy. With recent advancements in digital pathology, pathologists increasingly evaluate ASLN via remote telepathology. We aimed to compare the performance characteristics of remote telepathology and conventional on-site intraoperative ASLN assessment. Methods: Data from ASLN evaluation for breast cancer patients performed at two sites between April 2021 and October 2022 was collated. Remote telepathology consultation was conducted via the Aperio eSlideManager system. Results: A total of 385 patients were identified during the study period (83 telepathology, 302 on-site evaluations). Although not statistically significant (P = 0.20), the overall discrepancy rate between intraoperative and final diagnoses was slightly higher at 9.6% (8/83) for telepathology compared with 5.3% (16/302) for on-site assessment. Further comparison of performance characteristics of ASLN assessment between telepathology and conventional on-site evaluation revealed no statistically significant differences between deferral rates, discrepancy rates, interpretive or sampling errors, major or minor disagreements, false negative or false positive results as well as clinical impact and turn-around time (P ≥ 0.12). Conclusion: ASLN assessment via telepathology is not significantly different from conventional on-site evaluation, although it shows a slightly higher overall discrepancy rate between intraoperative and final diagnoses (9.6% vs. 5.3%). Further studies are warranted to ensure accuracy of ASLN assessment via telepathology. [ABSTRACT FROM AUTHOR]

Telediagnosis uses information and communication technologies to support diagnosis, shortening geographical distances. It helps make decisions about various oral lesions. The objective of this scoping review was to map the existing literature on digital strategies to assist in the diagnosis of oral squamous cell carcinoma. this review was structured based on the 5-stage methodology proposed by Arksey and O’Malley, the Joanna Briggs Institute Manual for Evidence Synthesis and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The methods were registered on the Open Science Framework. The research question was: What digital strategies have been used to assist in the diagnosis of oral squamous cell carcinoma? The search was conducted on PubMed/MEDLINE, Scopus, Web of Science, Embase, and ScienceDirect. Inclusion criteria comprised studies on telediagnosis, teleconsultation or teleconsultation mediated by a professional and studies in English, without date restrictions. The search conducted in June 2023 yielded 1,798 articles, from which 16 studies were included. Telediagnosis was reported in nine studies, involving data screening through applications, clinical images from digital cameras, mobile phones or artificial intelligence. Histopathological images were reported in four studies. Both, telediagnosis and teleconsultation, were mentioned in seven studies, utilizing images and information submission services to platforms, WhatsApp or applications. One study presented teleconsultations involving slides and another study introduced teleconsultation mediated by a professional. Digital strategies telediagnosis and teleconsultations enable the histopathological diagnosis of oral cancer through clinical or histopathological images. The higher the observed diagnostic agreement, the better the performance of the strategy.

