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Bruce C, Prassas I, Mokhtar M, Clarke B, Youssef E, Wang C, Yousef GM. Transforming diagnostics: The implementation of digital pathology in clinical laboratories. Histopathology 2024; 85:207-214. [PMID: 38516992 DOI: 10.1111/his.15178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
Digital pathology (DP) has emerged as a cutting-edge technology that promises to revolutionise diagnostics in clinical laboratories. This perspective article explores the implementation planning and considerations of DP in a single multicentre institution in Canada, the University Health Network, discussing benefits, challenges, potential implications and considerations for future adopters. We examine the transition from traditional microscopy to digital slide scanning and its impact on pathology practice, patient care and medical research. Furthermore, we address the regulatory, infrastructure and change management considerations for successful integration into clinical laboratories. By highlighting the advantages and addressing concerns, we aim to shed light on the transformative potential of DP and its role in shaping the future of diagnostics.
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Affiliation(s)
- Christine Bruce
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Ioannis Prassas
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Mark Mokhtar
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Blaise Clarke
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Elaria Youssef
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Catherine Wang
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - George M Yousef
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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2
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Janowczyk A, Zlobec I, Walker C, Berezowska S, Huschauer V, Tinguely M, Kupferschmid J, Mallet T, Merkler D, Kreutzfeldt M, Gasic R, Rau TT, Mazzucchelli L, Eyberg I, Cathomas G, Mertz KD, Koelzer VH, Soldini D, Jochum W, Rössle M, Henkel M, Grobholz R. Swiss digital pathology recommendations: results from a Delphi process conducted by the Swiss Digital Pathology Consortium of the Swiss Society of Pathology. Virchows Arch 2024; 485:13-30. [PMID: 38112792 DOI: 10.1007/s00428-023-03712-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/23/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
Integration of digital pathology (DP) into clinical diagnostic workflows is increasingly receiving attention as new hardware and software become available. To facilitate the adoption of DP, the Swiss Digital Pathology Consortium (SDiPath) organized a Delphi process to produce a series of recommendations for DP integration within Swiss clinical environments. This process saw the creation of 4 working groups, focusing on the various components of a DP system (1) scanners, quality assurance and validation of scans, (2) integration of Whole Slide Image (WSI)-scanners and DP systems into the Pathology Laboratory Information System, (3) digital workflow-compliance with general quality guidelines, and (4) image analysis (IA)/artificial intelligence (AI), with topic experts for each recruited for discussion and statement generation. The work product of the Delphi process is 83 consensus statements presented here, forming the basis for "SDiPath Recommendations for Digital Pathology". They represent an up-to-date resource for national and international hospitals, researchers, device manufacturers, algorithm developers, and all supporting fields, with the intent of providing expectations and best practices to help ensure safe and efficient DP usage.
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Affiliation(s)
- Andrew Janowczyk
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, USA.
- Department of Oncology, Division of Precision Oncology, Geneva University Hospitals, Geneva, Switzerland.
- Department of Diagnostics, Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland.
| | - Inti Zlobec
- Institute for Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Cedric Walker
- Institute of Animal Pathology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Sabina Berezowska
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Marianne Tinguely
- Institute of Pathology Enge, Zurich, Switzerland
- Medical Faculty, University of Zürich, Zurich, Switzerland
| | | | - Thomas Mallet
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | - Doron Merkler
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | - Mario Kreutzfeldt
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
- Department of Pathology and Immunology, University of Geneva, Geneva, Switzerland
| | | | - Tilman T Rau
- Institute of Pathology, University Hospital and Heinrich-Heine University, Düsseldorf, Germany
- Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Isgard Eyberg
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Gieri Cathomas
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
| | - Kirsten D Mertz
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Viktor H Koelzer
- Department of Pathology and Molecular Pathology, University and University Hospital of Zürich, Zurich, Switzerland
| | | | - Wolfram Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Matthias Rössle
- Pathologie Luzerner Kantonsspital (Pathology Cantonal Hospital Lucerne), Spitalstrasse, Switzerland
| | - Maurice Henkel
- Research & Analytic Services University Hospital Basel, Basel, Switzerland
- Institute of Radiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rainer Grobholz
- Medical Faculty, University of Zürich, Zurich, Switzerland
- Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland
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3
