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Munari E, Scarpa A, Cima L, Pozzi M, Pagni F, Vasuri F, Marletta S, Dei Tos AP, Eccher A. Cutting-edge technology and automation in the pathology laboratory. Virchows Arch 2024; 484:555-566. [PMID: 37930477 PMCID: PMC11062949 DOI: 10.1007/s00428-023-03637-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 11/07/2023]
Abstract
One of the goals of pathology is to standardize laboratory practices to increase the precision and effectiveness of diagnostic testing, which will ultimately enhance patient care and results. Standardization is crucial in the domains of tissue processing, analysis, and reporting. To enhance diagnostic testing, innovative technologies are also being created and put into use. Furthermore, although problems like algorithm training and data privacy issues still need to be resolved, digital pathology and artificial intelligence are emerging in a structured manner. Overall, for the field of pathology to advance and for patient care to be improved, standard laboratory practices and innovative technologies must be adopted. In this paper, we describe the state-of-the-art of automation in pathology laboratories in order to lead technological progress and evolution. By anticipating laboratory needs and demands, the aim is to inspire innovation tools and processes as positively transformative support for operators, organizations, and patients.
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Affiliation(s)
- Enrico Munari
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Piazza Del Mercato, 15, 25121, Brescia, BS, Italy.
| | - Aldo Scarpa
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Luca Cima
- Pathology Unit, Department of Laboratory Medicine, Santa Chiara Hospital, APSS, Trento, Italy
| | - Matteo Pozzi
- Bruno Kessler Foundation, Trento, Italy
- University of Trento, CIBIO Department, Trento, Italy
| | - Fabio Pagni
- Pathology Unit, Department of Medicine and Surgery, University of Milano-Bicocca, IRCCS Fondazione San Gerardo Dei Tintori, Monza, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Marletta
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Department of Pathology, Pederzoli Hospital, Peschiera del Garda, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua School of Medicine, Padua, Italy
| | - Albino Eccher
- Section of Pathology, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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Caputo A, L’Imperio V, Merolla F, Girolami I, Leoni E, Mea VD, Pagni F, Fraggetta F. The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board. Pathologica 2023; 115:127-136. [PMID: 37387439 PMCID: PMC10462988 DOI: 10.32074/1591-951x-868] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 07/01/2023] Open
Abstract
Objective The digital revolution in pathology represents an invaluable resource fto optimise costs, reduce the risk of error and improve patient care, even though it is still adopted in a minority of laboratories. Barriers include concerns about initial costs, lack of confidence in using whole slide images for primary diagnosis, and lack of guidance on transition. To address these challenges and develop a programme to facilitate the introduction of digital pathology (DP) in Italian pathology departments, a panel discussion was set up to identify the key points to be considered. Methods On 21 July 2022, an initial conference call was held on Zoom to identify the main issues to be discussed during the face-to-face meeting. The final summit was divided into four different sessions: (I) the definition of DP, (II) practical applications of DP, (III) the use of AI in DP, (IV) DP and education. Results Essential requirements for the implementation of DP are a fully tracked and automated workflow, selection of the appropriate scanner based on the specific needs of each department, and a strong commitment combined with coordinated teamwork (pathologists, technicians, biologists, IT service and industries). This could reduce human error, leading to the application of AI tools for diagnosis, prognosis and prediction. Open challenges are the lack of specific regulations for virtual slide storage and the optimal storage solution for large volumes of slides. Conclusion Teamwork is key to DP transition, including close collaboration with industry. This will ease the transition and help bridge the gap that currently exists between many labs and full digitisation. The ultimate goal is to improve patient care.
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Affiliation(s)
- Alessandro Caputo
- Department of Pathology, Ruggi University Hospital, Salerno, Italy
- Pathology Unit, Gravina Hospital Caltagirone ASP, Catania, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Francesco Merolla
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Eleonora Leoni
- Pathology Unit, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Vincenzo Della Mea
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milan-Bicocca, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
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The evolving landscape of Anatomic Pathology. Crit Rev Oncol Hematol 2022; 178:103776. [DOI: 10.1016/j.critrevonc.2022.103776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/11/2022] Open
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Hanna MG, Ardon O, Reuter VE, Sirintrapun SJ, England C, Klimstra DS, Hameed MR. Integrating digital pathology into clinical practice. Mod Pathol 2022; 35:152-164. [PMID: 34599281 DOI: 10.1038/s41379-021-00929-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 11/09/2022]
Abstract
The field of anatomic pathology has been evolving in the last few decades and the advancements have been largely fostered by innovative technology. Immunohistochemistry enabled a paradigm shift in discovery and diagnostic evaluation, followed by booming genomic advancements which allowed for submicroscopic pathologic characterization, and now the field of digital pathology coupled with machine learning and big data acquisition is paving the way to revolutionize the pathology medical domain. Whole slide imaging (WSI) is a disruptive technology where glass slides are digitized to produce on-screen whole slide images. Specifically, in the past decade, there have been significant advances in digital pathology systems that have allowed this technology to promote integration into clinical practice. Whole slide images (WSI), or digital slides, can be viewed and navigated comparable to glass slides on a microscope, as digital files. Whole slide imaging has increased in adoption among pathologists, pathology departments, and scientists for clinical, educational, and research initiatives. Integration of digital pathology systems requires a coordinated effort with numerous stakeholders, not only within the pathology department, but across the entire enterprise. Each pathology department has distinct needs, use cases and blueprints, however the framework components and variables for successful clinical integration can be generalized across any organization seeking to undergo a digital transformation at any scale. This article will review those components and considerations for integrating digital pathology systems into clinical practice.