Purpose: To investigate the use of super-resolution imaging techniques to enable telepathology using low-cost commercial cameras. Design: Experimental study. Participants: A total of 139 ophthalmic pathology slides obtained from the Ophthalmic Pathology service at the University of California, Irvine. Methods: Denoising Diffusion Probabilistic Model (DDPM) was developed to predict super-resolution pathology slide images from low-resolution inputs. The model was pretrained using 150 000 images randomly sampled from the ImageNet dataset. Patch aggregation was used to generate large images with DDPM. The performance of DDPM was evaluated against that of generative adversarial networks (GANs) and Robust UNet, which were also trained on the same dataset. Main Outcome Measures: The performance of models trained to generate super-resolution output images from low-resolution input images can be evaluated by using the mean squared error (MSE) and Structural Similarity Index Measure (SSIM), as well as subjective grades provided by expert pathologist graders. Results: In total, our study included 110 training images, 9 validation images, and 20 testing images. The objective performance scores were averaged over patches generated from 20 test images. The DDPM-based approach with pretraining produced the best results, with an MSE score of 1.35e-5 and an SSIM score of 0.8987. A qualitative analysis of super-resolution images was conducted by expert 3 pathologists and 1 expert ophthalmic microscopist, and the average accuracy of identifying the correct ground truth images ranged from 25% to 70% (with an average accuracy of 46.5%) for widefield images and 25% to 60% (with an average accuracy of 38.25%) for individual patches. Conclusions: The DDPM-based approach with pretraining is assessed to be effective at super-resolution prediction for ophthalmic pathology slides both in terms of objective and subjective measures. The proposed methodology is expected to decrease the reliance on costly slide scanners for acquiring high-quality pathology slide images, while also streamlining clinical workflow and expanding the scope of ophthalmic telepathology. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Abstract Background Using the World Health Organization Classification 5th edition (beta version online; WHO-HAEM5bv) in emerging economies is key to global healthcare equity. Although there may be ongoing updates, hesitancy in accepting and reporting these diagnoses in publication conflicts with the WHO’s commitment to global accessibility. Aggressive NK cell leukemia (ANKL) and systemic EBV-positive T-cell lymphoma of childhood (SEBVTCL) with CD4-positive immunophenotype are both rare entities, are most described in Asians and East Asians, are associated with prior systemic chronic active EBV disease (CAEBV), and presentation with Hemophagocytic Lymphohistiocytosis (HLH). Recognizing and diagnosing any one of these entities requires not only training and experience in hematopathology, but good cooperation between clinical physicians and all areas of the laboratory. We describe a 30-year-old woman who presented to a Vietnam hospital and was rapidly diagnosed with ANKL, SEBVTCL, and HLH using WHO-HAEM5bv essential criteria, aided by expert consultation from a United States (US) board certified hematopathologist in real-time using video conferencing software. Methods Zoom™ videoconferencing software; Immunohistochemistry; flow cytometric immunophenotyping; polymerase chain reaction (PCR), Next Generation Sequencing (NGS). Results At the time of hospital admission, automated complete blood count (CBC) with differential count showed slight anemia, slight lymphocytosis, and moderate thrombocytopenia. HIV serology was negative. Whole blood PCR for EBV was positive showing 98,000 copies/ml. A lymph node biopsy revealed histology and immunohistochemistry consistent with the online beta version WHO-HAEM5 classification of SEBVTCL arising in CAEBV. Blood and bone marrow studies performed for staging revealed no histologic or immunohistochemical evidence of T-cell lymphoma in the bone marrow core, however, atypical blood smear lymphocyte morphology and blood immunophenotyping by flow cytometry were consistent with WHO-HAEM5 classification of ANKL. NGS revealed no evidence of genetic variant(s) associated with HLH in Vietnam. All laboratory studies were performed at Blood Transfusion Hematology Hospital (BTHH) in Ho Chi Minh City Vietnam. Conclusion Although Vietnam, an emerging economy, currently lacks the laboratory infrastructure to more rigorously confirm a rare synchronous presentation of two distinct EBV-driven T/NK cell neoplasms, these two concomitant diagnoses were made using only laboratory techniques available in Vietnam with the help of WHO-HAEM5bv and real-time video consultation by a US hematopathologist.

In this manuscript we assessed the utility of a low-cost 3D printed microscope to evaluate esophageal biopsies. We conducted a comparative analysis between the traditional microscope and our 3-D printed microscope, utilizing a set of esophageal biopsy samples obtained from patients undergoing screening endoscopy. Two pathologists independently examined 30 esophageal biopsies by light microscopy and digital images obtained using a low-cost 3D printed microscope (Observer 1 and 2). The glass slide consensus diagnosis was compared to the findings of 2 additional pathologist who independently just reviewed the digital images (Observer 3 and 4). The intra-observer agreement was substantial to almost perfect for observer 1 (k:0.64) and 2 (k:0.84). All four observers had 100 % sensitivity and negative predictive value, whereas specificity ranged from 59 % to 100 % and positive predictive value ranged from 21 % to 100 %. The PPV and specificity were lower for the two Observers (3 and 4) who just examined the digital images. Overall, our results suggest that telepathology may be used with high sensitivity and specificity, utilizing the pictures produced by our 3D-printed microscope.

