Live remote digital microscopy in peripheral blood smear evaluation: Intraobserver concordance and experience.

Abstract

Peripheral blood smear (PBS) review is a routine laboratory test which requires pathologist's interpretation when abnormal indices, atypical cells, or critical findings are identified. Real-time remote digital microscopy (DM) can potentially facilitate rapid review when an on-site pathologist is not available. Herein, we assess intraobserver concordance of PBS evaluation with light microscopy (LM) and DM using VisionTek M6 robotic DM and TeamViewer imaging software. Thirty-seven de-identified PBS slides were evaluated by five reviewers. Slides were loaded on a VisionTek M6 robotic microscope at an off-site laboratory and evaluated remotely via TeamViewer software. Reviewers recorded interpretation, time required for interpretation (in minutes), imaging quality (score 0-3), and confidence of interpretation (score 0-3). Other relevant information associated with DM evaluation was also documented. Slides were subsequently evaluated using LM after washout interval. The intraobserver variation of results for impression, digital slide quality, minutes to interpretation, and confidence of interpretation was compared between DM and LM. The intraobserver concordance between LM and DM was 93%, with nine discordant interpretations among 135 evaluations under each review modality, respectively. Although reviewers spent more time under DM mode (5min/slide) than LM mode (2.5min/slide), the reviewers felt the DM provided sufficient image quality and the confidence levels of reviewers on slide interpretation were comparable between DM (2.6/3) and LM (2.8/3). There was a high level of intraobserver concordance and comparable interpretation confidence between DM and LM. DM can be a useful methodology for off-site pathologist's review of PBS.