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Magalhães G, Calisto R, Freire C, Silva R, Montezuma D, Canberk S, Schmitt F. Invisible for a few but essential for many: the role of Histotechnologists in the establishment of digital pathology. J Histotechnol 2024; 47:39-52. [PMID: 37869882 DOI: 10.1080/01478885.2023.2268297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
Digital pathology (DP) is indisputably the future for histopathology laboratories. The process of digital implementation requires deep workflow reorganisation which involves an interdisciplinary team. This transformation may have the greatest impact on the Histotechnologist (HTL) profession. Our review of the literature has clearly revealed that the role of HTLs in the establishment of DP is being unnoticed and guidance is limited. This article aims to bring HTLs from behind-the-scenes into the spotlight. Our objective is to provide them guidance and practical recommendations to successfully contribute to the implementation of a new digital workflow. Furthermore, it also intends to contribute for improvement of study programs, ensuring the role of HTL in DP is addressed as part of graduate and post-graduate education. In our review, we report on the differences encountered between workflow schemes and the limitations observed in this process. The authors propose a digital workflow to achieve its limitless potential, focusing on the HTL's role. This article explores the novel responsibilities of HTLs during specimen gross dissection, embedding, microtomy, staining, digital scanning, and whole slide image quality control. Furthermore, we highlight the benefits and challenges that DP implementation might bring the HTLs career. HTLs have an important role in the digital workflow: the responsibility of achieving the perfect glass slide.
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Affiliation(s)
- Gisela Magalhães
- Histopathology Department, Portsmouth Hospital University NHS Trust, Portsmouth, UK
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
| | - Rita Calisto
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
- Department of Pathological Anatomy, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Catarina Freire
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
- Department of Pathological Anatomy, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Regina Silva
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
- Centro de Investigação em Saúde e Ambiente, ESS,P.PORTO, Porto, Portugal
| | - Diana Montezuma
- Research & Development Unit, IMP Diagnostics, Porto, Portugal
- School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Sule Canberk
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Fernando Schmitt
- Department of Pathology, Faculty of Medicine of University of Porto, Porto, Portugal
- CINTESIS@RISE, Health Research Network, Alameda Prof. Hernâni Monteiro, Portugal
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Rozario SY, Sarkar M, Farlie MK, Lazarus MD. Responding to the healthcare workforce shortage: A scoping review exploring anatomical pathologists' professional identities over time. ANATOMICAL SCIENCES EDUCATION 2024; 17:351-365. [PMID: 36748328 DOI: 10.1002/ase.2260] [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: 06/06/2022] [Revised: 01/16/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Anatomical pathology (AP) is an anatomy-centric medical specialty devoted to tissue-based diagnosis of disease. The field faces a current and predicted workforce shortage, likely increasing diagnostic wait times and delaying patient access to urgent treatment. A lack of AP exposure is proposed to preclude recruitment to the field, as medical students are afforded only a limited understanding of who a pathologist is and what they do (their professional identity/PI and role). Anatomical sciences educators may be well placed to increase student understanding of anatomical pathologists' PI features, but until features of anatomical pathologists' PI are understood, recommendations for anatomy educators are premature. Thus, this scoping review asked: "What are the professional identity features of anatomical pathologists reported in the literature, and how have these changed over time?" A six-stage scoping review was performed. Medline and PubMed, Global Health, and Embase were used to identify relevant studies (n = 74). Team-based framework analysis identified that features of anatomical pathologists' professional identity encompass five overarching themes: professional practice, views about the role, training and education, personal implications, and technology. Technology was identified as an important theme of anatomical pathologists' PI, as it intersected with many other PI feature themes, including diagnosis and collaboration. This review found that pathologists may sometimes perceive professional competition with technology, such as artificial intelligence. These findings suggest unique opportunities for integrating AP-specific PI features into anatomy teaching, which may foster student interest in AP, and potentially increase recruitment into the field.