Background: This prospective study assesses the use of rapid remote online cytological evaluation for diagnosing endoscopical achieved biopsies. It focuses on its effectiveness in identifying benign and malignant conditions using digital image processing. Methods: The study was conducted between April 2021 and September 2022 and involved analyses of 314 Rapid Remote Online Cytological Evaluations in total (154 imprint cytologies, 143 fine needle aspirations and 17 brush cytologies) performed on 239 patients at the LungenClinic Grosshansdorf. During on-site evaluation via telecytology, the time requirement was recorded and the findings were compared with the cyto-/histological and final diagnoses. Results: By means of rapid remote online evaluation, findings of 86 cytological benign, 190 malignant and 38 unclear diagnoses were recorded (Ø assessment time, 100 s; range, 11–370 s). In 27 of the 37 specimens with unclear diagnoses, the final findings were malignant tumours and only 6 were benign changes. The diagnosis of another 4 of these 37 findings remained unclear. Excluding these 37 specimens, rapid remote online evaluation achieved a sensitivity of 90.5% with a specificity of 98.5% and a correct classification rate of 92.4% with regard to the final diagnosis of all cases. As expected, an increase in the sensitivity rate for the cytological detection of malignant tumours (76.1% vs. 92.5%) was found especially in fine-needle aspirations. Conclusions: Rapid remote online analysis allows the fast quantitative and qualitative evaluation of clinically obtained cytological specimens. With a correct classification rate of more than 93%, sampling deficiencies can be corrected promptly and diagnostic and therapeutic approaches can be derived. [ABSTRACT FROM AUTHOR]

Background: Using the World Health Organization Classification 5th edition (beta version online; WHO-HAEM5bv) in emerging economies is key to global healthcare equity. Although there may be ongoing updates, hesitancy in accepting and reporting these diagnoses in publication conflicts with the WHO's commitment to global accessibility. Aggressive NK cell leukemia (ANKL) and systemic EBV-positive T-cell lymphoma of childhood (SEBVTCL) with CD4-positive immunophenotype are both rare entities, are most described in Asians and East Asians, are associated with prior systemic chronic active EBV disease (CAEBV), and presentation with Hemophagocytic Lymphohistiocytosis (HLH). Recognizing and diagnosing any one of these entities requires not only training and experience in hematopathology, but good cooperation between clinical physicians and all areas of the laboratory. We describe a 30-year-old woman who presented to a Vietnam hospital and was rapidly diagnosed with ANKL, SEBVTCL, and HLH using WHO-HAEM5bv essential criteria, aided by expert consultation from a United States (US) board certified hematopathologist in real-time using video conferencing software. Methods: Zoom™ videoconferencing software; Immunohistochemistry; flow cytometric immunophenotyping; polymerase chain reaction (PCR), Next Generation Sequencing (NGS). Results: At the time of hospital admission, automated complete blood count (CBC) with differential count showed slight anemia, slight lymphocytosis, and moderate thrombocytopenia. HIV serology was negative. Whole blood PCR for EBV was positive showing 98,000 copies/ml. A lymph node biopsy revealed histology and immunohistochemistry consistent with the online beta version WHO-HAEM5 classification of SEBVTCL arising in CAEBV. Blood and bone marrow studies performed for staging revealed no histologic or immunohistochemical evidence of T-cell lymphoma in the bone marrow core, however, atypical blood smear lymphocyte morphology and blood immunophenotyping by flow cytometry were consistent with WHO-HAEM5 classification of ANKL. NGS revealed no evidence of genetic variant(s) associated with HLH in Vietnam. All laboratory studies were performed at Blood Transfusion Hematology Hospital (BTHH) in Ho Chi Minh City Vietnam. Conclusion: Although Vietnam, an emerging economy, currently lacks the laboratory infrastructure to more rigorously confirm a rare synchronous presentation of two distinct EBV-driven T/NK cell neoplasms, these two concomitant diagnoses were made using only laboratory techniques available in Vietnam with the help of WHO-HAEM5bv and real-time video consultation by a US hematopathologist. [ABSTRACT FROM AUTHOR]

In breast cancer surgery, some medical facilities lack the necessary resources to conduct sentinel lymph node biopsy and its intraoperative frozen section consultation. In the coastal rural area of Fukushima, Japan, which has suffered from physician undersupply following the 2011 triple disaster of earthquake, tsunami and nuclear disaster, we explored the feasibility of telepathology by evaluating the diagnostic accuracy in remote intraoperative frozen section consultation of sentinel lymph node biopsy and its required time. Although examination time has room for improvement, telepathology can be one possible solution in resource-limited areas. [ABSTRACT FROM AUTHOR]

