BACKGROUND: Machine learning (ML) models can help assisting diagnosis by rapidly localising and classifying regions of interest (ROIs) within whole slide images (WSIs). Effective ML models for clinical decision support require a substantial dataset of \'real\' data, and in reality, it should be robust, user-friendly and universally applicable.
METHODS: WSIs of primary IgAN were collected and annotated. The H-AI-L algorithm which could facilitate direct WSI viewing and potential ROI detection for clinicians was built on the cloud server of matpool, a shared internet-based service platform. Model performance was evaluated using F1-score, precision, recall and Matthew\'s correlation coefficient (MCC).
RESULTS: The F1-score of glomerular localisation in WSIs was 0.85 and 0.89 for the initial and pretrained models, respectively, with corresponding recall values of 0.79 and 0.83, and precision scores of 0.92 and 0.97. Dichotomous differentiation between global sclerotic (GS) and other glomeruli revealed F1-scores of 0.70 and 0.91, and MCC values of 0.55 and 0.87, for the initial and pretrained models, respectively. The overall F1-score of multiclassification was 0.81 for the pretrained models. The total glomerular recall rate was 0.96, with F1-scores of 0.68, 0.56 and 0.26 for GS, segmental glomerulosclerosis and crescent (C), respectively. Interstitial fibrosis/tubular atrophy lesion similarity between the true label and model predictions was 0.75.
CONCLUSIONS: Our results underscore the efficacy of the ML integration algorithm in segmenting ROIs in IgAN WSIs, and the internet-based model deployment is in favour of widespread adoption and utilisation across multiple centres and increased volumes of WSIs.

Digital pathological scanners transform traditional glass slides into whole slide images (WSIs), which significantly improve the efficiency of pathological diagnosis and promote the development of digital pathology. However, the huge economic burden limits the spread and application of general WSI scanners in relatively remote and backward regions. In this paper, we develop an automatic portable cytopathology scanner based on mobile internet, Landing-Smart, to avert the above problems. Landing-Smart is a tiny device with a size of 208 mm × 107 mm × 104 mm and a weight of 1.8 kg, which integrates four main components including a smartphone, a glass slide carrier, an electric controller, and an optical imaging unit. By leveraging a simple optical imaging unit to substitute the sophisticated but complex conventional light microscope, the cost of Landing-Smart is less than $3000, much cheaper than general WSI scanners. On the one hand, Landing-Smart utilizes the built-in camera of the smartphone to acquire field of views (FoVs) in the section one by one. On the other hand, it uploads the images to the cloud server in real time via mobile internet, where the image processing and stitching method is implemented to generate the WSI of the cytological sample. The practical assessment of 209 cervical cytological specimens has demonstrated that Landing-Smart is comparable to general digital scanners in cytopathology diagnosis. Landing-Smart provides an effective tool for preliminary cytological screening in underdeveloped areas.

Digital pathology (DP) is an emerging field of pathology that manages information generated from digitized specimen slides [...].

Whole-slide imaging allows the entire slide to be viewed in a manner that simulates microscopy; therefore, it is widely used in telepathology. However, managing the large digital files needed for whole-slide imaging is difficult. To solve this problem, we set up the Chinese National Cloud-Based Telepathology System (CNCTPS). CNCTPS has been running for more than 4 years and has accumulated a large amount of data.
The main purpose of this study was to comprehensively evaluate the effectiveness of the CNCTPS based on a large sample. The evaluation indicators included service volume, turnaround time, diagnosis accuracy, and economic benefits.
Details of 23,167 cases submitted to the CNCTPS from January 2016 to December 2019 were collected to analyze the service volume, turnaround time, and economic benefits. A total of 564 patients who visited the First Affiliated Hospital of Zhengzhou University and obtained final diagnoses were followed up to analyze the diagnostic accuracy of the CNCTPS.
From 2016 to 2019, the service volume of the CNCTPS increased from 2335 to 9240, and the number of participating hospitals increased from 60 to 74. Consultation requests from county-level hospitals accounted for 86.57% (20,287/23,167). A total of 17,495 of 23,167 cases (75.52%) were confirmed, including 12,088 benign lesions, 5217 malignant lesions, and 190 borderline lesions. Of the cases, 3.85% (893/23,167) failed to be diagnosed for reasons such as poor slice quality and incomplete sampling. The median turnaround time was 16.93 hours and was shortened yearly (between 2018 and 2019: adjusted P=.01; other groups: adjusted P<.001); 82.88% cases were diagnosed in 48 hours. There was a discrepancy between the diagnosis and final diagnosis for 11 cases, including 4 false-positive cases and 7 false-negative cases. The sensitivity and specificity were 97.66% and 98.49%, respectively. The diagnostic accuracy of the system was 98.05%, with no statistical difference from the final diagnosis in the hospital (P=.55). By using this system, a total of US $300,000 was saved for patients every year.
The novel cloud-based telepathology system has the potential to relieve the shortage of pathologists in primary hospitals. It can also simultaneously reduce medical costs for patients in China. It should, therefore, be further promoted to enhance the efficiency, quantity, and quality of telepathology diagnoses.

