A pilot study investigating the minimum requirements necessary for grading astrocytomas remotely.

OBJECTIVE To investigate the minimum requirements necessary for remote grading astrocytomas in terms of selected static images and descriptive histologic characteristics. STUDY DESIGN A histopathologist examined 106 formalin-fixed, paraffin-embedded tissue samples of low- and high-grade astrocytomas. Interobserver-checked cases were reviewed under a microscope to estimate the accuracy of the conventional glass slide diagnoses. Then cases based on 5 static-digitized images from each patient were diagnosed. Next, the grade of each tumor was assessed based on the set of 5 images and the World Health Organization (WHO) description of 8 histologic characteristics defined as crucial in grading astrocytomas. Finally, an evaluation was made using a custom-designed decision support system. RESULTS Conventional glass slide diagnosis was 93.9%. Diagnosis based only on the set of 5 images dropped to 81.6%. Diagnosis based on the set of 5 images and the WHO characteristics boosted accuracy to 88.8%. Accuracy improved to 91.8% with the addition of the decision support system. CONCLUSION Our findings suggest that a telepathology system might be valuable for accurate grade diagnosis of astrocytomas-providing a means for avoiding diagnostic errors-without blocks or slides having to leave the department. This could significantly reduce the overall time and cost of diagnosis.