PART 1 . Advantages of Telepathology Consultation: Optimizing the Allocation of Medical Resources and Promoting Hierarchical Medical Systems

At the national level, high-quality medical resources in China are concentrated in large cities such as those in the southeastern region and direct-administered municipalities, while medical standards in western regions lag behind. Within provinces, superior medical resources are predominantly located in provincial capitals, leaving towns and counties with limited medical capabilities. Telepathology enables the extension of high-quality medical resources to underserved areas, addressing patients’ demand for better healthcare services. It helps alleviate the disparity between the scarcity of medical resources in underdeveloped regions and the concentration of superior resources in major cities, thereby facilitating the implementation of hierarchical medical systems.

Case Study: Xiangya Hospital, Central South University

Taking Xiangya Hospital of Central South University as an example, it pioneered the exploration and gradually established a ‘cloud-based pathology’ consultation platform as early as 2015. Concurrently, its Pathology Department established a paired assistance program with Jianghua Yao Autonomous County, enabling them to conduct remote pathology consultations. This has effectively alleviated the local contradiction where pathological diagnoses could not keep pace with clinical demands.

Enhancing Primary-Level Healthcare through Clinical, Educational, and Research Support

At the hospital level, via the telepathology platform, senior pathologists can guide improvements in procedures such as tissue sampling, staining, slide preparation, and diagnosis, thereby helping primary-level doctors enhance their skills. This reduces the risk of treatment errors due to inaccurate pathological diagnoses. Utilizing this platform, primary-level doctors can access high-quality research guidance, continuous training, and continuing medical education services locally, in a cost-effective, efficient, and sustainable manner, thereby boosting their scientific research and teaching capabilities and fostering comprehensive development in primary-level hospitals.

Telepathology not only helps the pathology departments of primary-level hospitals enter a fast track of development but also drives the enhancement of the overall medical standards of the hospital. Some procedures that primary-level hospitals previously dared not or could not perform are now gradually being undertaken.

— Zhou Jianhua, Director of the Pathology Department, Xiangya Hospital, Central South University

 

Saving Time and Economic Costs for Patients

For patients, relying on traditional consultation methods often involves primary hospitals mailing pathological slides to larger hospitals, patients personally carrying slides to major centers, or specialists traveling to primary sites. These methods increase diagnostic turnaround time, incur additional transportation costs, and raise the risk of slides being lost or damaged.

Xiangya Hospital, through its ‘cloud-based pathology’ platform, typically enables patients to receive diagnoses from authoritative pathologists within 24 hours. In contrast, the traditional process of borrowing slides for consultation used to take at least five working days.

Beyond saving on transportation expenses, teleconsultation reduces diagnostic uncertainty at the primary level. Some patients who previously required referral to higher-level hospitals can now receive accurate diagnosis and treatment locally. This minimizes treatment delays and significantly reduces the overall burden on patients.

Strengthening International Exchange and Cooperation: High Cost-Effectiveness

Internationally, mailing slides or having experts travel abroad can be impractical due to customs inspections and other hurdles. Transmitting images via the internet faces fewer restrictions and is considerably less expensive. Furthermore, laws in some countries, including China, prohibit the cross-border transport of human tissues for diagnostic purposes. Therefore, remote consultation via digital images is currently often the only feasible method for international pathology consultation.

The origins of telepathology can be traced back to 1968, but it was not until 1987 that Weinstein from the Pathology Department of RUSH Medical College in the USA first proposed the concept of remote pathology consultation. In 1990, Norway took the lead in establishing a frozen section consultation center. Due to technical and economic challenges, remote diagnosis was initially promoted only in developed countries. With the advancement of information networks and digital slide scanning technology, remote pathology consultation technology and its applications have made significant progress, becoming an indispensable part of modern medicine. Its development has primarily gone through three modes: static images, remote-controlled automated microscopes, and digital pathology slides.

The discussion and research on remote pathology consultation in China began in the mid-to-late 1990s. In 1996, the Image Center of Beijing University of Aeronautics and Astronautics developed a point-to-point static image remote pathology diagnosis system via telephone lines, creating a solid platform for the initiation of remote pathology consultation work in China. In 1997, the Air Force General Hospital established a remote pathology consultation workstation consisting of six pathology experts from the Beijing area and set up secondary consultation stations in 28 large and medium-sized cities to provide specialized remote pathology consultation services. The advent of digital slide scanning systems realized the permanent storage of visual data and synchronous browsing and processing unrestricted by time and space, propelling remote pathology diagnosis into a new era. In December 2011, the Ministry of Health officially launched the pilot program for remote pathology consultation and quality control.

PART 3: Components and Implementation Methods of Remote Pathology Consultation

Modern remote pathology consultation comprises three parts: an image acquisition system, an image transmission system, and an expert consultation platform. The image acquisition system refers to the digital slide scanner. It digitizes entire pathology slides by rapidly scanning them under high magnification. A high-quality digital slide scanner ensures that all information on the pathology slide is accurately captured within the digital image, producing digital slides with high resolution and clarity. After digitization is complete, the hospital or pathology department can upload the digital pathology slides and relevant medical history to the diagnostic platform via the network. Experts from higher-level hospitals log into the platform, open the digital slides through a browser, view and analyze them, and provide diagnostic opinions.

