Comparing Conventional and Telepathological Diagnosis in Routine Frozen Section Service

  • Peter Hufnagl Charité - Universitätsmedizin Berlin
  • Hans Guski Charité - Universitätsmedizin Berlin
  • Jörg Hering Vivantes Clinic Berlin
  • Thomas Schrader University of Applied Sciences, Brandenburg
  • Klaus Kayser Charité - Universitätsmedizin Berlin
  • Cornelia Tennstedt-Schenck Practice for Pathology Mühlhausen
  • Manfred Dietel Charité - Universitätsmedizin Berlin
  • Klaus-Jürgen Winzer Charité - Universitätsmedizin Berlin


Aims: In a prospective randomised study the diagnostic accuracy of frozen section service of conventional and telepathological procedures was compared for routine breast surgery.
Material and Methods:In the telepathological approach the surgeon performed the gross examination and macroscopic cutting directly supervised via videoconference by a pathologist. Then a technician prepared the frozen sections and the staining. The on-line histological diagnosis was done using a remote controlled robotic microscope. The images were transferred to the computer screen of the pathologist. In the conventional mode, the pathologist himself manually performed the gross and microscopic tissue examination in the same laboratory. The material was restricted to breast specimens and the number of participating surgeons was limited in order to obtain comparable results. All in all, 81 routine frozen sections of the breast were included in the study within seven months.
Results: The overall diagnostic concordance of both approaches with the definite diagnosis based upon paraffin embedded tissue was calculated to 95,1 % (77/81 cases). The telepathology arm revealed 94,3 % (33/ 35 cases), and the conventional arm 95,7% (44/46 cases). Two cases of each arm remained uncertain. The median diagnostic time was calculated to 9 minutes in the conventional mode and to 17 minutes for telepathology. Not included are median 3 minutes for transportation and 12 minutes for slide preparation.
Discussion: Telepathology can replace successfully conventional performance of frozen section service within the same range of diagnostic accuracy.


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Author Biographies

Peter Hufnagl, Charité - Universitätsmedizin Berlin
Institute of Pathology
Hans Guski, Charité - Universitätsmedizin Berlin
Institute of Pathology
Jörg Hering, Vivantes Clinic Berlin
Clinic Neukölln
Klaus Kayser, Charité - Universitätsmedizin Berlin
Institute of Pathology
Manfred Dietel, Charité - Universitätsmedizin Berlin
Institute of Pathology
Klaus-Jürgen Winzer, Charité - Universitätsmedizin Berlin
Department of Gynecology


1. Adachi H, Inoue J, Nozu T, Aoki H, Ito H. Frozen-section services by telepathology: experience of 100 cases in the San-in District, Japan. Pathol.Int. 1996; 46:436-41.

2. Baak JPA, van Diest PJ, Meijer GA. Experience with a dynamic inexpansive video-conferencing system for frozen section telepathology. Anal Cell Pathol 2000; 21: 169-175.

3. Cross SS, Dennis T, Start RD. Telepathology: current status and future prospects in diagnostic hiostopathology. Histopathology 2002; 41: 91-109

4. Della Mea V, Cataldi P, Beltrami CA. Combinino dynamic and static robotic telepathology: a report o9n 184 consecutive cases of frozen sections, histology and cytology. Anal Cell Patholo 2000; 20: 33-39

5. Dunn BE, Choi H, Almagro UA, Recla DL, Krupinski EA, Weinstein RS. Routine surgical telepathology in the Department of Veterans Affairs: experience-related improvements in pathologist performance in 2200 cases Telemed J 1999; 5: 323-337.

6. Eide TJ, Nordrum I. Frozen section service via the telenetwork in northern Norway. Zentralbl.Pathol. 1992; 138:409-12.

7. Eide TJ, Nordrum I, Stalsberg H. The validity of frozen section diagnosis based on video-microscopy. Zentralbl.Pathol. 1992; 138:405-7.

8. Fujita M, Suzuki Y, Takahashi M, Tsukamoto K, Nagashima K. The validity of intraoperative frozen section diagnosis based on video- microscopy (telepathology). Gen.Diagn.Pathol. 1995; 141:105-10.

