Utility of WhatsApp as a Tool for Tele-oncopathology for Oral Lesions

Traditional telepathology techniques like whole slide imaging and robotic microscopy are too expensive to be used in developing countries. With the advent of smartphones with high-resolution cameras and faster internet services, it is now possible to send good-quality images to pathologist for diagnosis. To study the utility of WhatsApp image transfer in the histopathological diagnosis of common oral malignant and benign lesions. A total of 100 cases of oral biopsy were included in the study. These comprised of 58 cases of squamous cell carcinoma, 33 cases of oral leukoplakia, 3 cases of oral lichen planus and 6 cases of moderate to severe dysplasia. The conventional microscopy diagnosis made by glass slide viewing was taken as the gold standard and the concordance of the WhatsApp diagnosis with the gold standard was calculated for each category of diagnosis and also for all the 100 cases. The concordance rate for squamous cell carcinoma was 96.6%(56/58). For leukoplakia, there was 100%(33/33) concordance between the WhatsApp diagnosis and conventional microscopy. The concordance rates for dysplasia (4/6) and oral lichen planus (2/3) were 66.7% each. Hence, for all the categories taken together, the overall concordance rate was 95%. A concordance rate of 95% is very encouraging; however, for routine diagnostic use in telepathology, there is still a long way to go. With the availability of better smartphone cameras and faster internet, it will be possible to send better quality images in the future. The pathologists will also learn where to draw the line and ask for glass slides for final diagnosis.