Introduction: In low- and middle-income countries (LMICs), surgical care can be limited by access to pathology services. In Uganda, the pathologist-to-population ratio is less than 1 to 1 million people. The Kyabirwa Surgical Center in Jinja, Uganda, created a telepathology service in collaboration with an academic institution in New York City. This study demonstrated the feasibility and considerations of implementing a telepathology model to supplement the critical pathology needs of a low-income country. Methods: This was a retrospective, single-center study of an ambulatory surgery center with pathology capability using virtual microscopy. The remote pathologist (also known as a telepathologist) controlled the microscope and reviewed histology images transmitted across the network in real time. In addition, this study collected demographics, clinical histories, the surgeon's preliminary diagnoses, and the pathology reports from the center's electronic medical record. Results: Nikon's NIS Element Software was used as a dynamic, robotic microscopy model with a video conferencing platform for communication. An underground fiber optic cable established Internet connectivity. After a two-hour tutorial session, the lab technician and pathologist were able to proficiently use the software. The remote pathologist read (1) pathology slides with inconclusive reports from external pathology labs, and (2) tissues labeled by the surgeon as suspicious for malignancy, which belonged to patients who lacked financial means for pathology services. Between April 2021 and July 2022, tissue samples of 110 patients were examined by a telepathologist. The most common malignancies on histology were squamous cell carcinoma of the esophagus, ductal carcinoma of the breast, and colorectal adenocarcinoma. Conclusion: With the increasing availability of video conference platforms and network connections, telepathology is an emerging field that can be used by surgeons in LMICs to improve access to pathology services, confirming histological diagnosis of malignancies to ensure appropriate treatment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic accelerated technological changes in veterinary education, particularly in clinical pathology and anatomic pathology courses transitioning from traditional methods to digital pathology (DP). This study evaluates the personal effectiveness and satisfaction, as well as the advantages and disadvantages, of DP, in particular digital cytology (DC), as a teaching method among European veterinary students, both at the undergraduate and postgraduate level, who attended digital pathology courses during and before the pandemic. A further aim is to discuss the differences between the two student groups. A Google Form survey consisting of 11 multiple-choice questions was emailed to pathology teachers and distributed to their students. Results indicated that undergraduate students showed greater digital pathology training, favouring DC as the most effective learning modality. In contrast, postgraduate students reported less digital slide training, and their preference for learning cytology was split between DC alone and DC integrated with traditional microscopy. All students experienced whole slide imaging for learning cytology slides prevalently, and they stated that DC enhanced their learning experience. While DC demonstrates personal effectiveness and satisfaction as a teaching method, it is important to not replace pathology training with light microscopy completely, as almost a third of the students indicated.

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Digital pathological scanners transform traditional glass slides into whole slide images (WSIs), which significantly improve the efficiency of pathological diagnosis and promote the development of digital pathology. However, the huge economic burden limits the spread and application of general WSI scanners in relatively remote and backward regions. In this paper, we develop an automatic portable cytopathology scanner based on mobile internet, Landing-Smart, to avert the above problems. Landing-Smart is a tiny device with a size of 208 mm × 107 mm × 104 mm and a weight of 1.8 kg, which integrates four main components including a smartphone, a glass slide carrier, an electric controller, and an optical imaging unit. By leveraging a simple optical imaging unit to substitute the sophisticated but complex conventional light microscope, the cost of Landing-Smart is less than $3000, much cheaper than general WSI scanners. On the one hand, Landing-Smart utilizes the built-in camera of the smartphone to acquire field of views (FoVs) in the section one by one. On the other hand, it uploads the images to the cloud server in real time via mobile internet, where the image processing and stitching method is implemented to generate the WSI of the cytological sample. The practical assessment of 209 cervical cytological specimens has demonstrated that Landing-Smart is comparable to general digital scanners in cytopathology diagnosis. Landing-Smart provides an effective tool for preliminary cytological screening in underdeveloped areas. [ABSTRACT FROM AUTHOR]