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Affiliation(s)
- Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Schneider T, Jackups R. Transfusion Medicine Informatics: A Review of Current Practice and a Glimpse into the Future. Clin Lab Med 2021; 41:713-725. [PMID: 34689975 DOI: 10.1016/j.cll.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Clinical informatics has been described as the "relentless pursuit of assisting people" by using data and information technology to improve health care. A core principle is that a person supported by information technology is superior to either a person or machine alone. Striving toward this harmonization, the transfusion medicine field has had a significant number of accomplishments. Clinical informatics interventions have helped achieve better quality, efficiency, and safety in nearly all aspects of transfusion medicine. This review summarizes these accomplishments and provides a preview of novel ideas that could transform transfusion medicine into a proactive, data-driven, and patient-centered discipline.
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Affiliation(s)
- Thomas Schneider
- Department of Pathology and Immunology, Washington University School of Medicine in Saint Louis, 660. S Euclid Avenue #8118, St. Louis, MO 63110, USA
| | - Ronald Jackups
- Department of Pathology and Immunology, Washington University School of Medicine in Saint Louis, 660. S Euclid Avenue #8118, St. Louis, MO 63110, USA.
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L'Imperio V, Gibilisco F, Fraggetta F. What is Essential is (No More) Invisible to the Eyes: The Introduction of BlocDoc in the Digital Pathology Workflow. J Pathol Inform 2021; 12:32. [PMID: 34760329 PMCID: PMC8529340 DOI: 10.4103/jpi.jpi_35_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The implementation of a fully digital workflow in any anatomic pathology department requires a complete conversion to a tracked system. Ensuring the strict correspondence of the material submitted for the analysis, from the accessioning to the reporting phase, is mandatory in the anatomic pathology laboratory, especially when implementing the digital pathology for primary histological diagnosis. The proposed solutions, up to now, rely on the verification that all the materials present in the glass slide are also present in the whole slide images (WSIs). Although different methods have already been implemented for this purpose (e.g., the "macroimage" of the digital slide, representing the overview of the glass slide), the recent introduction of a device to capture the cut surface of paraffin blocks put the quality control of the digital workflow a step forward, allowing to match the digitized slide with the corresponding block. This system may represent a reliable, easy-to-use alternative to further reduce tissue inconsistencies between material sent to the lab and the final glass slides or WSIs. METHODS The Anatomic Pathology of the Gravina Hospital in Caltagirone, Sicily, Italy, has implemented the application of the BlocDoc devices (SPOT Imaging, Sterling Heights, USA) in its digital workflow. The instruments were positioned next to every microtome/sectioning station, with the possibility to capture the "normal" and the polarized image of the cut surface of the blocks directly by the technician. The presence of a monitor in the BlocDoc device allowed the technician to check the concordance between the cut surface of the block and the material on the corresponding slide. The link between BlocDoc and the laboratory information system, through the presence of the 2D barcode, allowed the pathologists to access the captured image of the cut surface of the block at the pathologist workstation, thus enabling the direct comparison between this image and the WSI (thumbnail and "macroimage"). RESULTS During the implementation period, more than 10.000 (11.248) blocks were routinely captured using the BlocDoc. The employment of this approach allowed a drastic reduction of the discordances and tissue inconsistencies. The implementation of the BlocDoc in the routine allowed the detection of two different types of "errors," the so-called "systematic" and "occasional" ones. The first type was intrinsic of some specific specimens (e.g., transurethral resection of the prostate, nasal polypectomies, and piecemeal uterine myomectomies) characterized by the three-dimensional nature of the fragments and affected almost 100% of these samples. On the other hand, the "occasional" errors, mainly due to inexperience or extreme caution of the technicians in handling tiny specimens, affected 98 blocks (0.9%) of these samples and progressively reduced with the rising confidence with the BlocDoc. One of these cases was clinically relevant. No problems in the recognition of the 2D barcodes were encountered using a laser cassette printer. Finally, rare failures have been recorded during the period, accounting for <0.1% of all the cases, mainly due to network connection issues. CONCLUSIONS The implementation of BlocDoc can further improve the effectiveness of the digital workflow, demonstrating its safety and robustness as a valid alternative to the traditional, nontracked analogic workflow.
