JMIR Publications

ABSTRACT

Background:

Whole slid imaging (WSI) allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing large digital files of WSI is difficult. To solve this problem, we set up a cloud-based telepathology system (Chinese national cloud-based telepathology system, CNCTPS).

Objective:

CNCTPS has been running for more than 4 years and has accumulated a number of data. The main purpose of this study is to comprehensively evaluate the operation effect of CNCTPS based on a large sample. The evaluation indicators include service volume, turnaround time, diagnosis accuracy, and economic benefits.

Methods:

The details of 23,167 cases submitted to CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who also directly visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of CNCTPS.

Results:

From 2016 to 2019, the service volume of CNCTPS increased from 2,335 to 9,240, and the number of participating hospitals increased from 60 to 74. Consultation applications from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of all the cases, 3.85% (893/23,167) failed to be diagnosed with the main reasons as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019, adjusted P= .012; other groups adjusted P< .001); 82.88% cases were diagnosed in 48 hours. The telepathological diagnosis of 11 cases was discrepant with the final diagnosis, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P= .549). By using this system, A total of $300,000 was saved for patients every year.

Conclusions:

The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce the high medical costs for patients in China. It should therefore be further promoted to enhance the efficiency, quantity and quality of telepathological diagnoses.