Expert consultation by use of telepathology--the Heidelberg experiences

The benefits and constraint using visual telecommunication in pathology (telepathology) are described based upon the experiences of the authors for more than 4 years. The experiences include first trials in visual telecommunication to analyze image quality, transfer rates, handling of commercially available equipment, and need for routinely diagnostic work followed by routinely expert consultations in frozen sections. A quality control study on diagnostic reliability of bronchial carcinomas was performed later, and the diagnosticly different cases were reclassified by a panel of pathologists using visual telecommunication. The latest experiences are based upon routinely expert consultations in morphologically difficult cases by ISDN-based telecommunication. As a result, image quality and transfer rates are sufficient to permit efficient expert contribution to diagnostically difficult cases in 30-50% of transmitted cases in both common telephone lines and ISDN connections. No influence of various staining procedures, immunohistology, or in situ hybridization on image quality or transfer rates were observed. The area of transmitted images is still too small, and the reliability of ISDN lines is still not sufficient for remote control service in Germany. The handling of commercially available equipment needs to be improved; however, as a general result, telepathology will probably improve the diagnostic quality and access in histopathology within the coming years.