The presence of lamina propria invasion is a prominent prognostic factor in papillary urothelial carcinoma of the bladder. Pathologic assessment of lamina propria invasion is frequently difficult due to the inevitable tangential sectioning and other factors, such as thermal and/or mechanical artifacts or pronounced stromal inflammation that may obscure invasion.1 Recent studies performed on cervical, vulvar and laryngeal carcinoma2-4 suggest that an elevated stromal eosinophil count may serve as a morphologic feature associated with tumor invasion. We performed a study to test the hypothesis that a high stromal eosinophil count and intense stromal inflammation are indicative of lamina propria invasion in papillary urothelial carcinoma of the bladder. Our aim was also to estimate the number of eosinophils per 1 high power field (HPF) and per 10 HPFs that could serve as thresholds in the diagnosis of invasion. The computer database at the Ljudevit Jurak Department of Pathology was used to generate a list of 50 consecutive patients with pTa and pT1 papillary urothelial carcinoma of the bladder each treated with transurethral resection, starting on January 1, 2005. The age of patients ranged from 35 to 87 years (median, 67.4), and the male:female ratio was 4.5:1. There was no statistically significant difference in the age (Mann-Whitney U-test, p> 0.05) or sex distribution (c2 test, p>0.05) between the pTa and pT1 groups. Thirty-one (62%) pT1 and 4 (8%) pTa tumors were high grade. Eosinophils were counted in lamina propria in an HPF (400•) with the maximal number of eosinophils and in 9 adjacent HPFs (Table I). The average number of inflammatory cells in 1 HPF was calculated from 10 randomly selected HPFs in lamina propria and graded as 0: 200 inflammatory cells/HPF.
The purpose of the present study was to evaluate the diagnostic accuracy of remote frozen sections examined by telepathology. The gold standard was the diagnosis made using direct examination of paraffin-embedded sections. A consecutive series of 134 frozen-section cases were examined by six qualified pathologists. We used the Zeiss telepathology system with robot microscopy, which allowed different magnifications and fields of view to be chosen. The wide-area network used the TCP/IP protocol. The diagnosis made on the frozen sections was compared with the final diagnosis in the paraffin-embedded sections. Times were recorded for each telepathology session, as well as the users comments on usability and software, and on any communication problems which occurred. In addition, we evaluated the importance of the macroscopic sampling of the surgical specimen, applied to each type of tissue. The diagnostic evaluation showed complete agreement in approximately 80% of cases, in 20% diagnosis was not possible due to insufficient quality of the slides. The median time for the telemedicine diagnosis was 14 min 30 sec.
