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Jain E, Patel A, Parwani AV, Shafi S, Brar Z, Sharma S, Mohanty SK. Whole Slide Imaging Technology and Its Applications: Current and Emerging Perspectives. Int J Surg Pathol 2024; 32:433-448. [PMID: 37437093 DOI: 10.1177/10668969231185089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Background. Whole slide imaging (WSI) represents a paradigm shift in pathology, serving as a necessary first step for a wide array of digital tools to enter the field. It utilizes virtual microscopy wherein glass slides are converted into digital slides and are viewed by pathologists by automated image analysis. Its impact on pathology workflow, reproducibility, dissemination of educational material, expansion of service to underprivileged areas, and institutional collaboration exemplifies a significant innovative movement. The recent US Food and Drug Administration approval to WSI for its use in primary surgical pathology diagnosis has opened opportunities for wider application of this technology in routine practice. Main Text. The ongoing technological advances in digital scanners, image visualization methods, and the integration of artificial intelligence-derived algorithms with these systems provide avenues to exploit its applications. Its benefits are innumerable such as ease of access through the internet, avoidance of physical storage space, and no risk of deterioration of staining quality or breakage of slides to name a few. Although the benefits of WSI to pathology practices are many, the complexities of implementation remain an obstacle to widespread adoption. Some barriers including the high cost, technical glitches, and most importantly professional hesitation to adopt a new technology have hindered its use in routine pathology. Conclusions. In this review, we summarize the technical aspects of WSI, its applications in diagnostic pathology, training, and research along with future perspectives. It also highlights improved understanding of the current challenges to implementation, as well as the benefits and successes of the technology. WSI provides a golden opportunity for pathologists to guide its evolution, standardization, and implementation to better acquaint them with the key aspects of this technology and its judicial use. Also, implementation of routine digital pathology is an extra step requiring resources which (currently) does not usually result increased efficiency or payment.
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Affiliation(s)
- Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ankush Patel
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Saba Shafi
- Department of Pathology, Wexner Medical Center, Columbus, OH, USA
| | - Zoya Brar
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
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2
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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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3
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Moscalu M, Moscalu R, Dascălu CG, Țarcă V, Cojocaru E, Costin IM, Țarcă E, Șerban IL. Histopathological Images Analysis and Predictive Modeling Implemented in Digital Pathology-Current Affairs and Perspectives. Diagnostics (Basel) 2023; 13:2379. [PMID: 37510122 PMCID: PMC10378281 DOI: 10.3390/diagnostics13142379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
In modern clinical practice, digital pathology has an essential role, being a technological necessity for the activity in the pathological anatomy laboratories. The development of information technology has majorly facilitated the management of digital images and their sharing for clinical use; the methods to analyze digital histopathological images, based on artificial intelligence techniques and specific models, quantify the required information with significantly higher consistency and precision compared to that provided by optical microscopy. In parallel, the unprecedented advances in machine learning facilitate, through the synergy of artificial intelligence and digital pathology, the possibility of diagnosis based on image analysis, previously limited only to certain specialties. Therefore, the integration of digital images into the study of pathology, combined with advanced algorithms and computer-assisted diagnostic techniques, extends the boundaries of the pathologist's vision beyond the microscopic image and allows the specialist to use and integrate his knowledge and experience adequately. We conducted a search in PubMed on the topic of digital pathology and its applications, to quantify the current state of knowledge. We found that computer-aided image analysis has a superior potential to identify, extract and quantify features in more detail compared to the human pathologist's evaluating possibilities; it performs tasks that exceed its manual capacity, and can produce new diagnostic algorithms and prediction models applicable in translational research that are able to identify new characteristics of diseases based on changes at the cellular and molecular level.