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Affiliation(s)
- Shemona Y Rozario
- Centre for Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Melanie K Farlie
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Pinto DG, Bychkov A, Tsuyama N, Fukuoka J, Eloy C. Real-World Implementation of Digital Pathology: Results From an Intercontinental Survey. J Transl Med 2023; 103:100261. [PMID: 37839634 DOI: 10.1016/j.labinv.2023.100261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/29/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023] Open
Abstract
The past 70 years have been characterized by rapid advancements in computer technology, and the health care system has not been immune to this trend. However, anatomical pathology has remained largely an analog discipline. In recent years, this has been changing with the growing adoption of digital pathology, partly driven by the potential of computer-aided diagnosis. As part of an international collaboration, we conducted a comprehensive survey to gain a deeper understanding of the status of digital pathology implementation in Europe and Asia. A total of 127 anatomical pathology laboratories participated in the survey, including 75 from Europe and 52 from Asia, with 72 laboratories having established digital pathology workflow and 55 without digital pathology. Laboratories using digital pathology for diagnostic (n = 29) and nondiagnostic (n = 43) purposes were thoroughly questioned about their implementation strategies and institutional experiences, including details on equipment, storage, integration with laboratory information system, computer-aided diagnosis, and the costs of going digital. The impact of the digital pathology workflow was also evaluated, focusing on turnaround time, specimen traceability, quality control, and overall satisfaction. Laboratories without access to digital pathology were asked to provide insights into their perceptions of the technology, expectations, barriers to adoption, and potential facilitators. Our findings indicate that although digital pathology is still the future for many, it is already the present for some. This decade may be a time when anatomical pathology finally embraces digital revolution on a larger scale.
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Affiliation(s)
- Daniel Gomes Pinto
- Serviço de Anatomia Patológica, Hospital Garcia de Orta, EPE, Almada, Portugal; NOVA Medical School, Lisboa, Portugal; IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Naoko Tsuyama
- Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan; Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Catarina Eloy
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal; Instituto de Investigação e Inovação Em Saúde (i3S) and Faculty of Medicine, University of Porto (FMUP), Porto, Portugal.
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Schwen LO, Kiehl TR, Carvalho R, Zerbe N, Homeyer A. Digitization of Pathology Labs: A Review of Lessons Learned. J Transl Med 2023; 103:100244. [PMID: 37657651 DOI: 10.1016/j.labinv.2023.100244] [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: 06/07/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
Pathology laboratories are increasingly using digital workflows. This has the potential of increasing laboratory efficiency, but the digitization process also involves major challenges. Several reports have been published describing the individual experiences of specific laboratories with the digitization process. However, a comprehensive overview of the lessons learned is still lacking. We provide an overview of the lessons learned for different aspects of the digitization process, including digital case management, digital slide reading, and computer-aided slide reading. We also cover metrics used for monitoring performance and pitfalls and corresponding values observed in practice. The overview is intended to help pathologists, information technology decision makers, and administrators to benefit from the experiences of others and to implement the digitization process in an optimal way to make their own laboratory future-proof.
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Affiliation(s)
- Lars Ole Schwen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany.
| | - Tim-Rasmus Kiehl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Rita Carvalho
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - Norman Zerbe
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Pathology, Berlin, Germany
| | - André Homeyer
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
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Browning L, Winter L, Cooper RA, Ghosh A, Dytor T, Colling R, Fryer E, Rittscher J, Verrill C. Impact of the transition to digital pathology in a clinical setting on histopathologists in training: experiences and perceived challenges within a UK training region. J Clin Pathol 2023; 76:712-718. [PMID: 35906044 PMCID: PMC10511979 DOI: 10.1136/jcp-2022-208416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
AIMS With increasing utility of digital pathology (DP), it is important to consider the experiences of histopathologists in training, particularly in view of the varied access to DP across a training region and the consequent need to remain competent in reporting on glass slides (GS), which is also relevant for the Fellowship of the Royal College of Pathologists part 2 examination. Understanding the impact of DP on training is limited but could aid development of guidance to support the transition. We sought to investigate the perceptions of histopathologists in training around the introduction of DP for clinical diagnosis within a training region, and the potential training benefits and challenges. METHODS An anonymous online survey was circulated to 24 histopathologists in training within a UK training region, including a hospital which has been fully digitised since summer 2020. RESULTS 19 of 24 histopathologists in training responded (79%). The results indicate that DP offers many benefits to training, including ease of access to cases to enhance individual learning and teaching in general. Utilisation of DP for diagnosis appears variable; almost half of the (10 of 19) respondents with DP experience using it only for ancillary purposes such as measurements, reporting varying levels of confidence in using DP clinically. For those yet to undergo the transition, there was a perceived anxiety regarding digital reporting despite experience with DP in other contexts. CONCLUSIONS The survey evidences the need for provision of training and support for histopathologists in training during the transition to DP, and for consideration of their need to maintain competence and confidence with GS reporting.
