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Jennings C, Treanor D, Brettle D. Pathologists light level preferences using the microscope-study to guide digital pathology display use. J Pathol Inform 2024; 15:100379. [PMID: 38846642 PMCID: PMC11153930 DOI: 10.1016/j.jpi.2024.100379] [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: 02/20/2024] [Revised: 04/05/2024] [Accepted: 04/26/2024] [Indexed: 06/09/2024] Open
Abstract
Background Currently, there is a paucity of guidelines relating to displays used for digital pathology making procurement decisions, and optimal display configuration, challenging.Experience suggests pathologists have personal preferences for brightness when using a conventional microscope which we hypothesized could be used as a predictor for display setup. Methods We conducted an online survey across six NHS hospitals, totalling 108 practicing pathologists, to capture brightness adjustment habits on both microscopes and displays.A convenience subsample of respondents was then invited to take part in a practical task to determine microscope brightness and display luminance preferences in the normal working environment. A novel adaptation for a lightmeter was developed to directly measure the light output from the microscope eyepiece. Results The survey (response rate 59% n=64) indicates 81% of respondents adjust the brightness on their microscope. In comparison, only 11% report adjusting their digital display. Display adjustments were more likely to be for visual comfort and ambient light compensation rather than for tissue factors, common for microscope adjustments. Part of this discrepancy relates to lack of knowledge of how to adjust displays and lack of guidance on whether this is safe; But, 66% felt that the ability to adjust the light on the display was important.Twenty consultants took part in the practical brightness assessment. Light preferences on the microscope showed no correlation with display preferences, except where a pathologist has a markedly brighter microscope light preference. All of the preferences in this cohort were for a display luminance of <500 cd/m2, with 90% preferring 350 cd/m2 or less. There was no correlation between these preferences and the ambient lighting in the room. Conclusions We conclude that microscope preferences can only be used to predict display luminance requirements where the microscope is being used at very high brightness levels. A display capable of a brightness of 500 cd/m2 should be suitable for almost all pathologists with 300 cd/m2 suitable for the majority. Although display luminance is not frequently changed by users, the ability to do so was felt to be important by the majority of respondents.Further work needs to be undertaken to establish the relationship between diagnostic performance, luminance preferences, and ambient lighting levels.
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Affiliation(s)
- Charlotte Jennings
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Darren Treanor
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Centre for Diagnostics, Division of Neurobiology, Department of Clinical and Experimental Medicine, Department of Clinical Pathology, Linköping University, Linköping, Sweden
| | - David Brettle
- National Pathology Imaging Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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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 PMCID: PMC11271322 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] [Grants] [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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Williams BJ. Practical guide to the use of digital slides in histopathology education. J Clin Pathol 2024; 77:366-371. [PMID: 38548321 PMCID: PMC11103283 DOI: 10.1136/jcp-2024-209415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 05/19/2024]
Abstract
Digital pathology (the technology whereby glass histology slides are scanned at high resolution, digitised, stored and shared with pathologists, who can view them using microscopy software on a screen) is transforming the delivery of clinical diagnostic pathology services around the world. In addition to adding value to clinical histopathology practice, digital histology slides provide a versatile medium to achieve the educational needs of a variety of learners including undergraduate students, postgraduate doctors in training and those pursuing continuing professional development portfolios. In this guide, we will review the principal use cases for digital slides in training and education and I will share tips for successful use of digital pathology to support a range of learners based on experience gathered at Leeds Teaching Hospitals National Health Service Trust and the National Pathology Imaging Co-Operative during the last 5 years of digital slide usage.