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Affiliation(s)
- Mihaela Moscalu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Roxana Moscalu
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M139PT, UK
| | - Cristina Gena Dascălu
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Viorel Țarcă
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ioana Mădălina Costin
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Elena Țarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Ionela Lăcrămioara Șerban
- Department of Morpho-Functional Sciences II, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iassy, Romania
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4
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Fraggetta F, Caputo A, Guglielmino R, Pellegrino MG, Runza G, L'Imperio V. A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The "Caltagirone Example". Diagnostics (Basel) 2021; 11:1916. [PMID: 34679614 PMCID: PMC8534326 DOI: 10.3390/diagnostics11101916] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 12/28/2022] Open
Abstract
Digital pathology for the routine assessment of cases for primary diagnosis has been implemented by few laboratories worldwide. The Gravina Hospital in Caltagirone (Sicily, Italy), which collects cases from 7 different hospitals distributed in the Catania area, converted the entire workflow to digital starting from 2019. Before the transition, the Caltagirone pathology laboratory was characterized by a non-tracked workflow, based on paper requests, hand-written blocks and slides, as well as manual assembling and delivering of the cases and glass slides to the pathologists. Moreover, the arrangement of the spaces and offices in the department was illogical and under-productive for the linearity of the workflow. For these reasons, an adequate 2D barcode system for tracking purposes, the redistribution of the spaces inside the laboratory and the implementation of the whole-slide imaging (WSI) technology based on a laboratory information system (LIS)-centric approach were adopted as a needed prerequisite to switch to a digital workflow. The adoption of a dedicated connection for transfer of clinical and administrative data between different software and interfaces using an internationally recognised standard (Health Level 7, HL7) in the pathology department further facilitated the transition, helping in the integration of the LIS with WSI scanners. As per previous reports, the components and devices chosen for the pathologists' workstations did not significantly impact on the WSI-based reporting phase in primary histological diagnosis. An analysis of all the steps of this transition has been made retrospectively to provide a useful "handy" guide to lead the digital transition of "analog", non-tracked pathology laboratories following the experience of the Caltagirone pathology department. Following the step-by-step instructions, the implementation of a paperless routine with more standardized and safe processes, the possibility to manage the priority of the cases and to implement artificial intelligence (AI) tools are no more an utopia for every "analog" pathology department.
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Affiliation(s)
- Filippo Fraggetta
- Pathology Unit, ASP Catania, “Gravina” Hospital, 95041 Caltagirone, Italy;
| | - Alessandro Caputo
- Department of Medicine and Surgery, University of Salerno, 84121 Salerno, Italy;
| | - Rosa Guglielmino
- Pathology Unit, ASP Catania, “Gravina” Hospital, 95041 Caltagirone, Italy;
| | | | - Giampaolo Runza
- Superintendency Unit, ASP Catania, “Gravina” Hospital, 95041 Caltagirone, Italy;
| | - Vincenzo L'Imperio
- Pathology, Department of Medicine and Surgery, ASST Monza, University of Milano-Bicocca, 20900 Monza, Italy;
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5
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Determination of the informational content of symptoms in the dynamic processes of assessing the patient’s condition in e-health. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The study is devoted to substantiating the tactics of choosing the signs of the patient's condition for diagnostic decision-making on corrective medical intervention in mobile medicine.
The aim of the research: to study a creation of a methodology for determining the integral informativeness of the patient's symptoms during remote monitoring of his condition.
Materials and methods: this article is based on search results in PubMed, Scopus, MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA articles published between January 1991 and January 2021 and containing the search terms “information technology”, “Mobile medicine”, “digital pathology” and “deep learning”, as well as the results of the authors' own research. The authors independently extracted data on concealment of distribution, consistency of distribution, blindness, completeness of follow-up, and interventions.
Results: concluded that to determine the Informativeness of symptoms in mobile monitoring of patients, it is possible to use risk indicators of predicted conditions as a universal method. Given that the Informativeness of the patient's condition changes constantly, for online diagnosis of conditions during remote monitoring of the patient it is recommended to use the function of informative symptoms from time to time and use a set of approaches to assess the Informativeness of patient symptoms. It is proposed to use the strategy of diagnosis and treatment using probabilistic algorithms based on the values of the risk of complications of the pathological process, as well as the formulas of Kulbach and Shannon to determine individual trends in the pathological patient process.
Conclusion: there was proposed to use risk indicators of predicted conditions as a universal method for determining the informational content of symptoms in mobile monitoring of patients.
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6
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Lujan GM, Savage J, Shana'ah A, Yearsley M, Thomas D, Allenby P, Otero J, Limbach AL, Cui X, Scarl R, Hardy T, Sheldon J, Plaza J, Whitaker B, Frankel W, Parwani A, Li Z. Digital Pathology Initiatives and Experience of a Large Academic Institution During the Coronavirus Disease 2019 (COVID-19) Pandemic. Arch Pathol Lab Med 2021; 145:1051-1061. [PMID: 33946103 DOI: 10.5858/arpa.2020-0715-sa] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/22/2021] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT. Pathology practices have begun integrating digital pathology tools into their routine workflow. During 2020 the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged as a pandemic causing a global health crisis that significantly affected the world population in several areas, including medical practice, and pathology was no exception. OBJECTIVE. To summarize our experience in implementing digital pathology for remote primary diagnosis, education and research during this pandemic. DESIGN. We surveyed our pathologists (all subspecialized) and trainees to gather information about their use of digital pathology tools before and during the pandemic. Quality assurance and slide distribution data were also examined. RESULTS. During the pandemic, the widespread usage of digital tools in our institution allowed a smooth transition of most clinical and academic activities into remote with no major disruptions. The number of pathologists using whole slide imaging (WSI) for primary diagnosis increased from 20 (62.5%) to 29 (90.6%) out of a total 32 (100 %) pathologists, excluding renal pathology and hematopathology, during the pandemic. Furthermore, the number of pathologists exclusively using WSI for primary diagnosis also increased from 2 (6.3%) to 5 (15.6%) during the pandemic from the total of 32 (100%) pathologists. From 35 (100%) survey responses from attending pathologists, 21 (65.6%) reported using WSI for remote primary diagnosis following the Centers for Medicare and Medicaid Services waiver. Of these 21 pathologists, 18 (87%) responded that if allowed, they will continue using WSI for remote primary diagnosis after the pandemic. CONCLUSIONS. The pandemic served as a catalyst to pathologists adopting a digital workflow into their daily practice and realizing the logistic and technical advantages of such tools.