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Affiliation(s)
- Lisa Browning
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucinda Winter
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Abhisek Ghosh
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Thomas Dytor
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Colling
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Eve Fryer
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jens Rittscher
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
| | - Clare Verrill
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Smith J, Johnsen S, Zeuthen MC, Thomsen LK, Marcussen N, Hansen S, Jensen CL. On the Road to Digital Pathology in Denmark-National Survey and Interviews. J Digit Imaging 2022; 35:1189-1206. [PMID: 35610395 PMCID: PMC9129899 DOI: 10.1007/s10278-022-00638-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022] Open
Abstract
Digital pathology (DP) is changing pathology departments dramatically worldwide, yet globally, few departments are presently digitalized for the full diagnostic workflow. Denmark is also on the road to full digitalization countrywide, and this study aim to cover experiences during the implementation process in a national context. Thus, quantitative questionnaires were distributed to all pathology departments in Denmark (n = 13) and distributed to all professions including medical clinical directors, medical doctors (MD) and biomedical laboratory scientists (BLS). For a qualitative perspective, we interviewed four employees representing four professions. Data were collected in 2019–2020. From the questionnaire and interviews, we found strategies differed at the Danish departments with regards to ambitions, technological equipment, workflows, and involvement of type of professions. DP education was requested by personnel. Informants were in general positive toward the digital future but mainly had concerns regarding the political pressure to integrate DP before technological advances are sufficient for maintaining rational budgets, workflows, and for sustaining diagnostic quality. This study is a glance on the Danish implementation process in its early stages from personnel’s point of view. It shows the complexity when large new workflow processes are to be implemented countrywide and with a large diversity of stakeholders like managers, MD, BLS, IT-professionals, and authorities. To ensure best technological and economical solutions and to maintain—or even optimize—diagnostic quality with DP and workflow alignment, we suggest superior inter- and intradepartmental communication. When implementing DP countrywide, a national working group is warranted with the variety of stakeholders represented.
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Affiliation(s)
- Julie Smith
- Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark.
| | - Sys Johnsen
- Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Mette Christa Zeuthen
- Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Lisbeth Koch Thomsen
- Centre for Engineering and Science, University College Absalon, Næstved, Denmark
| | - Niels Marcussen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark.,Department of Pathology, Department of Regional Health Research, Hospital Sønderjylland, University of Southern Denmark, Aabenraa, Denmark
| | - Stig Hansen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
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Rakovic K, Colling R, Browning L, Dolton M, Horton MR, Protheroe A, Lamb AD, Bryant RJ, Scheffer R, Crofts J, Stanislaus E, Verrill C. The Use of Digital Pathology and Artificial Intelligence in Histopathological Diagnostic Assessment of Prostate Cancer: A Survey of Prostate Cancer UK Supporters. Diagnostics (Basel) 2022; 12:1225. [PMID: 35626380 PMCID: PMC9141178 DOI: 10.3390/diagnostics12051225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/03/2022] Open
Abstract
There has been particular interest in the deployment of digital pathology (DP) and artificial intelligence (AI) in the diagnosis of prostate cancer, but little is known about the views of the public on their use. Prostate Cancer UK supporters were invited to an online survey which included quantitative and qualitative questions exploring views on the use of DP and AI in histopathological assessment. A total of 1276 responses to the survey were analysed (response rate 12.5%). Most respondents were supportive of DP (87%, 1113/1276) and of testing AI in clinical practice as a diagnostic adjunct (83%, 1058/1276). Respondents saw DP as potentially increasing workflow efficiency, facilitating research, education/training and fostering clinical discussions between clinician and patient. Some respondents raised concerns regarding data security, reliability and the need for human oversight. Among those who were unsure about AI, information was requested regarding its performance and others wanted to defer the decision to use it to an expert. Although most are in favour of its use, some are unsure, and their concerns could be addressed with more information or better communication. A small minority (<1%) are not in favour of the testing of the use of AI in histopathology for reasons which are not easily addressed.