Cytology is an option for triaging human papillomavirus (HPV)-positive women. The interpretation of cytologic slides requires expertise and financial resources that are not always available in resource-limited settings. A solution could be offered by manual preparation and digitization of slides on site for real-time remote cytologic diagnosis by specialists. In the present study, we evaluated the operational feasibility and cost of manual preparation and digitization of thin-layer slides and the diagnostic accuracy of screening with virtual microscopy. Operational feasibility was evaluated on 30 cervical samples obtained during colposcopy. The simplicity of the process and cellularity and quality of digitized thin-layer slides were evaluated. The diagnostic accuracy of digital versus glass slides to detect cervical intraepithelial neoplasia grade 2 or worse was assessed using a cohort of 264 HPV-positive Cameroonian women aged 30 to 49 years. The histologic results served as the reference standard. Manual preparation was found to be feasible and economically viable. The quality characteristics of the digital slides were satisfactory, and the mean cellularity was 6078 squamous cells per slide. When using the atypical squamous cells of undetermined significance or worse threshold for positivity, the diagnostic performance of screening digital slides was not significantly different statistically compared with the same set of slides screened using a light microscope (P = 0.26). We have developed an innovative triage concept for HPV-positive women. A quality-ensured telecytologic diagnosis could be an effective solution in areas with a shortage of specialists, applying a same day "test-triage-treat" approach. Our results warrant further on-site clinical validation in a large prospective screening trial. • Telecytology may be a feasible method of triaging HPV-positive women in low-resource settings. • The manual preparation of slides and their digitization is simple and low cost. • Accuracy of digital screening does not differ from light microscopy screening when ≥ASC-US. • Digital screening by remote specialists could be used in a one visit test-triage-treat approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: The need for extending pathology diagnostic expertise to more areas is now being met by the maturation of technology that can effectively deliver this level of care. The experience and lessons learned from our successfully deployed International Telepathology Service (ITS) to a hospital system in China guided us in starting a domestic telepathology network, the California Telepathology Service (CTS). Many of the lessons learned from the ITS project informed our decision-making for the CTS. New challenges were recognized and overcome, such as addressing the complexity and cost-benefit tradeoffs involved in setting up a digital consultation system that competes with an established conventional glass slide delivery system. METHODS: The CTS is based on a hub-and-spoke telepathology network using Leica Biosystems whole-slide image scanners and the eSlide Manager (eSM Version 12.3.3.7055, Leica Biosystems) digital image management software solution. The service currently comprises six spoke sites (UC San Diego [UCSD], UC Irvine [UCI], UC Davis, Northridge Hospital Medical Center [NHMC], Olive View Medical Center [OVMC], and Childrens Hospital Los Angeles) and one central hub site (UCLA Medical Center). So far, five sites have been validated for telepathology case consultations following established practice guidelines, and four sites (UCI, UCSD, NHMC, and OVMC) have activated the service. RESULTS: For the active spoke sites, we reviewed the volume, turnaround time (TAT), and case types and evaluated for utility and value. From May 2017 to July 2018, a total of 165 cases were submitted. Of note, digital consultations were particularly advantageous for preliminary kidney biopsy diagnoses (avg TAT 0.7 day). CONCLUSION: For spoke sites, telepathology provided shortened TAT and significant financial savings over hiring faculty with expertise to support a potentially low-volume service. For the hub site, the value includes exposure to educationally valuable cases, additional caseload volume to support specialized services, and improved communication with referring facilities over traditional carrier mail. The creation of a hub-and-spoke telepathology network is an expensive undertaking, and careful consideration needs to be given to support the needs of the clinical services, acquisition and effective deployment of the appropriate equipment, network requirements, and laboratory workflows to ensure a successful and cost-effective system.