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Affiliation(s)
- Giovanni M Lujan
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Johanna Savage
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Arwa Shana'ah
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Martha Yearsley
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Diana Thomas
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Patricia Allenby
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jose Otero
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Abberley Lott Limbach
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Xiaoyan Cui
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rachel Scarl
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Tanner Hardy
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jesse Sheldon
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Jose Plaza
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Bonnie Whitaker
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wendy Frankel
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Anil Parwani
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Zaibo Li
- All authors are in the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH
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7
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Lujan G, Quigley JC, Hartman D, Parwani A, Roehmholdt B, Meter BV, Ardon O, Hanna MG, Kelly D, Sowards C, Montalto M, Bui M, Zarella MD, LaRosa V, Slootweg G, Retamero JA, Lloyd MC, Madory J, Bowman D. Dissecting the Business Case for Adoption and Implementation of Digital Pathology: A White Paper from the Digital Pathology Association. J Pathol Inform 2021; 12:17. [PMID: 34221633 PMCID: PMC8240548 DOI: 10.4103/jpi.jpi_67_20] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/20/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022] Open
Abstract
We believe the switch to a digital pathology (DP) workflow is imminent and it is essential to understand the economic implications of conversion. Many aspects of the adoption of DP will be disruptive and have a direct financial impact, both in short term costs, such as investment in equipment and personnel, and long term revenue potential, such as improved productivity and novel tests. The focus of this whitepaper is to educate pathologists, laboratorians and other stakeholders about the business and monetary considerations of converting to a digital pathology workflow. The components of a DP business plan will be thoroughly summarized, and guidance will be provided on how to build a case for adoption and implementation as well as a roadmap for transitioning from an analog to a digital pathology workflow in various laboratory settings. It is important to clarify that this publication is not intended to list prices although some financials will be mentioned as examples. The authors encourage readers who are evaluating conversion to a DP workflow to use this paper as a foundational guide for conducting a thorough and complete assessment while incorporating in current market pricing. Contributors to this paper analyzed peer-reviewed literature and data collected from various institutions, some of which are mentioned. Digital pathology will change the way we practice through facilitating patient access to expert pathology services and enabling image analysis tools and assays to aid in diagnosis, prognosis, risk stratification and therapeutic selection. Together, they will result in the delivery of valuable information from which to make better decisions and improve the health of patients.
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Affiliation(s)
- Giovanni Lujan
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Douglas Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anil Parwani
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brian Roehmholdt
- Department of Pathology, Southern California Permanente Medical Group, La Canada Flintridge, CA, USA
| | | | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew G. Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Marilyn Bui
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Mark D. Zarella
- Johns Hopkins Medicine Pathology Informatics, Baltimore, MD 21287, USA
| | - Victoria LaRosa
- Education Services Department, Oracle Corp, Austin, Texas, USA
| | | | | | | | - James Madory
- Department of Pathology, Medical University of South Carolina, Charleston, SC, USA
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8
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Homeyer A, Lotz J, Schwen LO, Weiss N, Romberg D, Höfener H, Zerbe N, Hufnagl P. Artificial Intelligence in Pathology: From Prototype to Product. J Pathol Inform 2021; 12:13. [PMID: 34012717 PMCID: PMC8112352 DOI: 10.4103/jpi.jpi_84_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
Modern image analysis techniques based on artificial intelligence (AI) have great potential to improve the quality and efficiency of diagnostic procedures in pathology and to detect novel biomarkers. Despite thousands of published research papers on applications of AI in pathology, hardly any research implementations have matured into commercial products for routine use. Bringing an AI solution for pathology to market poses significant technological, business, and regulatory challenges. In this paper, we provide a comprehensive overview and advice on how to meet these challenges. We outline how research prototypes can be turned into a product-ready state and integrated into the IT infrastructure of clinical laboratories. We also discuss business models for profitable AI solutions and reimbursement options for computer assistance in pathology. Moreover, we explain how to obtain regulatory approval so that AI solutions can be launched as in vitro diagnostic medical devices. Thus, this paper offers computer scientists, software companies, and pathologists a road map for transforming prototypes of AI solutions into commercial products.
