Haematological cytology image bank and teletransmission for microscopic diagnosis

Video recording of microscopic preparations, digitalization and storage, transmission by a specialized telephone network are revolutionizing microscopic diagnosis procedures. Adjustment of standardization of medical diagnosis, based on internationally recognized classifications and their computerized coding are fundamental to this process (ADICAP coding system). We are evaluating telediagnosis procedure to test their relevance in practical hematology. Taking into account clinical and biological informations is necessary to deal with difficult cases, in using in addition to microscopic observations, a compromise of analytic data which must be rapidly available in a data bank by cross references research. In comparison with other pathological applications, the sampling problem is specially crucial in hematologic cases, for which it is necessary to observe at high resolution a fairly high number of microscopic fields, from the peripheral blood and bone marrow smears, in addition to samples of histopathologic sections from bone marrow and/or lymph-node. A previous teleconsultation of an extensive data bank appears as being one of the best way to reduce the procedure of telediagnosis to the only difficult cases, for which clear responses cannot be found in the data bank. A link between the access to the data bank and the telediagnosis procedures appears to be a fundamental approach. Our first experience shown us that a mean of 10 to 15 observed fields are necessary to conclude in ordinary cases (i.e. peripheral blood of lymphoproliferative disorders), while up to 30 fields or more are sometimes necessary for complex cases (acute leukemias, myelodysplastic and myeloproliferative syndromes), including cytologic and histopathologic data from the peripheral blood, bone marrow, lymph nodes.