Cancer diagnosis is based on a combination of careful analysis of tissue by a board certified pathologist, laboratory tests, radiological features and clinical signs and symptoms. Many skin lesions have clinical features that are adequate to diagnose skin cancer without the use of laboratory tests. This makes dermatology the speciality best positioned to utilise teleoncology in the diagnosis of cancer. Both the accuracy and the speed of skin cancer diagnosis is improved when the diagnostic clinician is a dermatologist.
Scarce literature exists on the diagnosis of solid organ or haematological cancers using teleoncology. This is most likely due to the increased complexity of these cases and the greater clinical impact of an incorrect cancer diagnosis. The exception is use of telepathology to send images of light microscopy slides to a centralised pathologist.
Diagnosis of skin cancer
Teledermatology typically involves sending images and/or a clinical history to a centralised dermatologist for diagnostic and management advice. Most of the teledermatology models use an asynchronous or a store-and-forward method whereby the pictures are transmitted after the patient has departed the clinic. This requires good quality cameras and adequate internet access. The feasibility of the asynchronous method has been proven in the USA, India, Turkey and Cambodia. Dermatological skin cancer diagnoses were compared to the gold standard tissue biopsies. Many of the studies included no or few malignant skin cancer diagnoses thereby diluting the relevance of the results. Despite the small numbers of skin cancers within the studies, the diagnostic accuracy between the in-person dermatologists and teledermatologist was reasonable; 88% in-person compared with 90% teledermatologist.
One health economics concern for teledermatology is a potential increase in the rate of skin biopsies. The Barnard et al study did not see a significant increase in the biopsy rate. Furthermore, the diagnostic accuracy was not greatly improved with the provision of clinical history when added to the digital image.
|Teleoncology to diagnose skin cancers is feasible.||IV||, , , , |
|In patients with suspected dermatological malignancies the use of asynchronous transmission of skin images to remote dermatologists produces acceptable diagnostic accuracy. In resource scarce health settings more timely diagnoses can be reached using teleoncology.||C|
Diagnosis of non-skin cancers
Few studies are available for the diagnosis of non-skin cancers using teleoncology. A study of patients with head and neck cancers provided encouraging evidence that teleoncology may deliver similar diagnostic accuracies to face-to-face assessments. Another study compared the accuracy of a telephone interview to a trained surgical examination for the diagnosis of breast cancers in Iranian women. The rate of concordance between the two approaches was 62%.
A study in Cambodia assessed the feasibility of reaching a cancer diagnosis in a developing-world community by sending images and clinical data to specialists in the USA. While cancer was correctly identified in all instances, all of the cases were advanced cancers. The utility of this model is therefore limited to developing countries where diagnostic services are scarce.. Another study assessed the concordance of cervical and non-cervical cancer diagnoses between remote pathologists using light microscopy slides compared to remote pathologists using only digitised images of a selection of slides. Complete concordance was seen in 75% of the cases assessed.
|There is insufficient evidence to support teleoncology as a safe alternative to diagnosing non-dermatological malignancies.||IV||, , , |
|In patients with suspected non-dermatological malignancies the use of teleoncology should not replace the standard diagnostic work up algorithm, except in supervised and externally scrutinised trial situations.||D|
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