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Affiliation(s)
| | | | | | | | | | | | - Norman Zerbe
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,HTW University of Applied Sciences Berlin, Berlin, Germany
| | - Peter Hufnagl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Berlin, Germany.,HTW University of Applied Sciences Berlin, Berlin, Germany
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9
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Kim YJ, Roh EH, Park S. A literature review of quality, costs, process-associated with digital pathology. J Exerc Rehabil 2021; 17:11-14. [PMID: 33728283 PMCID: PMC7939987 DOI: 10.12965/jer.2142018.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022] Open
Abstract
Digital pathology incorporates the acquisition, management, sharing, and interpretation of pathological information, including slides and data, in a digital environment. Digital slides are created using a scanning device to capture a high-resolution image on glass slides for analysis on a computer or a mobile device. Though digital pathology has drastically grown over the last 10 years and has created opportunities to support specialists, few have attempted to address its full-scale implementation in routine clinical practice. To incorporate new technologies in diagnostic processes, it is necessary to study their application, the value they provide to specialists, and their effects on improvements across the entire workflow, rather than studying a particular element. In this study, we aimed to identify what have the current digital pathology systems contributed to the pathological and diagnostic process. We retrieved articles published between 2010 and 2020 from the databases PubMed and Google Scholar. We explored how digital pathology systems can better utilize existing medical data and new technologies within the current diagnostic workflow. While the evidence concerning the efficacy and effectiveness of digital pathology is mounting, high-quality evidence regarding its impact on resource allocation and value for diagnosis is still needed to support clinical diagnosis and policy decision-making.
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Affiliation(s)
- Yoo Jung Kim
- Department of Health Services Management, Graduate School, Kyung Hee University, Seoul, Korea
| | - Eul Hee Roh
- Department of Business Administration, College of Management, Kyung Hee University, Seoul, Korea
| | - Sangchan Park
- Department of Business Administration, College of Management, Kyung Hee University, Seoul, Korea
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10
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Marble HD, Huang R, Dudgeon SN, Lowe A, Herrmann MD, Blakely S, Leavitt MO, Isaacs M, Hanna MG, Sharma A, Veetil J, Goldberg P, Schmid JH, Lasiter L, Gallas BD, Abels E, Lennerz JK. A Regulatory Science Initiative to Harmonize and Standardize Digital Pathology and Machine Learning Processes to Speed up Clinical Innovation to Patients. J Pathol Inform 2020; 11:22. [PMID: 33042601 PMCID: PMC7518200 DOI: 10.4103/jpi.jpi_27_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/20/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
Unlocking the full potential of pathology data by gaining computational access to histological pixel data and metadata (digital pathology) is one of the key promises of computational pathology. Despite scientific progress and several regulatory approvals for primary diagnosis using whole-slide imaging, true clinical adoption at scale is slower than anticipated. In the U.S., advances in digital pathology are often siloed pursuits by individual stakeholders, and to our knowledge, there has not been a systematic approach to advance the field through a regulatory science initiative. The Alliance for Digital Pathology (the Alliance) is a recently established, volunteer, collaborative, regulatory science initiative to standardize digital pathology processes to speed up innovation to patients. The purpose is: (1) to account for the patient perspective by including patient advocacy; (2) to investigate and develop methods and tools for the evaluation of effectiveness, safety, and quality to specify risks and benefits in the precompetitive phase; (3) to help strategize the sequence of clinically meaningful deliverables; (4) to encourage and streamline the development of ground-truth data sets for machine learning model development and validation; and (5) to clarify regulatory pathways by investigating relevant regulatory science questions. The Alliance accepts participation from all stakeholders, and we solicit clinically relevant proposals that will benefit the field at large. The initiative will dissolve once a clinical, interoperable, modularized, integrated solution (from tissue acquisition to diagnostic algorithm) has been implemented. In times of rapidly evolving discoveries, scientific input from subject-matter experts is one essential element to inform regulatory guidance and decision-making. The Alliance aims to establish and promote synergistic regulatory science efforts that will leverage diverse inputs to move digital pathology forward and ultimately improve patient care.