目的： 分析基于全景成像的远程细胞病理学在甲状腺穿刺活检中的应用效果，评价其诊断价值。 方法： 收集在国家远程医疗中心进行远程诊断的甲状腺穿刺病例共92例，回顾性分析其远程细胞病理学诊断结果并随访其手术情况，对32例手术患者的远程细胞病理学与术后组织病理学诊断结果进行对比分析。 结果： 92例甲状腺穿刺病例获取远程细胞学诊断报告的平均等待时长为7.09 h，标本无法诊断或不满意（ND/UNS）1例、良性病变36例、滤泡性病变/未明确意义的不典型增生（AUS/FLUS）4例、滤泡性肿瘤或可疑滤泡性肿瘤（SFN/FN）2例、可疑恶性肿瘤33例、恶性肿瘤16例。32例手术病例中，术后组织病理学诊断为良性病变的7例，诊断为恶性病变的25例。甲状腺细针穿刺细胞学病理（TBSRTC）分类中ND/UNS、AUS/FLUS、SFN/FN和可疑恶性肿瘤为未定性类别，以良性病变为阴性、恶性肿瘤为阳性，甲状腺穿刺远程细胞病理学诊断的灵敏度、特异度和准确率均为100%；以ND/UNS、良性病变和AUS/FLUS为阴性，SFN/FN、可疑恶性肿瘤和恶性肿瘤为阳性，诊断的灵敏度为100.00%、特异度为85.71%、正确率为96.88%；以ND/UNS、良性病变、AUS/FLUS和SFN/FN为阴性，可疑恶性肿瘤和恶性肿瘤为阳性，诊断的灵敏度为96.00%、特异度为85.71%、正确率为93.75%。三种分类下，诊断一致性均极好，Kappa值分别为1.000、0.904、0.817，P<0.01。 结论： 基于全景成像的远程细胞病理学能够对甲状腺穿刺进行快速准确的诊断，值得在基层医院推广应用。.

In recent years, with the progress of image processing and network transmission technology, digital pathology (DP) is being more and more extensive applied in clinical practice, and new artificial-intelligence-assisted diagnosis technology based on digital imaging is emerging. Being a widely-used mature field, telepathology is changing the temporal and spatial scope of pathological diagnosis through remote electronic transmission of digital images. Fully digitized pathology departments are realizing the transformation of diagnostic modes and workflow from microscopic diagnosis to digital image computer review, and there have already been successful examples of large-scale fully digitized pathology departments. However, there are still many problems in the implementation of DP, for example, the quality stability and cost of the scanner, the validation of the system, the reengineering of the workflow, the training of pathologists and the change of their perception of DP, which all await further improvement. Although artificial intelligence diagnostic technology is showing great potential, its application in pathological work is still limited to the field of auxiliary diagnostics, and there is still a long way to go to the realization of comprehensive intelligent pathology. The rise of DP will bring about a profound change in the way of how pathological work is done and become a solid foundation for intelligent pathology.

