Feedback du groupe de Pathologie

Marie-Cécile Vacher-Lavenu

10 mars 2016

Groupe des pathologistes des centres experts des tumeurs

rares • 39 pathologistes ont

participé/participent à l’activité – 3 à la retraite, 2 départs, 2 passations, 4

préparent la relève, 28 référents

• 23 centres attachés – 10 CHU, 12 CAC, 1 privé

• Groupe de relectures collégiales : PathGyn, CLB-HCL, IGR, Nantes, Caen, Grand-Sud-Ouest?

• 3 séances de relectures collégiales

Sur les 5 années d’activité

• 4992 lectures/ relectures expertes tout gynéco – 4367 en double lecture dont 212 double

référents

– 625 lectures référentes

• 3677 relectures ou diagnostiques comptés pour les TMRO-INCA

Discussions du groupe

• Organisation pour TMRO-INCA – critères histo,

– collaboration avec les cliniciens, pathologistes,

– activités des centres/ rétribution,

– frais d’archivage,

– répartition des cas au pro rata

• Recherche de mutation FOXL2 des TCS

• Discordances de diagnostic

• CR histologie type

Discussions du groupe (suite)

• Nouvelle classification OMS2014 et recommandations vs TMRO

• Algorithme des IHC

• Télépathologie

• Implication dans les essais – Relecture avant inclusion (essais

COCCINELLE, NICC)

– ... Essai ATALANTE

– Discussions pour la mise en place des essais : CHRONO

Telepathology network in Ile de France: a 18-month experiment project for

intraoperative consultation (telediagnosis) and second opinion diagnosis

(teleexpertise).

Ile de France: 12 000 000 inh

Telepathology network in Ile de France

Assistance Publique- Hôpitaux de Paris

420 health facilities

Context: Situation of Pathology in France

• Shortage of Pathologists

• Reorganization of Pathology structures • Increased number and complexity of pathology cases • Systematic reviewing of lymphomas and « rare

cancers » (neuroendocrine tumors, sarcomas, pediatric cancers) required by the National Institute of Cancer (INCa)

évolution comparée de la démographie ACP et

des nouveaux cas de cancers*

800

900

1000

1100

1200

1300

1400

1500

1600

1700

2007

2008

2009

2010

2011

nb

re d

e p

ath

olo

gis

tes

290000

300000

310000

320000

330000

340000

350000

360000

370000

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an

cers

nbre d'anapth nbre ACP<55 ans nouveaux cas de cancers

CHU Bichat CHU Cochin CHU HEGP CHU Pitié Salp. CHU Saint Antoine CHU St Louis CHU Trousseau

• CHU A. Paré • CHU A. Béclère • CHU K. Bicêtre • CHU P. Brousse • CHU H. Mondor

• CHG Pontoise • CHG Eaubonne • CHG Villeneuve St George • CHG Marnes La Vallée/Meaux • CHG Versailles • CHG Montfermeil

• ACP Bièvres • La Croix St Simon

PARIS

Extra-PARIS

18 structures of Pathology

Telepathology network in Ile de France: 18 month experimental

project

Regional Health Agency of Ile de France Call for tender 2012 Telemedecine

Telepathology 550 000€

Telepathology network in Ile de France

CHU Bichat CHU Cochin CHU HEGP CHU Pitié Salp. CHU Saint Antoine CHU St Louis CHU Trousseau CHU A. Paré CHU A. Béclère CHU K. Bicêtre CHU H. Mondor

CHU P. Brousse Juillet 2013

CHG Meaux

Telediagnosis for frozen sections

Teleexpertise for second opinion diagnosis

CHG Pontoise CHG Eaubonne CHG Villeneuve St George CHG Versailles ACP Bièvres

4 Scanners provided through the project

Already equipped with a scanner

CHU Bicêtre

La Croix St Simon

CHG Marnes La Vallée

CHU Saint Antoine

2 Scanners provided through the project

• APHP Assistance Publique- Hôpitaux de Paris

• DOMU- APHP – Telemedecine • IT departments • URC Eco

•General Hospitals • IT departments

•Private structure

•GCS-d-SISIF

Industrial Partners Tribvn/OrangeHealthcare

Telepathology network in Ile de France : a 18-month experiment project – Regional Health Agency

Specific agreement For Health data storage

Centralized Telepathology Platform

TELESLIDE

Frozen sections

Second opinions

Actors

Regional Telepathology platform

Second opinion teleconsultation (Teleexpertise)

Teleexpertise for second opinion diagnosis

Hospital 1 or Private structure

Hospital 2 Expert Pathologist

Slide numerisation Telepathology case (JPG, pdf, virtual slides, clinical informations) Choice of an expert pathologist Overnight upload on the PF

Required Pathologist

Requiring pathologist

Views the TP Case Accepts or not Asks for supplementary material Gives second opinion diagnosis

Internet/ 4G Modem

Regional Telepathology Platform

Future: Dedicated network

Different types of scanners

Teleexpertise for second opinion diagnosis

Teleexpertise for second opinion diagnosis

Teleexpertise for second opinion diagnosis

Teleexpertise for second opinion diagnosis

PDF telefile

Quantitative results

65 users of the platform • 56 as requerant/reviewer • 9 as requerant only

251 requests for second opinion diagnosis

211 completed/10 pending

• 5 closed requests because of refusal from the selected reviewer

• 16 closed requests because of no coverage of the request by the reviewer

28/11/2015

Mean response time: 1 week / 3 weeks for traditional second opinion consultation

17% of cases with request for supplementary material (slides or paraffin blocks) by the expert

Teleexpertise for second opinion diagnosis Qualitative results

URC Eco APHP

Technical difficulties Network latency with Internet Regional Network (lengthy time waiting for images to open, ROSES pixelated images when panning and zooming) Quality of slides Lab quality insurance Practice issues Time consuming for submitting a case Imaging technician Easy workflow even at home for the expert To make the link with the LIS Interface development Change in the way of reporting Reluctance of some pathologists Training and patience! Difficulties with Hematopathology cases

Issues for second opinion teleconsultation

Initial investment

Providing and implementation of the solution (infrastructure, scanners, software, installation, training, etc.), management of the project.

Costs for operational Telepathology

Intraoperative teleconsultation

Technical procedure Material and software maintenance Annual subscription to the regional TM platform if necessary Medical procedure (inter-health facilities convention )

Intraoperative consultation in the French Public welfare system: 84€

Second Opinion teleconsultation Material and software maintenance Annual subscription to the Regional TM platform Medical procedure ???? Not registered in the French Public Welfare System Financial support by ARS IdF

Economical aspects

Feasability

A real challenge for technicians and pathologists: information, formation, procedures, management

High speed dedicated network

Regional Telepathology Platform integrated to the Regional Telemedecine Platform (ORTIF)

InterRegion Network extension

First step to Digital Pathology

Conclusion and Future?

Digital Pathology : Why not for Humans?

PloS One November 2015

Telepathology Network in Ile de France

Philippe Bertheau St-Louis ACP Fréderic Beuvon Cochin ACP Frédérique Capron La Pitié ACP Agnès Chabouis DPM Télémédecine Joël Cucherousset Montfermeil ACP Bettina Fabiani St-Antoine ACP Isabelle Goubin-Versini Pontoise ACP Philippe Gros ACP Bièvres ACP Catherine Guettier Bicêtre ACP Gilles Le Naour La Pitié IT Eric Poullier CSS SI Patient IT