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Affiliation(s)
- Hetal Desai Marble
- Department of Pathology, Center for Integrated Diagnostics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Huang
- Department of Pathology, Center for Integrated Diagnostics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah Nixon Dudgeon
- Division of Imaging, Diagnostics, and Software Reliability, Center for Devices and Radiological Health, Food and Drug Administration, Office of Science and Engineering Laboratories, Silver Spring, MD, USA
| | | | - Markus D Herrmann
- Department of Pathology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Mike Isaacs
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jithesh Veetil
- Medical Device Innovation Consortium, Arlington, VA, USA
| | | | | | | | - Brandon D Gallas
- Division of Imaging, Diagnostics, and Software Reliability, Center for Devices and Radiological Health, Food and Drug Administration, Office of Science and Engineering Laboratories, Silver Spring, MD, USA
| | | | - Jochen K Lennerz
- Department of Pathology, Center for Integrated Diagnostics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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11
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Hanna MG, Pantanowitz L. Feasibility of using the Omnyx digital pathology system for cytology practice. J Am Soc Cytopathol 2019; 8:182-189. [PMID: 31272601 DOI: 10.1016/j.jasc.2019.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Whole slide imaging systems have focused mostly on surgical pathologic evaluation. However, for pathology laboratories to become fully digital, cytology slides will also need to be digitized, managed, viewed, and analyzed. Our aim was to determine the feasibility of using the Omnyx whole slide imaging system for various purposes in cytology. MATERIALS AND METHODS Our institution implemented the Omnyx digital pathology system, which was tested for feasibility and not implemented for clinical use in cytology. Glass slides (n = 18), scanned using various whole slide scanners, were uploaded into the Omnyx system. The system was evaluated for its feasibility with cytology case management, digital slide navigation and annotation, telecytology, and cytologic-histologic correlation. RESULTS The Omnyx software was able to manage cases similar to a laboratory information system. Users were able to electronically distribute, search, and sort the clinical cases. A graphic dashboard approach and virtual slide tray is available for end users to evaluate cases. The ability to create custom folders and drag-and-drop images into these folders fulfilled clinical, quality assurance, education, and research needs. Innovative tools for digital slide navigation and annotation (eg, auto-pan, adding text to annotation, hiding annotations, image coregistration) offered innovative methods to work with slides. Omnyx also provided a mechanism for sharing images with others to perform teleconsultation. CONCLUSIONS We have demonstrated the feasibility of using the Omnyx whole slide imaging system for various purposes in cytology practice. The application supported, not only case management, but also the ability to perform cytologic-histologic correlation and telecytology. The viewer offered many features that improved digital slide navigation and annotation.
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Affiliation(s)
- Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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12
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Hanna MG, Reuter VE, Samboy J, England C, Corsale L, Fine SW, Agaram NP, Stamelos E, Yagi Y, Hameed M, Klimstra DS, Sirintrapun SJ. Implementation of Digital Pathology Offers Clinical and Operational Increase in Efficiency and Cost Savings. Arch Pathol Lab Med 2019; 143:1545-1555. [PMID: 31173528 DOI: 10.5858/arpa.2018-0514-oa] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Digital pathology (DP) implementations vary in scale, based on aims of intended operation. Few laboratories have completed a full-scale DP implementation, which may be due to high overhead costs that disrupt the traditional pathology workflow. Neither standardized criteria nor benchmark data have yet been published showing practical return on investment after implementing a DP platform. OBJECTIVE.— To provide benchmark data and practical metrics to support operational efficiency and cost savings in a large academic center. DESIGN.— Metrics reviewed include archived pathology asset retrieval; ancillary test request for recurrent/metastatic disease; cost analysis and turnaround time (TAT); and DP experience survey. RESULTS.— Glass slide requests from the department slide archive and an off-site surgery center showed a 93% and 97% decrease, respectively. Ancillary immunohistochemical orders, compared in 2014 (52%)-before whole slide images (WSIs) were available in the laboratory information system-and 2017 (21%) showed $114 000/y in anticipated savings. Comprehensive comparative cost analysis showed a 5-year $1.3 million savings. Surgical resection cases with prior WSIs showed a 1-day decrease in TAT. A DP experience survey showed 80% of respondents agreed WSIs improved their clinical sign-out experience. CONCLUSIONS.— Implementing a DP operation showed a noteworthy increase in efficiency and operational utility. Digital pathology deployments and operations may be gauged by the following metrics: number of glass slide requests as WSIs become available, decrease in confirmatory testing for patients with metastatic/recurrent disease, long-term decrease in off-site pathology asset costs, and faster TAT. Other departments may use our benchmark data and metrics to enhance patient care and demonstrate return on investment to justify adoption of DP.
