Use of digital pathology imaging allows both specialists to jointly review cases

In a pioneering effort at The University of Kansas, a radiologist and a pathologist are working side by side to review each other’s primary images and issue an integrated diagnostic report for breast cancer patients. The big surprise from this groundbreaking collaboration is a measurable improvement in diagnostic accuracy, leading to improved patient outcomes.

By reaching across the traditional silos that separate the daily practice of radiology from the daily practice of pathology, these two specialists have demonstrated that the concept of diagnostic integration of in vivo (imaging) and in vitro (pathology) diagnostics can demonstrably improve patient care. In part, this happens because of improved concordance in the reports issued by the radiologist and the pathologist.

At University of Kansas, Radiologist and Pathologist Improve Diagnostic Concordance

The story begins a little more than one year ago. That’s when pathologist Ossama Tawfik, M.D., Ph.D., who is Professor and Vice Chairman for Education and Outreach at the Department of Pathology and Lab Medicine at The University of Kansas Medical Center and radiologist Mark Redick, M.D., Ph.D., who is Assistant Professor of Radiology at The University of Kansas Medical Center and a breast imager in the breast imaging section at The Richard and Annette Bloch Cancer Care Center, decided to work in close collaboration.

One hurdle to overcome was that these specialists worked in different facilities, located almost two miles apart. Here is where digital imaging of pathology specimens played a key role in facilitating this in vivo/in vitro integration effort. The decision was made to conduct a regular weekly meeting via videoconference. Both the pathologist and the radiologist would view the primary digital images upon which each had based his patient report.

All radiology and pathology images would be available in an interactive full fidelity and high resolution digital format. There would be simultaneous real-time visualization of both radiology and histological images. Also, the images would be interactive, which allows any videoconference participant to direct attention to a particular finding on tissue slides or a radiology imaging study.

“Prior to starting this joint effort, we recognized up front, that the breast radiologist was unable to resolve discordance between reported histologic diagnosis and imaging findings,” stated Tawfick, as he addressed the Molecular Summit on In Vivo and In Vitro Integration in Philadelphia earlier this year. “It was the same for pathology. Pathologists were unable to correlate the imaging features of breast lesions with the tissue specimens. Our major challenge in tackling this project was that no available time existed to prepare all required materials, then travel to a meeting room to discuss biopsy cases side-by-side. That’s why we did the next best thing. We organized a weekly teleconference and used digital images of the histology and radiology that we could both view simultaneously.”

Redick observed that, “It is common practice for each specialist to rely on the written report of the case provided by the other specialist. However, without a common review of the images used by each other, there is the potential for discordance in ways that negatively affect patient care and patient outcomes. Our goal was to improve concordance by close and regular collaboration.

“In fact, in instances where the radiologist and pathologist do not achieve acceptable concordance on a breast cancer case,” added Redick, “there are three sources of inaccuracy. They are:

  • Failure to recognize that the lesion was inadequately sampled;
  • False negative delayed diagnosis of malignancy; and,
  • Failure to recognize nonmalignant risk lesions which should prompt additional testing or more aggressive clinical surveillance.”

This collaboration quickly demonstrated that better integration of imaging and pathology would improve patient care. Following a joint review of 106 breast cancer cases, involving 122 biopsies, Tawfick and Redick determined there was full concordance on 80 of the biopsies (66% of the total). However, minor revisions on the reports were needed on 28 biopsies (23% of the total) to achieve concordance. And, in 14 biopsies (11% of the total), the joint review identified the need for major revisions.

The two specialists observed that the joint case review didn’t change the primary diagnosis. But revisions made to the original reports to improve concordance did have significant influence on decisions as to how the patient should be treated.

To help pathologists, radiologists, and others understand the improved clinical performance that resulted from this integration of in vivo and in vitro diagnostics, The Dark Report www.darkreport.com has invited Dr. Tawfick and Dr. Redick to share their insights at an upcoming audio conference next week.

You are invited to join in and listen to this valuable session. The audio conference is titled  “Pathology and Radiology’s Combined Future is Now at KU: How Integrated Breast Cancer Diagnostics are Improving Patient Care.” It will take place on Wednesday, August 19, 2009 at 1:00 PM EDT (and 12 PM CDT; 11 AM MDT; 10 PM PDT). Moderator is Syed Hafeez, who Administrative Director, SPHN Pathology & Transfusion Medicine at Providence Memorial Hospital in El Paso, Texas.

You’ll have the opportunity to ask your own questions and explore the best methods for achieving similar diagnostic concordance with your radiology and pathology groups. All this for one low flat fee of only $245 per dial-in site. So don’t wait! Reserve your “seat” today for this very special conference.

THE DARK REPORT AUDIO CONFERENCE AT A GLANCE

DATE: Wednesday, August 19, 2009
TIME: 1 p.m. EDT; 12 p.m. CDT; 11 a.m. MDT; 10 a.m. PDT
PLACE: Your telephone or speakerphone
COST: $245 per dial-in site (unlimited attendance per site)
TO REGISTER: Click here or call 1-800-560-6363 toll-free

HOW TO REGISTER:
1. Online
2. Call toll free: 800-560-6363

Registrations accepted until Wednesday, 19, 2009, noon EDT.
Cancellations before 5:00 p.m. EST on Monday, August 17, 2009 may receive a full refund less a $25 service charge.

Your audio conference registration includes:

  • A site license to attend the conference (invite as many people as you can fit around your speakerphone at no extra charge)
  • Downloadable PowerPoint presentations from our speakers
  • A full transcript emailed to you soon after the conference
  • The opportunity to connect directly with our speakers during the audience Q&A session

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