厚生連医誌

第１３巻

１号 １
１０〜１１３ ２００４Statistic Report

Reevaluation of telepathology system in the Niigata―kenKoseiren at a turning point of the fifth year after theestablishment（the second report）
Department of Telepathology（Telemedicine study group in JA Niigata）．Pathology Center ; Pathologist,
Director of Telemedicine study group in JA Niigata.

Toshihiko Ikarashi

Background : As previously reported, the supporting
system for a remote intraoperative rapid histopathologicaldiagnosis by frozen sections（abbreviated to Telepathology）has been established in the Health and Welfare Association of Niigata―prefectural Agricultrural Co―operative；e.g. between PatholSociety（the Niigata―ken Koseiren）
ogy Center in Nagaoka City as a receiver and diagnostician side and Kariwagun General Hospital in Kashiwazaki
City as a transmitter and surgeon side since October，
１９９８and, furthermore, Murakami General Hospital in Murakami City as a transmitter and surgeon side since October，
２００１. In this study, our telepathological system wasevaluated on its utility. Statistics : The number of telepathological cases ordered from Kariwagun General
Hospital increased from ２．
１ cases a month to １１．
１ casesa month, which was statistically significant （p＜０．
０５，correlation coefficient during １６ months after introductionof telepathology＝０．
８３）．In Niigata Prefecture, the number of intraoeprative rapid histopathological diagnosis（Frozen sections）was in proportion to that of permanent
histopathology（correlation coefficient＝０．
７９，[expectednumbers of frozen sections a month]＝０．
０２６ x [numbersof permanent pathology a month]＋０．
０２６）．The requested
numbers of telepathological cases from above two hospitals became within a statistically expected normal limit.
The purposes of requests for telepathology from above
two hospitals were as follows：７０％ of cases were examined for an assessment of metastasis，
２５％ for a reconfirmation of malignancy, and ５％ for an assessment
whether the excised margin of a specimen was involved
by tumor or not. As to devices of telepathology, we used
the animation―type image transmission with bi―directionalmike and speaker（Telepathology based on the Television
conference system produced by Nippon Telegraph andTelephone Corporation（NTT））, which was more convenient than other photograph―typed image transmission systems. Furtherm
Key Words : telepathology, telemedicine, supporting system for remote histopathological diagnosis, Television
Conference System（Nippon Telegraph and TelephoneCorporation, NTT）
，intraoperative rapid histopathologicaldiagnosis, frozen sections, the Niigata―ken Koseiren

Background
There were fewer pathologists in Japan, especially inthe provinces ; there were ３．
４ doctors per hospital in theUnited States，
０．
４ in Tokyo of the metropolitan area,
０．
１７ in Niigata Prefecture of the country, and ０．
１４ inTohoku Prefecture of the country. Furthermore, in Niigata
Prefecture, an uneven distribution of pathologists amonghospitals was pointed out and was the lowest in the Niigata―ken Koseiren（Table１）!．To make matters worse,
hospitals of the Niigata―ken Koseiren were spread all overNiigata Prefecture : e.g. Kariwagun General Hospital,
where a telepathology was firstly established, was ２５km
away from our laboratory in a straight line and it took ５０minutes by car, and Murakami General Hospital, where atelepathology was secondarily established, was １０５km
away and it took ２ hours and ３
０ minutes by car. It wasimpossible for these hospitals to perform intraoperative
frozen sections without pathologists because of being too
far from our Pathology Center to perform an intraoeprative diagnosis. Regardless of their remote residences,
however, not a few patients requested modern medicine
equal to those reported on newspaper or television. On theother hand, with the advance of intelligent technology（IT），telemedicine could partially satisfy their requirements. Telemedicine was of wide use as followings : teleradiology for４
５％ of cases, at―home care for １７％，andtelepathology for １２％!．Furthermore, as to telepathology, the Japanese Telepathology Study Meeting was established to assist doctors in performing safer operations
on August２５th，
２００１．
Telepathological devices were classified into two maintypes on the base of image transmission：! animation―type（produced by NTT）and " photograph―type or motionless type（produced by Olympus company and Nikoncompany）．The former was cheaper and more rapid totransmit a picture than the latter. But the latter rendered― 110 ―厚生連医誌

第１３巻

１号 １１０〜１１３ ２００４sharper picture rather than the former. In our telepathological system Television Conference System（NTT）was used as an animation―type image transmission system. Five years having passed after an establishment of this system, we made a re―assessment of this system in the Niigata―ken Kouseiren group in this study.