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Affiliation(s)
- Matthew G Hanna
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer Samboy
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christine England
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lorraine Corsale
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samson W Fine
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Narasimhan P Agaram
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Evangelos Stamelos
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yukako Yagi
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meera Hameed
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David S Klimstra
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - S Joseph Sirintrapun
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
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13
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Fraggetta F, Rossi ED, Pantanowitz L. Advocating a Laboratory Information System-Centric Approach to Digital Pathology. Arch Pathol Lab Med 2019; 142:434. [PMID: 29565205 DOI: 10.5858/arpa.2017-0487-le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Esther Diana Rossi
- 2 Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Liron Pantanowitz
- 3 Department of Pathology, University of Pittsburgh Medical Center Shadyside, Pittsburgh, Pennsylvania
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14
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Herrmann MD, Clunie DA, Fedorov A, Doyle SW, Pieper S, Klepeis V, Le LP, Mutter GL, Milstone DS, Schultz TJ, Kikinis R, Kotecha GK, Hwang DH, Andriole KP, Iafrate AJ, Brink JA, Boland GW, Dreyer KJ, Michalski M, Golden JA, Louis DN, Lennerz JK. Implementing the DICOM Standard for Digital Pathology. J Pathol Inform 2018; 9:37. [PMID: 30533276 PMCID: PMC6236926 DOI: 10.4103/jpi.jpi_42_18] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022] Open
Abstract
Background: Digital Imaging and Communications in Medicine (DICOM®) is the standard for the representation, storage, and communication of medical images and related information. A DICOM file format and communication protocol for pathology have been defined; however, adoption by vendors and in the field is pending. Here, we implemented the essential aspects of the standard and assessed its capabilities and limitations in a multisite, multivendor healthcare network. Methods: We selected relevant DICOM attributes, developed a program that extracts pixel data and pixel-related metadata, integrated patient and specimen-related metadata, populated and encoded DICOM attributes, and stored DICOM files. We generated the files using image data from four vendor-specific image file formats and clinical metadata from two departments with different laboratory information systems. We validated the generated DICOM files using recognized DICOM validation tools and measured encoding, storage, and access efficiency for three image compression methods. Finally, we evaluated storing, querying, and retrieving data over the web using existing DICOM archive software. Results: Whole slide image data can be encoded together with relevant patient and specimen-related metadata as DICOM objects. These objects can be accessed efficiently from files or through RESTful web services using existing software implementations. Performance measurements show that the choice of image compression method has a major impact on data access efficiency. For lossy compression, JPEG achieves the fastest compression/decompression rates. For lossless compression, JPEG-LS significantly outperforms JPEG 2000 with respect to data encoding and decoding speed. Conclusion: Implementation of DICOM allows efficient access to image data as well as associated metadata. By leveraging a wealth of existing infrastructure solutions, the use of DICOM facilitates enterprise integration and data exchange for digital pathology.
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Affiliation(s)
| | | | - Andriy Fedorov
- Department of Radiology, Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sean W Doyle
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA
| | | | - Veronica Klepeis
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Long P Le
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - George L Mutter
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - David S Milstone
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Thomas J Schultz
- Enterprise Medical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Ron Kikinis
- Department of Radiology, Surgical Planning Laboratory, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gopal K Kotecha
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA
| | - David H Hwang
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Katherine P Andriole
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - A John Iafrate
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - James A Brink
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Giles W Boland
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Keith J Dreyer
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Michalski
- MGH and BWH Center for Clinical Data Science, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jeffrey A Golden
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - David N Louis
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Jochen K Lennerz
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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15
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Digital pathology in nephrology clinical trials, research, and pathology practice. Curr Opin Nephrol Hypertens 2018; 26:450-459. [PMID: 28858910 DOI: 10.1097/mnh.0000000000000360] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW In this review, we will discuss (i) how the recent advancements in digital technology and computational engineering are currently applied to nephropathology in the setting of clinical research, trials, and practice; (ii) the benefits of the new digital environment; (iii) how recognizing its challenges provides opportunities for transformation; and (iv) nephropathology in the upcoming era of kidney precision and predictive medicine. RECENT FINDINGS Recent studies highlighted how new standardized protocols facilitate the harmonization of digital pathology database infrastructure and morphologic, morphometric, and computer-aided quantitative analyses. Digital pathology enables robust protocols for clinical trials and research, with the potential to identify previously underused or unrecognized clinically useful parameters. The integration of digital pathology with molecular signatures is leading the way to establishing clinically relevant morpho-omic taxonomies of renal diseases. SUMMARY The introduction of digital pathology in clinical research and trials, and the progressive implementation of the modern software ecosystem, opens opportunities for the development of new predictive diagnostic paradigms and computer-aided algorithms, transforming the practice of renal disease into a modern computational science.