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Affiliation(s)
- Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, ASST Monza, University of Milano-Bicocca, Monza, Italy
| | - Fabio Gibilisco
- Department of Medical and Surgical Sciences and Advanced Technologies, “G.F. Ingrassia”, Anatomic Pathology, University of Catania, Catania, Italy
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Crowson AN, Harvey M, Stout S. Data warehouse strategies and the modern anatomic pathology laboratory: Quality management, patient safety, and pathology productivity issues and opportunities. Semin Diagn Pathol 2019; 36:294-302. [DOI: 10.1053/j.semdp.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Norgan AP, Simon KE, Feehan BA, Saari LL, Doppler JM, Welder GS, Sedarski JA, Yoch CT, Comfere NI, Martin JA, Bartholmai BJ, Reichard RR. Radio-Frequency Identification Specimen Tracking to Improve Quality in Anatomic Pathology. Arch Pathol Lab Med 2019; 144:189-195. [PMID: 31246113 DOI: 10.5858/arpa.2019-0011-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Preanalytic errors, including specimen labeling errors and specimen loss, occur frequently during specimen collection, transit, and accessioning. Radio-frequency identification tags can decrease specimen identification and tracking errors through continuous and automated tracking of specimens. OBJECTIVE.— To implement a specimen tracking infrastructure to reduce preanalytic errors (specimen mislabeling or loss) between specimen collection and laboratory accessioning. Specific goals were to decrease preanalytic errors by at least 70% and to simultaneously decrease employee effort dedicated to resolving preanalytic errors or investigating lost specimens. DESIGN.— A radio-frequency identification specimen-tracking system was developed. Major features included integral radio-frequency identification labels (radio-frequency identification tags and traditional bar codes in a single printed label) printed by point-of-care printers in collection suites; dispersed radio-frequency identification readers at major transit points; and systems integration of the electronic health record, laboratory information system, and radio-frequency identification tracking system to allow for computerized physician order entry driven label generation, specimen transit time tracking, interval-based alarms, and automated accessioning. RESULTS.— In the 6-month postimplementation period, 6 mislabeling events occurred in collection areas using the radio-frequency identification system, compared with 24 events in the 6-month preimplementation period (75% decrease; P = .001). In addition, the system led to the timely recovery of 3 lost specimens. Labeling expenses were decreased substantially in the transition from high-frequency to ultrahigh frequency radio-frequency identification tags. CONCLUSIONS.— Radio-frequency identification specimen tracking prevented several potential specimen-loss events, decreased specimen recovery time, and decreased specimen labeling errors. Increases in labeling/tracking expenses for the system were more than offset by time savings and loss avoidance through error mitigation.
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Affiliation(s)
- Andrew P Norgan
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Kurt E Simon
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Barbara A Feehan
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Lynn L Saari
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Joseph M Doppler
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - G Scott Welder
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - John A Sedarski
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Christopher T Yoch
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Nneka I Comfere
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - John A Martin
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - Brian J Bartholmai
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
| | - R Ross Reichard
- From the Departments of Laboratory Medicine and Pathology (Drs Norgan, Comfere, and Reichard, Messrs Simon, Sedarski, and Yoch, and Ms Feehan), Nursing (Ms Saari), Dermatology (Messrs Doppler and Welder and Dr Comfere), and Radiology (Dr Bartholmai) and the Division of Gastroenterology and Hepatology (Dr Martin), Mayo Clinic, Rochester, Minnesota
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Noël GPJC, Connolly CC. Monitoring the use of anatomical teaching material using a low-cost radio frequency identification system: A comprehensive assessment. ANATOMICAL SCIENCES EDUCATION 2016; 9:197-202. [PMID: 26441139 DOI: 10.1002/ase.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 08/23/2015] [Accepted: 09/11/2015] [Indexed: 06/05/2023]
Abstract
The correct tracking and monitoring of anatomical specimens is not only imperative in any modern body donation programs but also in any universities for which teaching the next generation of health care professionals is the primary mission. This has long been an arduous process for anatomy institutions across the world, and the recent focus of new curricula on self-directed learning adds new stress on specimens which are used by students. The radio frequency identification (RFID) technology has been proposed as a very effective tracking system in healthcare considering that it enables automatic identification and data capture of multiple items at once. In this study, the feasibility of a low-cost RFID inventory system is assessed, from its design to the performance of commercially available RFID tags in a gross anatomy laboratory. The results show that ultrahigh frequency-based RFID tags successfully performed when attached to a collection of 112 plastinated and 280 wet dissected specimens. Comparison analysis of different tags reveals, however, that careful selection of RFID tags needs to be considered when wet specimens need to be tracked as preservation fluids can absorb radio waves energy. This study demonstrates that it is economically feasible to incorporate RFID technology to closely monitor the use of anatomical teaching specimens. The described RFID inventory system was not only able to preserve the integrity of the specimens being used by limiting handling and therefore human error but was also able to identify missing or misplaced specimens and to update their status.
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Affiliation(s)
- Geoffroy P J C Noël
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciaran C Connolly
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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