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Browning L, Jesus C, Malacrino S, Guan Y, White K, Puddle A, Alham NK, Haghighat M, Colling R, Birks J, Rittscher J, Verrill C. Artificial Intelligence-Based Quality Assessment of Histopathology Whole-Slide Images within a Clinical Workflow: Assessment of 'PathProfiler' in a Diagnostic Pathology Setting. Diagnostics (Basel) 2024; 14:990. [PMID: 38786288 PMCID: PMC11120465 DOI: 10.3390/diagnostics14100990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/17/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Digital pathology continues to gain momentum, with the promise of artificial intelligence to aid diagnosis and for assessment of features which may impact prognosis and clinical management. Successful adoption of these technologies depends upon the quality of digitised whole-slide images (WSI); however, current quality control largely depends upon manual assessment, which is inefficient and subjective. We previously developed PathProfiler, an automated image quality assessment tool, and in this feasibility study we investigate its potential for incorporation into a diagnostic clinical pathology setting in real-time. A total of 1254 genitourinary WSI were analysed by PathProfiler. PathProfiler was developed and trained on prostate tissue and, of the prostate biopsy WSI, representing 46% of the WSI analysed, 4.5% were flagged as potentially being of suboptimal quality for diagnosis. All had concordant subjective issues, mainly focus-related, 54% severe enough to warrant remedial action which resulted in improved image quality. PathProfiler was less reliable in assessment of non-prostate surgical resection-type cases, on which it had not been trained. PathProfiler shows potential for incorporation into a digitised clinical pathology workflow, with opportunity for image quality improvement. Whilst its reliability in the current form appears greatest for assessment of prostate specimens, other specimen types, particularly biopsies, also showed benefit.
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Affiliation(s)
- Lisa Browning
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Christine Jesus
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Stefano Malacrino
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Yue Guan
- Department of Cellular Pathology, Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK
| | - Kieron White
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Alison Puddle
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | | | - Maryam Haghighat
- School of Electrical Engineering and Robotics, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Richard Colling
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - Jacqueline Birks
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Jens Rittscher
- Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Clare Verrill
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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Iwuajoku V, Haas A, Ekici K, Khan MZ, Stögbauer F, Steiger K, Mogler C, Schüffler PJ. [Digital transformation of a routine histopathology lab : Dos and don'ts!]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024; 45:98-105. [PMID: 38189845 PMCID: PMC10902067 DOI: 10.1007/s00292-023-01291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Abstract
The implementation of digital histopathology in the laboratory marks a crucial milestone in the overall digital transformation of pathology. This shift offers a range of new possibilities, including access to extensive datasets for AI-assisted analyses, the flexibility of remote work and home office arrangements for specialists, and the expedited and simplified sharing of images and data for research, conferences, and tumor boards. However, the transition to a fully digital workflow involves significant technological and personnel-related efforts. It necessitates careful and adaptable change management to minimize disruptions, particularly in the personnel domain, and to prevent the loss of valuable potential from employees who may be resistant to change. This article consolidates our institute's experiences, highlighting technical and personnel-related challenges encountered during the transition to digital pathology. It also presents a comprehensive overview of potential difficulties at various interfaces when converting routine operations to a digital workflow.
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Affiliation(s)
- Viola Iwuajoku
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Anette Haas
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Kübra Ekici
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Mohammad Zaid Khan
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Fabian Stögbauer
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Katja Steiger
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Carolin Mogler
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland
| | - Peter J Schüffler
- Institut für Pathologie, TUM School of Medicine and Health, Technische Universität München, Trogerstraße 18, 81675, München, Deutschland.
- TUM School of Computational Information and Technology, Technische Universität München, München, Deutschland.
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Gown AM. The Biomarker Ki-67: Promise, Potential, and Problems in Breast Cancer. Appl Immunohistochem Mol Morphol 2023; 31:478-484. [PMID: 36730064 DOI: 10.1097/pai.0000000000001087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
Abstract
Ki-67 is a nuclear protein serendipitously discovered by monoclonal antibody selection in the early 1980s. While it has been applied for decades in the context of breast cancer as a putative prognostic and, more recently, predictive, biomarker, even after all this time there is incomplete agreement as to the validity of the immunohistochemical assays employed for Ki-67 assessment, given possible effects of the disparate methodologies employed and possible confounding preanalytical, analytical, and interpretive variables. In this brief review, the history of Ki-67 and the problems, particularly with the analytical and interpretive variables, are highlighted through a selective review of the published literature. The contributions of the International Ki-67 Breast Cancer Working Group are highlighted, and in particular, the recommendations made by this group are reviewed. The potential of Ki-67 as a biomarker for breast cancer has not yet been fully realized, but an understanding of the power as well as the limitations of the methods of Ki-67 assessment are important if this biomarker can realize its potential.