Statistics
The number of telepathological cases increased year after year（Fig．
１）．In Kariwagun General Hospital the telepathological requests increased from ２．
１ of cases amonth to １１．
１ a month, before and after an introductionof telepathology, respectively. Furthermore, its increment
was statistically significant（p＜０．
０５，correlation coefficient during １６ months after introduction＝０．
８３）
（Fig．
２）．In Niigata Prefecture, the number of frozen sections had a tendency to increase in proportion to that ofpermanent histopathology（correlation coefficient＝０．
７９，[expected numbers of frozen sections a month]＝０．
０２６x [numbers of permanent pathology a month]＋０．
０２６）（Table２and Fig．
２）
．The requested telepathological cases from above two hospitals increased and reached
to expected ones.
Telepathological system had mainly three uses : assessing disease progression for ７０％ of cases, reconfirming
malignancy for２５％，and considering whether a resection
stump was involved in tumor or not for ５％．
In an operation of system devices, our animation―typeimage transmission system took less time to reach a histological diagnosis than that by other photograph―type in０ ，respectively.
struments，
５ to１
５―３Discussion
Our telepathological system has played a sufficient role
because we have preserved a telepathology system withKariwagun General Hospital for ５ years with the growing demand and, furthermore, a telepathology has been introduced into Murakami General Hospital（１―３）．Thefrequency of telepathological uses increased to an expected number agreed with each hospital scale, which indicated that the significance of telepathology had spreadover surgeons. Operators used telepathology at operation
mainly for an assessment of disease progression such aswhether lymph nodes and other structures were involved
by neoplasm and whether the excisional magins of a
specimen were free from cancer, so that further surgery
should be performed if necessary. There were also a fewcases which had no definite diagnosis preoperatively, inwhich it was very useful to diagnose their tumors as malignant or benign by telepathology during operation.
The animation―type image transmission system of ouradoption was more convenient than other motionless photograph―type one. On the other hand, there remained apoor quality of pictures and a slow transmitting velocity
on image transmission in telepathology, which required amodest attitude not to make a misjudgement in a diagnos-tic process ub pathologists : i.e. we should not make a diagnosis irresponsibly without any well―grounded confidence!．In these situations it was important for pathologists to say operating doctors clearly, "We cannot diagnose because ・・・・" or "We can affirm to this point
but cannot assert regarding other points. Final diagnosis
should be rendered to permanent sections."
A progress of IT will make a telemedical service moreconvenient for us and come into wide use. It follows thatany patient can receive modern medicine equal to thosereported on newspaper or television regardless of theirhandicaps of remote residences.

References
１．Telepathology, In Ikarashi's medical ABC understandable even by a cat ―Clinicopathologicalmechanism and its medical strategy―，ed Ikarashi T，
３８th ed, Pimento Press, Nagaoka，
２００３．
（stored inhard disk of ３３．
０ GB content）（Soft : Windows,Exel, PowerPoint（above―mentioned soft provided byMicrosoft Co．
），Photoshop （Adobe Co．
），Ichitaroh（Justsystem Co．
），and DocuWorks Desk（FujiXerox Co．
））
２．Ikarashi T. Introduction of the telepathology for theintraoperative rapid histopathological diagnosis（IRHD）―rapid report―．Niigata―ken Koseiren Med１J １９９９；９：１
８―２３．Watanabe N, Honda N, and Seki H. Image transmission between our hospital and Pathology Center for
immediate intraoperative pathological diagnosis. Niigata―ken Koseiren Med J ２０００；１
１：５６―８．

新潟県厚生連病院における術中迅速病理組織の画像伝送による遠隔病理診 断 支 援 シ ス テ ム（テ レ パ ソ ロジー）導入後の５年間の統計（第２報）
病理センター、遠隔画像診断室（JA 新潟遠隔医療研究会）；病理医、JA 新潟遠隔医療研究会責任者
五十嵐俊彦
背景：凍結切片を使った術中迅速病理組織の画像伝送による遠隔病理診 断 支 援 シ ス テ ム（テ レ パ ソ ロジー）は、１
９９８年に受信・診断側の新潟県厚生連病理センター（長岡市）と送信・術者側の新潟県厚生連刈羽郡総合病院（柏崎市）の間に、また、２００
１年に送信・受信者側の新潟県厚生連村上総合病院（村上市）との間に設置された。今回、テレパソロジーの利用状況とその操作性について、導入５年後の節目に際して、再検討がなされた。
統計内容：テレパソロジー依頼症例数は、刈羽郡総合病院において、１ヶ月あたり２．
１症例から１１．
１症例までに増加し、その増加率は統計的に有意であった（p＜０．
０５、導 入 直 後 の１６か 月 間 に お け る 相 関 係 数＝０．
８３）
。新潟県内の病院においては、迅速病理診断件数は通常 の 永 久 標 本 件 数 に 比 例 す る（相 関 係 数＝０．
７９、［月当りの予測迅速診断件数］＝０．
０２
６ x［月― 111 ―Reevaluation of telepathology system in the Niigata―ken Koseiren at a turning point of the fifth year after the establishment（the second report）