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Affiliation(s)
- Bethany Jill Williams
- National Pathology Imaging Co-Operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
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4
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Magalhães G, Calisto R, Freire C, Silva R, Montezuma D, Canberk S, Schmitt F. Invisible for a few but essential for many: the role of Histotechnologists in the establishment of digital pathology. J Histotechnol 2024; 47:39-52. [PMID: 37869882 DOI: 10.1080/01478885.2023.2268297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
Digital pathology (DP) is indisputably the future for histopathology laboratories. The process of digital implementation requires deep workflow reorganisation which involves an interdisciplinary team. This transformation may have the greatest impact on the Histotechnologist (HTL) profession. Our review of the literature has clearly revealed that the role of HTLs in the establishment of DP is being unnoticed and guidance is limited. This article aims to bring HTLs from behind-the-scenes into the spotlight. Our objective is to provide them guidance and practical recommendations to successfully contribute to the implementation of a new digital workflow. Furthermore, it also intends to contribute for improvement of study programs, ensuring the role of HTL in DP is addressed as part of graduate and post-graduate education. In our review, we report on the differences encountered between workflow schemes and the limitations observed in this process. The authors propose a digital workflow to achieve its limitless potential, focusing on the HTL's role. This article explores the novel responsibilities of HTLs during specimen gross dissection, embedding, microtomy, staining, digital scanning, and whole slide image quality control. Furthermore, we highlight the benefits and challenges that DP implementation might bring the HTLs career. HTLs have an important role in the digital workflow: the responsibility of achieving the perfect glass slide.
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Affiliation(s)
- Gisela Magalhães
- Histopathology Department, Portsmouth Hospital University NHS Trust, Portsmouth, UK
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
| | - Rita Calisto
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
- Department of Pathological Anatomy, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Catarina Freire
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
- Department of Pathological Anatomy, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Regina Silva
- Department of Pathological Anatomy, School of Health Polytechnic of Porto (ESS|P.PORTO), Porto, Portugal
- Centro de Investigação em Saúde e Ambiente, ESS,P.PORTO, Porto, Portugal
| | - Diana Montezuma
- Research & Development Unit, IMP Diagnostics, Porto, Portugal
- School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Sule Canberk
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Cancer Signalling & Metabolism, Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Fernando Schmitt
- Department of Pathology, Faculty of Medicine of University of Porto, Porto, Portugal
- CINTESIS@RISE, Health Research Network, Alameda Prof. Hernâni Monteiro, Portugal
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Grobholz R, Janowczyk A, Frei AL, Kreutzfeldt M, Koelzer VH, Zlobec I. National digital pathology projects in Switzerland: A 2023 update. PATHOLOGIE (HEIDELBERG, GERMANY) 2023; 44:225-228. [PMID: 37987815 PMCID: PMC10739407 DOI: 10.1007/s00292-023-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
The Swiss Digital Pathology Consortium (SDiPath) was founded in 2018 as a working group of the Swiss Society for Pathology with the aim of networking, training, and promoting digital pathology (DP) at a national level. Since then, two national surveys have been carried out on the level of knowledge, dissemination, use, and needs in DP, which have resulted in clear fields of action. In addition to organizing symposia and workshops, national guidelines were drawn up and an initiative for a national DP platform actively codesigned. With the growing use of digital image processing and artificial intelligence tools, continuous monitoring, evaluation, and exchange of experiences will be pursued, along with best practices.
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Affiliation(s)
- Rainer Grobholz
- Medical Faculty, University of Zurich, Zurich, Switzerland.
- Institute of Pathology, Kantonsspital Aarau, Tellstr. 25, 5001, Aarau, Switzerland.