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Affiliation(s)
- Kai Rakovic
- Institute of Cancer Sciences, University of Glasgow, Switchback Road, Glasgow G61 1QH, UK
- Department of Pathology, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (R.C.); (L.B.); (C.V.)
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (R.C.); (L.B.); (C.V.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Monica Dolton
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | | | - Andrew Protheroe
- Department of Oncology, University of Oxford, Roosevelt Drive, Oxford OX3 7DQ, UK;
- Oxford Cancer & Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Alastair D. Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Richard J. Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Richard Scheffer
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - James Crofts
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - Ewart Stanislaus
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (R.C.); (L.B.); (C.V.)
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; (M.D.); (A.D.L.); (R.J.B.); (R.S.); (J.C.); (E.S.)
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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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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Digital Pathology Transformation in a Supraregional Germ Cell Tumour Network. Diagnostics (Basel) 2021; 11:diagnostics11122191. [PMID: 34943429 PMCID: PMC8700654 DOI: 10.3390/diagnostics11122191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023] Open
Abstract
Background: In this article we share our experience of creating a digital pathology (DP) supraregional germ cell tumour service, including full digitisation of the central laboratory. Methods: DP infrastructure (Philips) was deployed across our hospital network to allow full central digitisation with partial digitisation of two peripheral sites in the supraregional testis germ cell tumour network. We used a survey-based approach to capture the quantitative and qualitative experiences of the multidisciplinary teams involved. Results: The deployment enabled case sharing for the purposes of diagnostic reporting, second opinion, and supraregional review. DP was seen as a positive step forward for the departments involved, and for the wider germ cell tumour network, and was completed without significant issues. Whilst there were challenges, the transition to DP was regarded as worthwhile, and examples of benefits to patients are already recognised. Conclusion: Pathology networks, including highly specialised services, such as in this study, are ideally suited to be digitised. We highlight many of the benefits but also the challenges that must be overcome for such clinical transformation. Overall, from the survey, the change was seen as universally positive for our service and highlights the importance of engagement of the whole team to achieve success.
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Neri F, Eccher A, Rigotti P, Girolami I, Zaza G, Gambaro G, Mastrosimini M, Bencini G, Bella CD, Mescoli C, Boschiero L, Marletta S, Tos PAD, Furian L. Advantages of Using a Web-based Digital Platform for Kidney Preimplantation Biopsies. J Pathol Inform 2021; 12:41. [PMID: 34881096 PMCID: PMC8609286 DOI: 10.4103/jpi.jpi_23_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/02/2021] [Accepted: 06/20/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In the setting of kidney transplantation, histopathology of kidney biopsies is a key element in the organ assessment and allocation. Despite the broad diffusion of the Remuzzi-Karpinski score on preimplantation kidney biopsies, scientific evidence of its correlation to the transplantation outcome is controversial. The main issues affecting the prognostic value of histopathology are the referral to general on-call pathologists and the semiquantitative feature of the score, which can raise issues of interpretation. Digital pathology has shown very reliable and effective in the oncological diagnosis and treatment; however, the spread of such technologies is lagging behind in the field of transplantation. The aim of our study was to create a digital online platform where whole-slide images (WSI) of preimplantation kidney biopsies could be uploaded and stored. METHODS We included 210 kidney biopsies collected between January 2015 and December 2019 from the joint collaboration of the transplantation centers of Padua and Verona. The selected slides, stained with hematoxylin and eosin, were digitized and uploaded on a shared web platform. For each case, the on-call pathologists' Remuzzi grades were obtained from the original report, together with the clinical data and the posttransplantation follow-up. RESULTS The storage of WSI of preimplantation kidney biopsies would have several clinical, scientific, and educational advantages. The clinical utility relies on the possibility to consult online expert pathologists and real-time quality checks of diagnosis. From the perspective of follow-up, the archived digitized biopsies can offer a useful comparison to posttransplantation biopsies. In addition, the digital online platform is a precious tool for multidisciplinary meetings aimed both at the clinical discussion and at the design of research projects. Furthermore, this archive of readily available WSI is an important educational resource for the training of professionals. CONCLUSIONS Finally, the web platform lays the foundation for the introduction of artificial intelligence in the field of transplantation that would help create new diagnostic algorithms and tools with the final aim of increasing the precision of organ assessment and its predictive value for transplant outcome.