High-quality digital pathology images and a convenient remote consultation platform resolve issues such as borrowing and transporting slides for consultation, liberating physicians from microscopes. Pathology experts can communicate with physicians anytime and anywhere via the network. Medical experts can freely access and review patients’ digital pathology slides and electronic medical record information, engaging in face-to-face communication with medical staff at the requesting end, as well as patients and their families, to discuss the condition collectively. This enables patients to receive expert diagnostic opinions promptly. Studies have shown that the concordance rate between remote static image consultation and microscope-based consultation results can reach 98.5%.

As a pioneer in the field of digital pathology in China, KFBIO started with digital pathology slide scanners, converting physical slides into digital images. This not only made slide viewing more convenient but also laid the foundation for remote consultation, pathology teaching, and digital slide storage. Building upon this, KFBIO developed a remote pathology consultation platform that provides functions and services such as remote diagnosis, remote complex case consultation, remote intraoperative frozen section diagnosis, pathology personnel training, and remote expert guidance for individual hospitals, regional hospital alliances, third-party testing institutions, and provincial telemedicine networks. It has currently established over 200 such platforms nationwide. (Image: KFBIO Remote Consultation Center Business Process)

PART 4: Applications of Remote Pathology Consultation

Currently, remote pathology consultation can be conducted for difficult, complex, or rare cases. This includes histopathology, intraoperative frozen section consultation, cytopathological diagnosis, immunohistochemistry slide consultation, as well as remote pathology slide reading and discussion, and training/teaching for pathologists.

1. Histopathology Consultation: Primarily for diagnostically challenging cases, such as small biopsy specimens, cases where distinguishing between benign, malignant, or borderline lesions is difficult, or cases where the classification is hard to define; or cases of common and frequent diseases that present with atypical morphology due to various factors, making diagnosis difficult for primary-level hospitals; complex cases and rare/uncommon cases.
2. Intraoperative Rapid Frozen Section Diagnosis: Plays a decisive role in determining surgical approach, treatment plan, and clinical prognosis, and is an indispensable diagnostic method for medical institutions. Studies have shown that applying remote pathology consultation to intraoperative rapid frozen section diagnosis provides valuable information for the majority of patients and offers correct diagnostic opinions (including definitive diagnoses and suggestive diagnoses) for over 86.4% of patients. Furthermore, this can, to some extent, alleviate the tension between surgeons and pathologists when an intraoperative frozen section diagnosis is inconclusive. A consensus reached through consultation may lead to better understanding from clinicians.
3. Cytology Slides: Including difficult or atypical cases involving exfoliative cytology smears, liquid-based cytology slides, fine-needle aspiration cytology slides, and cell block sections.
4. Interpretation and Evaluation of Immunohistochemistry Staining Results.
5. Remote Pathology Teaching: Conducting lectures, slide reading discussions, etc., for pathologists in primary-level hospitals via the network.

PART 5: Quality Control in Remote Pathology Consultation

Literature reports indicate that the accuracy of remote pathology consultation can reach 88% to 99%. Halliday et al. reported rates of 88% to 97.5%, or even 100%. However, to achieve satisfactory consultation accuracy, the following conditions must be met:

1. High-quality pathology slides or cytology slides with appropriate thickness and clear staining.
2. High-quality image acquisition system, i.e., a digital slide scanner that faithfully reproduces slide information and compresses images with high fidelity.
3. Relatively fast network system.
4. Reliable clinical and pathological data, including medical history, imaging studies, other laboratory tests, clinical diagnosis, and preliminary pathological opinion.
5. Expert platform with experienced specialists.
6. Supplementary diagnostic aids such as immunohistochemistry and molecular pathology tests when necessary.

To carry out remote pathology consultation more efficiently and accurately, it is essential to strengthen the training and assessment of pathology technicians and diagnostic physicians in primary-level hospitals. Simultaneously, the introduction of high-quality digital slide scanning and application systems in primary-level hospitals is a fundamental prerequisite for initiating remote pathology consultation.

Certainly, the further promotion and use of remote pathology consultation still face some challenges. For instance, regarding legal and safety issues, more detailed regulations and policies are needed to clearly define liability. Additionally, patient privacy and data security on remote pathology platforms require sufficient safeguards. Although remote pathology consultation items are included in the new medical pricing schemes, most provinces have not yet officially issued fee schedules for digital slide scanning and remote pathology consultation.

Summary

Since the implementation of remote pathology diagnosis, high-quality medical resources have become more fluid, alleviating the shortage of pathological diagnosis capabilities at the primary level, improving the ability to diagnose and treat diseases locally, and playing a positive role in the development of China’s healthcare industry. It is believed that with the continuous improvement of various technologies, the increasing recognition and acceptance by pathologists and clinicians, and the introduction of corresponding laws, regulations, and fee structures, remote pathology consultation will embrace a broader application prospect.

Some content adapted from: “Development and Prospects of Remote Pathology Diagnosis in China,” China Digital Medicine, authors: Liu Yang, Yan Honglin, Tang Qizhu, Liu Xinquan, Xia Liangbing, Yuan Jingping; “Establishment and Application of Remote Pathology Consultation,” Practical Clinical Journal of Hospitals, authors: Xu Gang, Xiao Xue, Chen Liumei.

KFBIO’s tray-based models KF-PRO-005 and KF-PRO-020 digital pathology scanner have been extensively adopted in telepathology diagnosis, with their exceptional stability serving as the foundation for remote pathological services.