| | - Andrew Janowczyk
- Department of Biomedical Engineering, Emory University, Atlanta, GA, USA
- Department of Oncology, Division of Precision Oncology, University Hospital of Geneva, Geneva, Switzerland
- Department of Diagnostics, Division of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Ana Leni Frei
- Institute for Tissue Medicine and Pathology, University Bern, Bern, Switzerland
| | - Mario Kreutzfeldt
- Department of Pathology and Immunology, Division of Clinical Pathology, University & University Hospitals of Geneva, Geneva, Switzerland
| | - Viktor H Koelzer
- Department of Pathology und Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Inti Zlobec
- Institute for Tissue Medicine and Pathology, University Bern, Bern, Switzerland
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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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7
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Piletska N. International survey of cytopathology training during the pandemic: Water under the bridge? Cytopathology 2023; 34:433-441. [PMID: 37377122 DOI: 10.1111/cyt.13262] [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: 12/16/2022] [Revised: 04/16/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
The purpose of this study was to assess the impact of the COVID-19 pandemic on cytopathology training at an international level. An anonymous online questionnaire was distributed by members of the international cytopathological community to medical practitioners in cytopathology. The survey explored perceived changes in cytology workload and workflow during the pandemic, and its effect on both non-cervical and cervical cytology reporting and teaching. A total of 82 responses were received from seven countries. Approximately half of the respondents reported a decrease in the number and range of cytology cases during the pandemic. Nearly half (47%) saw a reduction in the opportunity to co-report with consultants/attendings, and 72% of the respondents reported that their consultants/attendings were working remotely during the pandemic. Another 34% of the respondents were redeployed for 3 weeks to 1 year, with 96% stating that this period was only partially compensated for during their training, if at all. The pandemic negatively affected the opportunity to report cervical cytology, perform fine needle aspirations, and participate in multidisciplinary team meetings. Most respondents (69%) saw a decrease in the amount and quality (52%) of face-to-face departmental cytology teaching, whereas remote departmental teaching improved in amount (54%) and quality (49%). Almost half (49%) reported that cytology teaching in the regional, national, and international settings increased in both amount and quality. The pandemic catalysed many changes in cytopathology training, affecting the trainees' exposure to cases, the use of remote reporting, consultant/attending working practices, redeployment, and local as well as external teaching.
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Affiliation(s)
- Nataliya Piletska
- North West London Pathology hosted at Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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8
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Elghobashy M, Wahab L, Gunavardhan A, O'Sullivan E, Provenzano E, Deb R, Pritchard S, Di Palma S, Ellis IO, Boyd C, Pinder SE, Shaaban AM. Impact of COVID-19 on the practice of breast pathologists: a survey of breast pathologists in the UK and Ireland. J Clin Pathol 2023; 76:234-238. [PMID: 34620607 PMCID: PMC8507406 DOI: 10.1136/jclinpath-2021-207725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/23/2021] [Indexed: 12/16/2022]
Abstract
AIMS There is little information on the impact of COVID-19 on breast pathologists. This survey assessed the effect of the COVID-19 pandemic on UK and Ireland-based breast pathologists to optimise working environments and ensure preparedness for potential future pandemics. METHODS A 35-question survey during the first wave of COVID-19 infections in the UK including questions on workload, working practices, professional development, training, health and safety and well-being was distributed to consultant breast pathologists and responses collected anonymously. RESULTS There were 135 responses from breast pathologists based in the UK and Ireland. Most participants (75.6%) stated that their workload had decreased and their productivity dropped. 86/135 (63.7%) were given the option of working from home and 36% of those who did reported improved efficiency. Multidisciplinary team meetings largely moved to virtual platforms (77.8%) with fewer members present (41.5%). Online education, including webinars and courses, was utilised by 92.6%. 16.3% of pathologists reported shortages of masks, visors or gowns as the the most common health and safety concern. COVID-19 had a significant negative impact on the physical and mental health of 33.3% of respondents. A small number of pathologists (10.4%) were redeployed and/or retrained. CONCLUSION The UK and Ireland breast pathologists adapted to the rapid change and maintained service delivery despite the significant impact of the pandemic on their working practices and mental health. It is important to apply flexible working patterns and environments that improve productivity and well-being. The changes suggested should be considered for long-term shaping of breast pathology services.