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Affiliation(s)
- Flavia Neri
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostic, University and Hospital Trust of Verona, Verona, Italy
| | - Paolo Rigotti
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Ilaria Girolami
- Division of Pathology, Central Hospital Bolzano, Bolzano, Italy
| | - Gianluigi Zaza
- Department of General Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Gambaro
- Department of General Medicine, Renal Unit, University and Hospital Trust of Verona, Verona, Italy
| | - MariaGaia Mastrosimini
- Department of Pathology and Diagnostic, University and Hospital Trust of Verona, Verona, Italy
| | - Giulia Bencini
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Caterina Di Bella
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
| | - Claudia Mescoli
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Luigino Boschiero
- Department of Surgical Sciences, Kidney Transplant Center, Hospital Trust of Verona, Verona, Italy
| | - Stefano Marletta
- Department of Pathology and Diagnostic, University and Hospital Trust of Verona, Verona, Italy
| | - Paolo Angelo Dei Tos
- Department of Medicine, Surgical Pathology and Cytopathology Unit, University of Padua, Padua, Italy
| | - Lucrezia Furian
- Department of Surgical, Oncological and Gastroenterological Sciences, Unit of Kidney and Pancreas Transplantation, University of Padua, Padua, Italy
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Betmouni S. Diagnostic digital pathology implementation: Learning from the digital health experience. Digit Health 2021; 7:20552076211020240. [PMID: 34211723 PMCID: PMC8216403 DOI: 10.1177/20552076211020240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/04/2021] [Indexed: 01/18/2023] Open
Abstract
Digital Pathology (also referred to as Telepathology and Whole Slide Imaging) is the process of producing high resolution digital images from tissue sections on glass slides. These glass slides are normally examined under a microscope by a pathologist as part of the diagnostic process. The emergence of digital pathology now means that digital images are stored on secure servers and can be viewed on computer monitors; enabling pathologists to work remotely and to collaborate with other colleagues when second opinions are needed. The implementation of digital pathology into clinical practice has many potential benefits. Although this has been long recognised, its adoption as a diagnostic tool remains low and pathologists’ projections about its future deployment are cautious. Notable early digital pathology adopters have led the way. The challenge now is to scale-up digital pathology beyond the relatively few large networks and centres of excellence. Many other areas of healthcare have accumulated experience about optimising approaches to digital health/healthcare technology deployment and sustainability. This has been done in a multi-disciplinary context and has applied theoretical/conceptual frameworks. Thus far there has been little use of similar frameworks in the planning of digital pathology deployment in clinical practice. In this essay, I will explore the scope of digital pathology implementation approaches that have been deployed in clinical practice and examine what can be learned from the wider healthcare experience of adopting, scaling-up and sustaining innovative healthcare solutions.
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Affiliation(s)
- Samar Betmouni
- Digital Health Enterprise Zone, University of Bradford, Bradford, UK.,Digital Health Enterprise Zone, University of Bradford, Bradford, UK
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