Introduction: Ex-vivo FCM is a novel digital optical technique that provides images of fresh tissues in a real-time fashion with magnification to subcellular details of a flattened unprocessed sample. Digital images are hematoxylin-eosin-like and can be shared and interpreted remotely. In urology, FCM has been successfully applied for prostate tissue interpretation, either during biopsy and radical prostatectomy. Possible applications of FCM may reflect those of frozen section analysis and can be extended to all fields in which the intra-operative microscopical control is advisable. Materials and methods: This is an investigative prospective case series that aims to explore FCM feasibility in novel surgical settings and provide a depiction of FCM digital images in those fields. The definite purpose is to check the accuracy of surgical specimen during the following interventions: (a) trans-urethral resection of bladder tumors, to confirm the presence of muscular layer; (b) biopsy of a retroperitoneal mass, to check for the location and quality of cores; (c) training in robotic radical prostatectomy, to control surgical margins after a nerve sparing performed by a trainee. To this aim, we collected FCM images during seven surgical procedures. FCM findings were compared to those from the final histopathological analysis and the agreement was assessed. Results: In all cases, FCM digital images were obtained in the OR. FCM was able to confirm the presence of muscular layer in TURB specimen, the presence of lymphomatous tissue, surgical margins at prostate specimen. FCM intra-operative interpretation was consistent with final histopathology in all cases. Conclusions: Ex vivo FCM may represent a novel approach to control the quality of specimens, likely to tailor surgical strategy in a real-time fashion. Moreover, digitalization represents a step toward the implementation of telepathology in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Telepathology (TP) allows for remote slide review with performance comparable to traditional light microscopy. Use of TP in the intraoperative setting allows for faster turnaround and greater user convenience by obviating the physical presence of the attending pathologist. We sought to perform a practical validation of an intraoperative TP system using the Leica Aperio LV1 scanner in tandem with Zoom teleconferencing software. Methods: A validation was performed in accordance with recommendations from CAP/ASCP, using a retrospectively identified sample of surgical pathology cases with a 1 year washout period. Only cases with frozen-final concordance were included. Validators underwent training in the operation of the instrument and conferencing interface, then reviewed the blinded slide set annotated with clinical information. Validator diagnoses were compared to original diagnoses for concordance. Results: 60 slides were chosen for inclusion. 8 validators completed the slide review, each requiring 2 h. The validation was completed in 2 weeks. Overall concordance was 96.4%. Intraobserver concordance was 97.3%. No major technical hurdles were encountered. Conclusion: Validation of the intraoperative TP system was completed rapidly and with high concordance, comparable to traditional light microscopy. Institutional teleconferencing implementation driven by the COVID pandemic facilitated ease of adoption. [ABSTRACT FROM AUTHOR]

Background: Anatomical pathology care services play an essential role in cancer diagnosis through histological analysis, effective treatment of patients, and determination of prognosis. Therefore, quality control is necessary for the diagnosis of pathology. Based on this need, telepathology technology is rapidly developing in the world. This study aimed to share the experience of implementing telepathology case consultation between Mongolian and Japanese expert pathologists. Methods: The study included 173 cases that required telepathology consultation, which was complicated and doubtful in diagnosis, submitted by Mongolian pathologists between May 2019 and April 2022. The scanned digital slides were transmitted with the help of the LOOKREC cloud-based system, and the expert pathologists of Hiroshima University Hospital, Japan, browsed the images through the data on the internet and their advice and made a mutual diagnosis. Results: During the study period, 173 cases were consulted. Out of 58.4% of all cases, consultation reports were released in 2022. The majority of the cases in 2020 had a mean standard deviation turn-around time of 4.2±6.2 days. The most cases were from the lung and mediastinum were 29.4%, followed by head and neck at 12.6%, the bone at 11.9%, lymph nodes at 8.4%, GIT at 7.7%, soft tissues at 6.3%, etc. Comparing the sample submission of biopsy and cytology was significantly higher in the under 10 years of an experienced group than over 10 years of an experienced group (p<.005). The diagnostic agreement between submitter Mongolian pathologists and expert Japanese pathologists was 82.7%, and disagreement was 17.3% of all cases, with a sensitivity of 67.3% and specificity of 85.5%. Conclusions: Telepathology could save many lost opportunities and play an essential role in developing quality control and surgical pathology in Mongolia. This digital technology and the appropriate strategy and policy of the government could accelerate the overall pathology field development. [ABSTRACT FROM AUTHOR]