当りの永久病理診断件数］＋０．
０２６）。この式に基づくと、テレパソロジー導入後の２病院からのテレパソロジー依頼件数は、病院規模に相当するものであった。
また、
テレパソロジー依頼目的に関しては、症例の７０％が臨床病期確定の為の転移の確認に、２５％が悪性の確定に、５％が切除断端部分における腫瘍の取り残しの評価であった。装置に関しては、従来の静止画像送信装置に比較して、双方向性マイク・スピーカー付き動画像送信装置（NTT 製テレビ会議システムを基本とする遠隔病理診断支援システム）が利便性に優れており、診断に要する時間は１５〜３０分対５分と著明に短縮できた。
結論：テレパソロジー希望の症例数は年々増加し、その増加度はシステム導入前後の比較において統計的に有意であった。テレパソロジー導入後の２病院からのテレパソロジーによる迅速病理診断依頼件数がそれぞれの病院規模相応であったことより、病理医の常勤していない施設の外科医にとって、テレパソロジーは信頼に値する手段となり、手術に不可欠のものとなりつつあると判断された。依頼症例の２５％においては術前に悪性の診断がつかないままの手術となったものであり、このような症例においては、術中迅速病理診断は不可欠と考えられた。テレパソロジー装置について
は、NTT 製テレビ会議システムを基盤とする遠隔病理診断支援システムが、他装置に比較して、便利であった。
キーワード：テレパソロジー、遠隔医療、テレメディ
シン、遠隔病理診断支援システム、テレビ会議システ
ム（NTT）、術中迅速病理組織診断、新潟県厚生連

Table１． Arrangement of Pathologists and the scales of their hospitals in Niigata Prefecture in１
９９９．
hospitals
calssification
National
PrefecturalCivilRed Cross
KoseirenSaiseikai
Ocupational Health& MedicalOthers
totalin the year １９９９．

total number

total sick beds
１０
１６
１２
１
１４
３

frozen sections

Pathologists

total number/year

total number

density of members/
hospital
１．
１０．
４０．
３
２．
６０．
１０．
５

３
１２５４
１５４２
１７
１
７４
８
３４
４
６
７
７
３

４
９
８
５
７
２
１６７
３２
１２
４０２
２

１
１
７
３
３
２
２

２

６
８
５

７
８

２

０．
８

８
０
１
３８

１
５２
３
５
３０
３
３８

１
８
９８

７
２０．
５

Table２． Changes of frozen sections number before and after introduction of telepathology with several controls forcomparison in Niigata Prefecture（referring Fig．
２）．
subjects

General HospitalObject of study**

Koseiren Kariwagun

Koseiren MurakamiControl of study*** Koseiren Nagaoka Central

numbers of mean numbers of frozen sections/monthsignificancehistopathology / month（２０００）（２０００）
before intro- after
introduction of te- duction of telepathology lepathologcy
２７２１
４．
９２．
１
１
１．
１
p＜０．
０５，
correlation
coefficient＝０．
８３＊
１２４００
２．
４
３７６
４．
８６＆

Niigata Prefectural Cancer ９６３CenterNiigata Prefectural Central ６００１８．
７Niigata Prefectural Shibata ２８７９．
３１
９．
７Niigata Civil
４９４１３．
９Nagaoka Red Cross
７１６２
６．
８
Saiseikai Niigata ２nd３４３
８．
５
Tachikawa
３２９５．
６* : during first １
６ months after introduction of telepathology** : groups with introduction of telepathology*** : groups without introduction of telepathology＆：５−year average from １
９９８ to ２００３
in the year ２０００― 112 ―厚生連医誌

第１３巻１号 １１０〜１１３ ２００４Fig１．Change of specimens a month in each institute from１９９８to２００３．

Fig２．Change of specimens in Kariwagun General Hospital after an introduction of telepathology system. Correlation between total numbers of histopathology amonth and those of frozen sections amonth（referring Table ２）．

― 113 ―