OBJECTIVE: To investigate the minimum requirements necessary for remote grading astrocytomas in terms of selected static images and descriptive histologic characteristics. STUDY DESIGN: A histopathologist examined 106 formalin-fixed, paraffin-embedded tissue samples of low- and high-grade astrocytomas. Interobserver-checked cases were reviewed under a microscope to estimate the accuracy of the conventional glass slide diagnoses. Then cases based on 5 static-digitized images from each patient were diagnosed. Next, the grade of each tumor was assessed based on the set of 5 images and the World Health Organization (WHO) description of 8 histologic characteristics defined as crucial in grading astrocytomas. Finally, an evaluation was made using a custom-designed decision support system. RESULTS: Conventional glass slide diagnosis was 93.9%. Diagnosis based only on the set of 5 images dropped to 81.6%. Diagnosis based on the set of 5 images and the WHO characteristics boosted accuracy to 88.8%. Accuracy improved to 91.8% with the addition of the decision support system. CONCLUSION: Our findings suggest that a telepathology system might be valuable for accurate grade diagnosis of astrocytomas-providing a means for avoiding diagnostic errors-without blocks or slides having to leave the department. This could significantly reduce the overall time and cost of diagnosis.