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16
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Nahal A, Batac CMO, Slaw RJ, Bauer TW. Setting Up an ePathology Service at Cleveland Clinic Abu Dhabi: Joint Collaboration With Cleveland Clinic, United States. Arch Pathol Lab Med 2018; 142:1216-1222. [PMID: 29688032 DOI: 10.5858/arpa.2017-0216-ra] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The production of whole slide images is the most advanced form of digital pathology, in which a high-resolution digital scanner is used to rapidly scan glass microscope slides and produce a computer-generated whole slide image that can be saved, stored in a network-attached storage device, and accessed through slide management software within the hospital domain and remotely by authorized users. Digital transformation of glass slides has revolutionized the practice of anatomic pathology by facilitating and expediting consultative services, improving clinical workflow, and becoming an indispensable tool in education and research. OBJECTIVE.— To highlight the institutional need of Cleveland Clinic Abu Dhabi (Abu Dhabi, United Arab Emirates) and the cultural background for obtaining the United Arab Emirates' first comprehensive digital pathology program; to describe a multiphase road map for achieving full implementation of this platform; and to describe the system's clinical applications and its future potential growth. DATA SOURCES.— At Cleveland Clinic Abu Dhabi, we prioritized our efforts to initiate digital consultations (eConsultations) and digital immunohistochemistry services (eIHC) with Cleveland Clinic Laboratories (Cleveland, Ohio). After this, we established an internal archiving system together with a subspecialty-based, organ-specific digital library of pathologic diseases. CONCLUSIONS.— We describe the strategic adoption and implementation of digital pathology into the clinical workflow of the pathology and laboratory medicine institute of Cleveland Clinic Abu Dhabi, and we highlight its impact on clinical operations, educational activities, and patient care.
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Affiliation(s)
| | | | | | - Thomas W Bauer
- From the Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (Dr Nahal and Ms Batac); the Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (Ms Slaw and Dr Bauer); and the Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York (Dr Bauer)
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17
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Fraggetta F, Garozzo S, Zannoni GF, Pantanowitz L, Rossi ED. Routine Digital Pathology Workflow: The Catania Experience. J Pathol Inform 2017; 8:51. [PMID: 29416914 PMCID: PMC5760840 DOI: 10.4103/jpi.jpi_58_17] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/10/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction: Successful implementation of whole slide imaging (WSI) for routine clinical practice has been accomplished in only a few pathology laboratories worldwide. We report the transition to an effective and complete digital surgical pathology workflow in the pathology laboratory at Cannizzaro Hospital in Catania, Italy. Methods: All (100%) permanent histopathology glass slides were digitized at ×20 using Aperio AT2 scanners. Compatible stain and scanning slide racks were employed to streamline operations. eSlide Manager software was bidirectionally interfaced with the anatomic pathology laboratory information system. Virtual slide trays connected to the two-dimensional (2D) barcode tracking system allowed pathologists to confirm that they were correctly assigned slides and that all tissues on these glass slides were scanned. Results: Over 115,000 glass slides were digitized with a scan fail rate of around 1%. Drying glass slides before scanning minimized them sticking to scanner racks. Implementation required introduction of a 2D barcode tracking system and modification of histology workflow processes. Conclusion: Our experience indicates that effective adoption of WSI for primary diagnostic use was more dependent on optimizing preimaging variables and integration with the laboratory information system than on information technology infrastructure and ensuring pathologist buy-in. Implementation of digital pathology for routine practice not only leveraged the benefits of digital imaging but also creates an opportunity for establishing standardization of workflow processes in the pathology laboratory.
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Affiliation(s)
| | | | - Gian Franco Zannoni
- Division of Anatomic Pathology and Histology, School of Medicine, "Agostino Gemelli", Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, School of Medicine, "Agostino Gemelli", Rome, Italy
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18
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Hartman DJ, Pantanowitz L, McHugh JS, Piccoli AL, OLeary MJ, Lauro GR. Enterprise Implementation of Digital Pathology: Feasibility, Challenges, and Opportunities. J Digit Imaging 2017; 30:555-560. [PMID: 28116576 PMCID: PMC5603431 DOI: 10.1007/s10278-017-9946-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Digital pathology is becoming technically possible to implement for routine pathology work. At our institution, we have been using digital pathology for second opinion intraoperative consultations for over 10 years. Herein, we describe our experience in converting to a digital pathology platform for primary pathology diagnosis. We implemented an incremental rollout for digital pathology on subspecialty benches, beginning with cases that contained small amounts of tissue (biopsy specimens). We successfully scanned over 40,000 slides through our digital pathology system. Several lessons (both challenges and opportunities) were learned through this implementation. A successful conversion to digital pathology requires pre-imaging adjustments, integrated software and post-imaging evaluations.