Background: This prospective study assesses the use of rapid remote online cytological evaluation for diagnosing endoscopical achieved biopsies. It focuses on its effectiveness in identifying benign and malignant conditions using digital image processing. Methods: The study was conducted between April 2021 and September 2022 and involved analyses of 314 Rapid Remote Online Cytological Evaluations in total (154 imprint cytologies, 143 fine needle aspirations and 17 brush cytologies) performed on 239 patients at the LungenClinic Grosshansdorf. During on-site evaluation via telecytology, the time requirement was recorded and the findings were compared with the cyto-/histological and final diagnoses. Results: By means of rapid remote online evaluation, findings of 86 cytological benign, 190 malignant and 38 unclear diagnoses were recorded (Ø assessment time, 100 s; range, 11–370 s). In 27 of the 37 specimens with unclear diagnoses, the final findings were malignant tumours and only 6 were benign changes. The diagnosis of another 4 of these 37 findings remained unclear. Excluding these 37 specimens, rapid remote online evaluation achieved a sensitivity of 90.5% with a specificity of 98.5% and a correct classification rate of 92.4% with regard to the final diagnosis of all cases. As expected, an increase in the sensitivity rate for the cytological detection of malignant tumours (76.1% vs. 92.5%) was found especially in fine-needle aspirations. Conclusions: Rapid remote online analysis allows the fast quantitative and qualitative evaluation of clinically obtained cytological specimens. With a correct classification rate of more than 93%, sampling deficiencies can be corrected promptly and diagnostic and therapeutic approaches can be derived.

Introduction: The era of artificial intelligence (AI) has dawned, and its influence on different aspects of our lives is now tremendously evident. The introduction of whole slide imaging in digital pathology has changed the face of histopathology (HP) and is in the process of paving a smooth platform towards the far-reaching telepathology. Aim: The present study was aimed to evaluate the knowledge, attitude, and practice (KAP) of Oral Pathologists (OPs) in India regarding the incorporation of AI in diagnostic HP. Materials and Methods: This cross-sectional study was conducted among OPs across India. A structured online questionnaire comprising 27 questions was sent to each participant through email and social media platforms and responses were collected and analyzed. The relationship between demographic variables and good KAP was analyzed using Chi-square and Fisher's exact test. Results and Discussion: One hundred and seventy-one OPs participated in the study, with 8.8% having good knowledge, 70.2% having a positive attitude, and only 4.1% using AI in diagnostic HP. Knowledge regarding AI in pathology increased in a statistically significant way (P = 0.001) with respect to years of experience. 43.9% of OPs expect AI to be integrated into HP in India over the next ten years. Conclusion: OPs in India have a positive attitude towards the incorporation of AI in their pathology practice. Vital measures to enable the integration of AI into diagnostic HP and to improve its awareness are an absolute requisite in our scenario.

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.

Context: Telepathology is a promising tool for remote communities to receive pathology services where professional diagnosis services are inadequate. Aims: We aimed to clarify how effective telepathology was when compared with conventional pathology service among rural communities of Bangladesh. Methods and Materials: We conducted a cross-sectional study in suburban and rural areas of Bangladesh between June and August 2020. We enrolled 117 participants who received both telepathology services from Thakurgaon Eye Hospital and conventional pathology service experience. The participant's satisfaction with the accessibility and perceptions were statistically compared. In addition, we summarized descriptive statistics using the frequencies and percentages of participants' responses. Statistical Analysis Used: Wilcoxon's Signed-rank test using SPSS statistic software version 25.00. Results: Among the study participants, service cost, travel cost, travel time, waiting time, and travel distance were significantly higher for conventional pathology than telepathology (P < 0.001). The majority of participants (94%) were satisfied with the telepathology experience; however, one out of 117 participants was dissatisfied with this service when their travel distance was far away (≥50 km). Among the participants, 91.5% thought that telepathology service was effective for their treatment, and 98.3% wanted to continue this service in their community. On an average, participants saved 58% (95% CI, 53.4–61.5) of cost using telepathology rather than conventional pathology service. Conclusions: Remote under-resourced communities received professional pathology services with less time-consuming and significantly lower costs using the telepathology approach. Where pathology services are absent/insufficient, telepathology is efficacious for primary diagnosis, screening, and referral through professional pathologists for the satisfactory treatment of unreached communities.

