Originally created 06/09/01

A second opinion thousands of miles away



PITTSBURGH - When Dr. Jake Demetris gets paged during the night, the patient in need is sometimes 4,750 miles away in Palermo, Italy.

Rather than make the trip himself, Demetris, who is chief of transplant pathology at the University of Pittsburgh Medical Center, simply turns to a computer in his living room and calls up slides that have been transmitted through phone lines. Demetris then relays a message back to Dr. Marta Ida Minervini, a pathologist in Palermo, offering his opinion on whether a donor's organ is suitable for transplant.

This "telepathology" computer system is one way that doctors in Pittsburgh keep in touch with colleagues in Palermo, where the University of Pittsburgh manages a hospital called the Mediterranean Institute of Transplantation and Advanced Specialized Therapies.

The system has been used successfully in more than 150 cases since July 1999, said Yukako Yagi, director of telepathology at Pittsburgh. She reported the results Monday at the annual meeting of the American Telemedicine Association in Fort Lauderdale, Fla.

In the vast majority of cases, the computer consultation has confirmed the primary diagnosis made in Palermo. But at other times, doctors in Pittsburgh have offered second opinions that have significantly changed the course of care.

In one case, Minervini questioned whether a small lesion on a donor's liver was actually a colon cancer that had spread to the liver.

Upon consultation with doctors in Pittsburgh, the pathologists determined that the lesion was a bile duct adenoma that looks similar to cancer, but is relatively harmless. Doctors could proceed with the transplant.

But only about 5 percent of the consultations between Palermo and Pittsburgh involve questions about donor organs. In most cases, Minervini is looking for a second opinion on how a patient is doing either before or after transplant. The system has proven important in these cases as well.

One patient being worked up in Italy for a kidney transplant had skin lesions that concerned Minervini. She asked for a second opinion and, after using the computer system, doctors here said they needed Minervini to mail them the actual glass slides. After a careful review, doctors here determined the patient had melanoma, a skin cancer. Rather than go forward with a kidney transplant, the patient was sent for cancer care.

That was an important catch, Demetris said, because had doctors gone ahead with the transplant, the melanoma could have spread rapidly due to the immunosuppression drugs that transplant recipients must take.

The telepathology system was recently installed at the University of Kyushu in Fukuoka, Japan, where there is an active liver transplant program. The transplant pathologists here also plan to collaborate with a center in India.