2019年1月由中国病理医师协会数字病理与人工智能病理学组牵头，对我国远程病理的应用情况进行了全国性调研。自2011年起，我国远程病理诊断已走过了8年的发展历程，截至2019年3月已完成超过100万例的远程病理诊断量，极大地促进了基层医院病理诊断水平的提升及分级诊疗，使更多患者受益。实施远程病理初次诊断和术中冷冻诊断是中国远程病理发展的重要一步，深受基层医院欢迎。国内远程病理的开展存在5种方式，可持续发展是关键。国内远程病理的质控体系建设仍很薄弱，需要进一步重视和加强。中国远程病理的发展还面临着很多问题和挑战，需要多方协作加以解决，从而促进远程病理的推广应用。.

BACKGROUND: Telepathology (TP) provides remote pathology services for primary diagnosis practices, including intraoperative consultation of surgical pathology; it has not been widely implemented in China. In this study, the results of an implementation were reported, which lasted for two and a half years, and demonstrated the experience of the diagnosis of the intraoperative frozen sections by using TP consultation platform of Southern Medical University and Guangzhou Huayin Medical Laboratory Center (SMU-HUAYIN TP) in China.
METHODS: The SMU-HUAYIN TP consultation platform connects 71 participating basic hospitals and 11 senior pathologists. Nanfang Hospital is a high-level hospital located in a large city in China. This retrospective study summarizes the experience and results of TP for frozen section diagnosis by comparing the data of the platform and Nanfang Hospital over a period of 2.5 years from January 2015 to June 2017.
RESULTS: A total of 5233 cases were submitted to the platform, including 1019 cases in 2015, 2320 cases in 2016, and 1894 cases in 2017. The most common cases were breast (30.42%), followed by thyroid (29.05%) and gynecological (24.86%). Average turn-around time (TAT) of the cases from the platform in 2015 and 2016 was controlled within 30 min. In most TP cases (90.31%) and cases from Nanfang Hospital (86.14%), a definitive diagnosis was provided. The coincidence rate was 99.77% in the TP cases and 99.35% in the cases from Nanfang Hospital. The false positive and false negative rates of TP cases were 0.04 and 0.19%, respectively and no significant difference was found among different senior pathologists (P = 0.974, P = 0.989, P > 0.05). Similarly, there was no significant difference between TP cases and cases from Nanfang Hospital that were diagnosed by the same senior pathologist (P > 0.05).
CONCLUSIONS: Our results indicate that TP in frozen section diagnosis could improve patient care and solve the problem of unevenly distributed pathology resources in China. We believe that in the near future, TP in frozen section diagnosis will become an important component of telemedicine and will play a significant role in health care reform in China.

International telecytology can improve patient care by increasing access to regional and international expertise in cytopathology. The majority of international telecytology studies published to date have been based on static telepathology platforms. Overall concordance rates for these studies ranged from 71% to 93%. This is comparable to the concordance rates published for other studies comparing diagnoses made by digital still images to reference glass slides, which vary from 80% to 95%. Static telepathology systems are relatively cheap and easy to use, and have the potential to increase access to international experts in developing countries with limited resources. In contrast, resource-rich academic and private medical centers can use whole slide digital imaging (WSI) for telecytology consultation, though few studies have been published addressing this topic. International telepathology consultation services with digital whole slide image capabilities have been established at several academic medical centers including the University of Pittsburgh Medical Center (UPMC) and the University of California at Los Angeles (UCLA), through the UCLA Center for Telepathology and Digital Pathology. In a small series of 20 telecytology cases submitted to UCLA from 2014 to 2017 (10 gynecologic and 10 fine needle aspiration cases), a meaningful diagnosis was rendered for 100% of cases, with 100% concordance between the submitting institution, versus consultation diagnosis provided by UCLA. These limited results are promising, and in the future both WSI and static telecytology consultation may have a place serving clinical needs in different practice settings.

BACKGROUND: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service.
METHODS: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014.
RESULTS: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases.
CONCLUSIONS: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated pathologists who understood the language and culture on both sides. Lack of clinical information, missing gross pathology descriptions, and insufficient tissue sections submitted for evaluation were the main reasons for indefinite diagnoses. The overall experience encourages international telepathology practice for second opinions.