9. Gu J. Recent advances in telepathology. Cell Vis. 1998; 5:62-6.

10. Hufnagl P, Graschew G, Rakowsky S, Haensch W, Schlag PM, Dietel M. Second opinion telepathology on frozen sections as part of daily routine in a university institute. Elec J Pathol Histol 2000; 6: 002-009

11. Hufnagl P, Bayer G, Oberbarnscheidt P, Wehrstedt K, Guski H, Hauptmann S, Dietel M. Comparison of different telepathology solutions for primary frozen section diagnostic. Anal Cell Pathol 2001; 21:161-167.

12. Kayser K; Szymas J, Weinstein RS: Telepathology, Telecommunication, Electronic Education and Publication in Pathology. Springer Berlin, New York 1999.

13. Leong F, Graham A, Schwarzmann P, McGee J. Clinical Trial of Telepathology As an Alternative Modality in Breast Histopathology Quality Assurance. Telemedicine Journal and e-Health 2000; 6:373-7.

14. Leong, F and McGee, J. Robotic Interactive Telepathology in proficiency testing/quality assurance schemes. Electronic Journal of Pathology and Histology 7 (2). 2001.

15. Nordrum I, Engum B, Rinde E, et al. Remote frozen section service: a telepathology project in northern Norway [see comments]. Hum.Pathol. 1991; 22:514-8.

16. Nordrum I. Telepathology. Is there a future? Telemed.Today 1996; 4:24-6.

17. Nordrum I, Isaksen V, Arvola L. Breast carcinoma diagnosed by telepathology. J.Telemed.Telecare. 1997; 3:172-3.

18. Oberbarnscheidt P, Hufnagl P, Guski H, Hauptmann S, Dietel M. 2000. Analysis of errors in telepathology. Elec J Pathol Histol 6: 003-011.

19. Öngürü Ö, Celasun B. Intra-hospital Use of Telepathology System. Pathology Onkology Research 2000; 6:197-201.

20. Schlag PM, Moesta KT, Rakovsky S, Graschew G. Telemedicine: the new must for surgery. Arch Surg 1999; 134:1216-21

21. Schwarzmann P, Schmid J, Schnorr G. Telemicroscopy stations for telepathology based on broadband and ISDN connections. Arch Anat Cytol Pathol 43 (1995) 209-215.

22. Schwarzmann P, Binder H, Klose R. Technical aspects of telepathology with emphasis on future development. Anal Cell Pathol 2001; 21:107-126.

23. Stolte M. Schnellschnitt-Diagnostik per "Telepathologie" Gefahr der Verletzung der Fachgebietsgrenzen. Pathologe 1999; 20: 373.

24. Weinstein RS, Bhattacharyya AK, Graham AR, Davis JR. Telepathology: a ten-year progress report. Hum.Pathol. 1997; 28:1-7.

25. Weinstein RS, DesCour MR, Liang C, Bhattacharyya AK, Graham AR, Davis JR, Scott KM, Richter L, Krupinski EA, Szymas J, Kayser K, Dunn B. Telepathology overview: From concept to implementation. Hum Pathol 2001; 32: 1283-1299

26. Wellnitz U, Binder B, Fritz P, Friedel G, Schwarzmann P. Reliability of telepathology for frozen sections. Anal Cell Pathol 2000; 21: 213-222.

27. Weisz-Carrington P, Blount M, Kipreos B, et al. Telepathology between Richmond and Beckley Veterans Affairs Hospital: Report on the first 1000 Cases. Telemed.J. 1999; 5:367-73.
How to Cite
HUFNAGL, Peter et al. Comparing Conventional and Telepathological Diagnosis in Routine Frozen Section Service. Diagnostic Pathology, [S.l.], v. 2, n. 1, june 2016. ISSN 2364-4893. Available at: <>. Date accessed: 26 nov. 2020. doi:


Frozen section service, Telepathology, Remote telemicroscopy, Breast surgery, Randomised study