Introduction: Telepathology (TP) allows for remote slide review with performance comparable to traditional light microscopy. Use of TP in the intraoperative setting allows for faster turnaround and greater user convenience by obviating the physical presence of the attending pathologist. We sought to perform a practical validation of an intraoperative TP system using the Leica Aperio LV1 scanner in tandem with Zoom teleconferencing software. Methods: A validation was performed in accordance with recommendations from CAP/ASCP, using a retrospectively identified sample of surgical pathology cases with a 1 year washout period. Only cases with frozen-final concordance were included. Validators underwent training in the operation of the instrument and conferencing interface, then reviewed the blinded slide set annotated with clinical information. Validator diagnoses were compared to original diagnoses for concordance. Results: 60 slides were chosen for inclusion. 8 validators completed the slide review, each requiring 2 h. The validation was completed in 2 weeks. Overall concordance was 96.4%. Intraobserver concordance was 97.3%. No major technical hurdles were encountered. Conclusion: Validation of the intraoperative TP system was completed rapidly and with high concordance, comparable to traditional light microscopy. Institutional teleconferencing implementation driven by the COVID pandemic facilitated ease of adoption.

Kaposi sarcoma is a vascular endothelial neoplasm caused by human herpesvirus 8. Although it is a well-studied disease, little is known about the specific characteristics or epidemiology of Kaposi sarcoma in Afghanistan. The data consist primarily of anecdotal reports and epidemiological studies extrapolated from neighboring countries. In this case series, we summarize existing data about Kaposi sarcoma in Afghanistan and present seven histologically confirmed cases with associated clinical features to shed light on the characteristics of Kaposi sarcoma in this unique geographic setting. [ABSTRACT FROM AUTHOR]

With increase in the number and types of biopsies requiring rapid on-site evaluation for adequacy, telecytopathology is one of the solutions. Using a microscope camera with MS Surface Pro, a live telecytopathology audio video feed for the adequacy of 55 study set validation cases was sent over Zoom from the satellite hospital over 10 miles away with cytopathologists at the main hospital. The study set cases included Diff-Quik–stained smears and core imprints. The overall percent of positive agreement (accuracy) for adequacy during rapid on-site evaluation via telecytopathology was 96%. Core imprint percentage for positive agreement was slightly higher (96.2%), than fine-needle aspiration smears (95.8%). Use of telecytopathology is the best solution for optimizing the cytopathologist's time for evaluating biopsy adequacy from distant sites. • Telecytopathology for Rapid Off-Site Evaluation (ROSE) of biopsy specimens. • General set-up of the telecytopathology system. • Validation study for telecytopathology. [ABSTRACT FROM AUTHOR]

Introduction: The era of artificial intelligence (Al) has dawned, and its influence on different aspects of our lives is now tremendously evident. The introduction of whole slide imaging in digital pathology has changed the face of histopathology (HP) and is in the process of paving a smooth platform towards the far-reaching telepathology. Aim: The present study was aimed to evaluate the knowledge, attitude, and practice (KAP) of Oral Pathologists (OPs) in India regarding the incorporation of Al in diagnostic HP. Materials and Methods: This cross-sectional study was conducted among OPs across India. A structured on line questionnaire comprising 27 questions was sent to each participant through email and social media platforms and responses were collected and analyzed. The relationship between demographic variables and good KAP was analyzed using Chi-square and Fisher's exact test. Results and Discussion: One hundred and seventy-one OPs participated in the study, with 8.8% having good knowledge, 70.2% having a positive attitude, and only 4.1% using Al in diagnostic HP. Knowledge regarding Al in pathology increased in a statistically significant way (P = 0.001) with respect to years of experience. 43.9% of OPs expect Al to be integrated into HP in India over the next ten years. Conclusion: OPs in India have a positive attitude towards the incorporation of Al in their pathology practice. Vital measures to enable the integration of Al into diagnostic HP and to improve its awareness are an absolute requisite in our scenario. [ABSTRACT FROM AUTHOR]