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Affiliation(s)
- Allen M Gown
- Department of Pathology, University of British Columbia, Vancouver, BC
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Duenweg SR, Bobholz SA, Lowman AK, Stebbins MA, Winiarz A, Nath B, Kyereme F, Iczkowski KA, LaViolette PS. Whole slide imaging (WSI) scanner differences influence optical and computed properties of digitized prostate cancer histology. J Pathol Inform 2023; 14:100321. [PMID: 37496560 PMCID: PMC10365953 DOI: 10.1016/j.jpi.2023.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose Digital pathology is becoming an increasingly popular area of advancement in both research and clinically. Pathologists are now able to manage and interpret slides digitally, as well as collaborate with external pathologists with digital copies of slides. Differences in slide scanners include variation in resolution, image contrast, and optical properties, which may influence downstream image processing. This study tested the hypothesis that varying slide scanners would result in differences in computed pathomic features on prostate cancer whole mount slides. Design This study collected 192 unique tissue slides from 30 patients following prostatectomy. Tissue samples were paraffin-embedded, stained for hematoxylin and eosin (H&E), and digitized using 3 different scanning microscopes at the highest available magnification rate, for a total of 3 digitized slides per tissue slide. These scanners included a (S1) Nikon microscope equipped with an automated sliding stage, an (S2) Olympus VS120 slide scanner, and a (S3) Huron TissueScope LE scanner. A color deconvolution algorithm was then used to optimize contrast by projecting the RGB image into color channels representing optical stain density. The resulting intensity standardized images were then computationally processed to segment tissue and calculate pathomic features including lumen, stroma, epithelium, and epithelial cell density, as well as second-order features including lumen area and roundness; epithelial area, roundness, and wall thickness; and cell fraction. For each tested feature, mean values of that feature per digitized slide were collected and compared across slide scanners using mixed effect models, fit to compare differences in the tested feature associated with all slide scanners for each slide, including a random effect of subject with a nested random effect of slide to account for repeated measures. Similar models were also computed for tissue densities to examine how differences in scanner impact downstream processing. Results Each mean color channel intensity (i.e., Red, Green, Blue) differed between slide scanners (all P<.001). Of the color deconvolved images, only the hematoxylin channel was similar in all 3 scanners (all P>.05). Lumen and stroma densities between S3 and S1 slides, and epithelial cell density between S3 and S2 (P>.05) were comparable but all other comparisons were significantly different (P<.05). The second-order features were found to be comparable for all scanner comparisons, except for lumen area and epithelium area. Conclusion This study demonstrates that both optical and computed properties of digitized histological samples are impacted by slide scanner differences. Future research is warranted to better understand which scanner properties influence the tissue segmentation process and to develop harmonization techniques for comparing data across multiple slide scanners.
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Affiliation(s)
- Savannah R. Duenweg
- Departments of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Samuel A. Bobholz
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Allison K. Lowman
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Margaret A. Stebbins
- Departments of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Aleksandra Winiarz
- Departments of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Biprojit Nath
- Departments of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Fitzgerald Kyereme
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Kenneth A. Iczkowski
- Department of Pathology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
| | - Peter S. LaViolette
- Departments of Biophysics, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA
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7
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Cho MY, Kim SC, Choi YS, Jang DS, Heo SJ, Choi YJ, Chung KY, Roh MR, Kim J. Mohs Micrographic Surgery With Digital Pathology Improves Surgical Quality and Efficiency: A Retrospective Cohort Study. Dermatol Surg 2023; 49:635-640. [PMID: 37235875 DOI: 10.1097/dss.0000000000003819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Mohs micrographic surgery, involving pathology of the surgical margin, has the lowest recurrence rate for skin cancer. Moreover, because of technological advances, digital pathology systems are gradually being adopted in hospitals. Yongin Severance Hospital was the first hospital to construct a fully digitalized pathology system in Korea. OBJECTIVE To evaluate the efficiency and characteristics of the digital pathology system for Mohs micrographic surgery. METHODS The medical records of 80 patients with skin cancer who underwent Mohs micrographic surgery from March 2020 to August 2022 were analyzed for the number of frozen margins, number of stages, operation time, and recurrence rate to compare cases based on the pathology system. RESULTS Overall, 23 and 57 patients were examined using the conventional and digital pathology systems, respectively. The mean number of final stages was 0.494 lower ( p -value = .008), the time from the previous to the next stage was 0.687-fold shorter ( p = .002), and the rate of switching from positive to negative margins was 1.990 times higher ( p = .044) in the digital than the conventional group. LIMITATIONS Retrospective single-center experience; short follow-up time. CONCLUSION Digital pathology reduces operative time and increases accuracy in Mohs micrographic surgery.
