1. Validating A Currently Available Measuring Tool for Melanoma Gabor Hertz, M.D.

6. Telepathology System

7. Ancillary uses could ease its adoption Skin cancers are common neoplasms in clinical practice (1/5) Melanoma Treatment and Prognosis depend on stage –<1 mm –1-4 mm

8. Validate the digital measuring tool available in microsuite 5

9. Design Retrospective validation study 18 cases 2006-2007 Digitally imaged at varying optical mag. Measurements compared to clinically reported Breslow thickness

10. Validate Digital Measuring Tool Validated digital measurement against stage micrometer standard

16. Results Case #Mean mBreslowClinically Reported BreslowDiffStage 07-18250.530.375%I 07-041750.410.518%I 07-058483.791.45175%IIA 07-062670.50.5610%I 07-069980.30.313%I 07-104900.9119%IIA 07-116731.8>1.520%IIB 07-132293.143.4810%IIB 07-141390.860.882%I 07-178633.7945%IIB 07-178991.331.511%IIA 07-179421.04>1.04%IIA 07-179720.320.420%I 07-223034.584.52%IIC 08-003670.30.425%I 08-0016400.260.3832%I 08-036810.35 0%I 08-078040.35.35-.413%I

17. Results Validating against stage micrometer –Avg 0.3 mm discrapency (30%/1mm) Validating against 18 clinical case –Avg 0.12 mm discrepency (24%)

18. Discrepency against stage micrometer Technical problems with initial installation as it focused only on telepath system Optical input was not initially configured/calibrated

19. Slightly tighter correlation against clinical measurements Likely due to additional confounding variables –Pathologic diagnosis/measurement is really semiquantitative and known to be subject to large intra and interobserver variation.

20. Lessons Even off the shelf products require anticipation of ancillary uses. New technology has a learning curve Applying highly accurate measuring tools will not by itself improve an inherently poorly reproducible measurement (sampling and interpretation variables need to be addressed)

21. Next Steps Develop the required technical understanding of digital medical imaging in microscopy Determine method and timing of input image calibration. Identify and rely on intra-image controls Develop logistical support to manage confounding variables (sampling & Dx variation)

25. Poster #482 Available on Tues 10/21

27. System Requirements Pentium processor At least Windows 98 256 MB RAM 200 MB Free space VGA monitor with 1024 x 768 resolution and 256 colors Microsoft Internet Explorer 3.02

31. Case # Mean mBreslow Clinically Reported BreslowDiffStage 07-18250.560.387%I 07-041750.5 0%I 07-058481.661.4515%IIA 07-062670.160.5672%I 07-069980.31 0%I 07-104900..9713%IIA 07-116731.5>1.50%IIB 07-1413910.8814%I 07-178991.261.516%IIA 07-179422.48>1.0148%IIA 07-179720.260.435%I 07-223034.224.56%IIC 08-003670.320.420%I 08-0016400.38 0%I 08-036810.360.353%I 08-078040.41.35-.43%I