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Affiliation(s)
- D J Hartman
- Department of Pathology, Division of Pathology Informatics, University of Pittsburgh Medical Center, Presbyterian Hospital, A610, 200 Lothrop Street, Pittsburgh, PA, 15213-2546, USA.
| | - L Pantanowitz
- Department of Pathology, Division of Pathology Informatics, University of Pittsburgh Medical Center, Presbyterian Hospital, A610, 200 Lothrop Street, Pittsburgh, PA, 15213-2546, USA
| | - J S McHugh
- Clinical Department Systems, University of Pittsburgh Medical Center, Pittsburgh, 15213, PA, USA
| | - A L Piccoli
- Clinical Department Systems, University of Pittsburgh Medical Center, Pittsburgh, 15213, PA, USA
| | - M J OLeary
- Clinical Department Systems, University of Pittsburgh Medical Center, Pittsburgh, 15213, PA, USA
| | - G R Lauro
- Clinical Department Systems, University of Pittsburgh Medical Center, Pittsburgh, 15213, PA, USA
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19
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Barisoni L, Gimpel C, Kain R, Laurinavicius A, Bueno G, Zeng C, Liu Z, Schaefer F, Kretzler M, Holzman LB, Hewitt SM. Digital pathology imaging as a novel platform for standardization and globalization of quantitative nephropathology. Clin Kidney J 2017; 10:176-187. [PMID: 28584625 PMCID: PMC5455257 DOI: 10.1093/ckj/sfw129] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/01/2016] [Indexed: 12/16/2022] Open
Abstract
The introduction of digital pathology to nephrology provides a platform for the development of new methodologies and protocols for visual, morphometric and computer-aided assessment of renal biopsies. Application of digital imaging to pathology made substantial progress over the past decade; it is now in use for education, clinical trials and translational research. Digital pathology evolved as a valuable tool to generate comprehensive structural information in digital form, a key prerequisite for achieving precision pathology for computational biology. The application of this new technology on an international scale is driving novel methods for collaborations, providing unique opportunities but also challenges. Standardization of methods needs to be rigorously evaluated and applied at each step, from specimen processing to scanning, uploading into digital repositories, morphologic, morphometric and computer-aided assessment, data collection and analysis. In this review, we discuss the status and opportunities created by the application of digital imaging to precision nephropathology, and present a vision for the near future.
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Affiliation(s)
- Laura Barisoni
- Department of Pathology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Charlotte Gimpel
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center – University of Freiburg, Germany
| | - Renate Kain
- Clinical Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Arvydas Laurinavicius
- Faculty of Medicine and National Center of Pathology, Vilnius University, Vilnius, Lithuania
| | - Gloria Bueno
- VISILAB – E.T.S.I.I., University of Castilla-La Mancha, Ciudad Real, Spain
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Franz Schaefer
- University Children Hospital, Pediatric Nephrology, Heidelberg, Germany
| | - Matthias Kretzler
- Department of Internal Medicine and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - Lawrence B. Holzman
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen M. Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA
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20
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Vainer B, Mortensen NW, Poulsen SS, Sørensen AH, Olsen J, Saxild HH, Johansen FF. Turning Microscopy in the Medical Curriculum Digital: Experiences from The Faculty of Health and Medical Sciences at University of Copenhagen. J Pathol Inform 2017; 8:11. [PMID: 28382225 PMCID: PMC5364742 DOI: 10.4103/2153-3539.201919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
Abstract
Familiarity with the structure and composition of normal tissue and an understanding of the changes that occur during disease is pivotal to the study of the human body. For decades, microscope slides have been central to teaching pathology in medical courses and related subjects at the University of Copenhagen. Students had to learn how to use a microscope and envisage three-dimensional processes that occur in the body from two-dimensional glass slides. Here, we describe how a PathXL virtual microscopy system for teaching pathology and histology at the Faculty has recently been implemented, from an administrative, an economic, and a teaching perspective. This fully automatic digital microscopy system has been received positively by both teachers and students, and a decision was made to convert all courses involving microscopy to the virtual microscopy format. As a result, conventional analog microscopy will be phased out from the fall of 2016.
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Affiliation(s)
- Ben Vainer
- Department of Biomedical Sciences, Molecular Pathology Section, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Steen Seier Poulsen
- Department of Biomedical Sciences, Endocrinology Research Section, University of Copenhagen, Copenhagen, Denmark
| | | | - Jørgen Olsen
- Department of Cellular and Molecular Medicine, Section VIII, University of Copenhagen, Copenhagen, Denmark
| | - Hans Henrik Saxild
- The Dean's Office, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Fryd Johansen
- Department of Biomedical Sciences, Molecular Pathology Section, University of Copenhagen, Copenhagen, Denmark
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