Mobile device smartphones for intraoperative diagnosis at the University Hospital Trust of Modena/UNIMORE: from validation process to costs analysis

Background: Telepathology enables remote diagnostic consultation through digital image transmission and is particularly valuable in settings where subspecialty expertise is not immediately available. This study evaluated the diagnostic accuracy of PathoZoom®, a web-based platform that allows real-time remote review of microscope images via mobile devices during intraoperative frozen section examination in a high-complexity academic hospital. Methods: Seventy-five consecutive frozen section cases, processed between January and April 2024 at the University Hospital Trust of Modena/UNIMORE, were included. All cases were first diagnosed using conventional light microscopy (LM) and then, after a washout period, the same slides were reviewed remotely using the PathoZoom® system and mobile smartphones. Diagnostic concordance between LM and telepathology was assessed, classifying discrepancies as major or minor, depending on their clinical impact in accordance with the current guidelines of the College of American Pathologists guidelines. Results: Overall concordance was 96% (72/75 cases). One major discordance occurred in a basal cell carcinoma margin assessment, interpreted as negative by telepathology and positive by LM. Two minor discrepancies involved polymorphonuclear cell counts in orthopedic specimens. No differences in performance were observed between mobile devices. Conclusions: Thanks to the technological setting and results, PathoZoom® and Smartphones are proposed as a diagnostic option for intraoperative consultation. Results support safety, feasibility and cost effectiveness of mobile-based telepathology in complex surgical settings and geographically extended healthcare networks.