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Affiliation(s)
- Mi Yeon Cho
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Soo Chan Kim
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Ye Seul Choi
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Dong Su Jang
- Research Affairs, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Yoon Jung Choi
- Department of Pathology, Yongin Severance Hospital, Yongin-si, Republic of Korea
| | - Kee-Yang Chung
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
| | - Jihee Kim
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin-si, Republic of Korea
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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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9
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Ardon O, Klein E, Manzo A, Corsale L, England C, Mazzella A, Geneslaw L, Philip J, Ntiamoah P, Wright J, Sirintrapun SJ, Lin O, Elenitoba-Johnson K, Reuter VE, Hameed MR, Hanna MG. Digital pathology operations at a tertiary cancer center: Infrastructure requirements and operational cost. J Pathol Inform 2023; 14:100318. [PMID: 37811334 PMCID: PMC10550754 DOI: 10.1016/j.jpi.2023.100318] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 10/10/2023] Open
Abstract
Whole slide imaging is revolutionizing the field of pathology and is currently being used for clinical, educational, and research initiatives by an increasing number of institutions. Pathology departments have distinct needs for digital pathology systems, yet the cost of digital workflows is cited as a major barrier for widespread adoption by many organizations. Memorial Sloan Kettering Cancer Center (MSK) is an early adopter of whole slide imaging with incremental investments in resources that started more than 15 years ago. This experience and the large-scale scan operations led to the identification of required framework components of digital pathology operations. The cost of these components for the 2021 digital pathology operations at MSK were studied and calculated to enable an understanding of the operation and benchmark the accompanying costs. This paper describes the unique infrastructure cost and the costs associated with the digital pathology clinical operation use cases in a large, tertiary cancer center. These calculations can serve as a blueprint for other institutions to provide the necessary concepts and offer insights towards the financial requirements for digital pathology adoption by other institutions.
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Affiliation(s)
- Orly Ardon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Klein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allyne Manzo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorraine Corsale
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine England
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allix Mazzella
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luke Geneslaw
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Philip
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Ntiamoah
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeninne Wright
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Oscar Lin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kojo Elenitoba-Johnson
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E. Reuter
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera R. Hameed
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew G. Hanna
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Piya S, Lennerz JK. Sustainable development goals applied to digital pathology and artificial intelligence applications in low- to middle-income countries. Front Med (Lausanne) 2023; 10:1146075. [PMID: 37256085 PMCID: PMC10225661 DOI: 10.3389/fmed.2023.1146075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Digital Pathology (DP) and Artificial Intelligence (AI) can be useful in low- and middle-income countries; however, many challenges exist. The United Nations developed sustainable development goals that aim to overcome some of these challenges. The sustainable development goals have not been applied to DP/AI applications in low- to middle income countries. We established a framework to align the 17 sustainable development goals with a 27-indicator list for low- and middle-income countries (World Bank/WHO) and a list of 21 essential elements for DP/AI. After categorization into three domains (human factors, IT/electronics, and materials + reagents), we permutated these layers into 153 concatenated statements for prioritization on a four-tiered scale. The two authors tested the subjective ranking framework and endpoints included ranked sum scores and visualization across the three layers. The authors assigned 364 points with 1.1-1.3 points per statement. We noted the prioritization of human factors (43%) at the indicator layer whereas IT/electronic (36%) and human factors (35%) scored highest at the essential elements layer. The authors considered goal 9 (industry, innovation, and infrastructure; average points 2.33; sum 42), goal 4 (quality education; 2.17; 39), and goal 8 (decent work and economic growth; 2.11; 38) most relevant; intra-/inter-rater variability assessment after a 3-month-washout period confirmed these findings. The established framework allows individual stakeholders to capture the relative importance of sustainable development goals for overcoming limitations to a specific problem. The framework can be used to raise awareness and help identify synergies between large-scale global objectives and solutions in resource-limited settings.
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Affiliation(s)
- Sumi Piya
- Nepal Medical College and Teaching Hospital (NMCTH), Kathmandu, Nepal
- Nepal Cancer Hospital and Research Center, Lalitpur, Nepal
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jochen K. Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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