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Affiliation(s)
- Mirna Elghobashy
- University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
| | - Lutful Wahab
- Histopathology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Anu Gunavardhan
- Histopathology, Betsi Cadwaladr University Health Board, Bangor, UK
| | | | | | - Rahul Deb
- Cellular Pathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | - Silvana Di Palma
- Histology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ian O Ellis
- Molecular Medical Sciences, University of Nottingham, Nottingham, UK
| | - Clinton Boyd
- Histopathology, Belfast Health and Social Care Trust, Belfast, UK
| | - Sarah E Pinder
- Academic Oncology/Breast Pathology, King's College London, London, UK
| | - Abeer M Shaaban
- Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Cellular Pathology, Queen Elizabeth Hospital, Birmingham, UK
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9
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Desai S. Digital pathology: an overview. CSI TRANSACTIONS ON ICT 2023. [PMCID: PMC10042104 DOI: 10.1007/s40012-023-00376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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10
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Bracey T. The Nomadic Digital Pathologist. Validation of a simple, dual slide scanner with remote reporting for a regional upper gastrointestinal specialist multidisciplinary meeting. J Pathol Inform 2022; 14:100161. [DOI: 10.1016/j.jpi.2022.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022] Open
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Ali M, Evans H, Whitney P, Minhas F, Snead DRJ. Using Systemised Nomenclature of Medicine (SNOMED) codes to select digital pathology whole slide images for long-term archiving. J Clin Pathol 2022; 76:349-352. [PMID: 36109157 PMCID: PMC10176345 DOI: 10.1136/jcp-2022-208483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/20/2022] [Indexed: 11/04/2022]
Abstract
The archiving of whole slide images represents a hurdle to digital pathology implementation largely because of the amount of data generated. The retention of glass slides is currently recommended for a minimum of 10 years, but it is for individual departments to determine how digital images are archived and for how long. In a retrospective study, we examined the combination of Systemised Nomenclature of Medicine (SNOMED) codes allocated to cases reported between July 2011 and December 2015 and recalled more than 12 months after diagnosis in comparison to non-recalled cases.Our results show that 0.2% of cases are recalled after 12 months, and SNOMED code combinations can be used to identify which cases are likely to be recalled and which are not. This approach could reduce the number of cases archived by 62% and still ensure all cases likely to be recalled remain in the archive.
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Affiliation(s)
- Mahmoud Ali
- Histopathology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Histopathology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Harriet Evans
- Histopathology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Peter Whitney
- Histopathology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Fayyaz Minhas
- Department of Computer Science, University of Warwick, Coventry, West Midlands, UK
| | - David R J Snead
- Histopathology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warick Medical School, University of Warwick, Coventry, UK
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12
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Liscia DS, D’Andrea M, Biletta E, Bellis D, Demo K, Ferrero F, Petti A, Butinar R, D’Andrea E, Davini G. Use of digital pathology and artificial intelligence for the diagnosis of Helicobacter pylori in gastric biopsies. Pathologica 2022; 114:295-303. [DOI: 10.32074/1591-951x-751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 12/20/2022] Open
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13
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Dawson H. Digital pathology – Rising to the challenge. Front Med (Lausanne) 2022; 9:888896. [PMID: 35935788 PMCID: PMC9354827 DOI: 10.3389/fmed.2022.888896] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Digital pathology has gone through considerable technical advances during the past few years and certain aspects of digital diagnostics have been widely and swiftly adopted in many centers, catalyzed by the COVID-19 pandemic. However, analysis of requirements, careful planning, and structured implementation should to be considered in order to reap the full benefits of a digital workflow. The aim of this review is to provide a practical, concise and hands-on summary of issues relevant to implementing and developing digital diagnostics in the pathology laboratory. These include important initial considerations, possible approaches to overcome common challenges, potential diagnostic pitfalls, validation and regulatory issues and an introduction to the emerging field of image analysis in routine.
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14
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Coulter C, McKay F, Hallowell N, Browning L, Colling R, Macklin P, Sorell T, Aslam M, Bryson G, Treanor D, Verrill C. Understanding the ethical and legal considerations of Digital Pathology. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2022; 8:101-115. [PMID: 34796679 PMCID: PMC8822384 DOI: 10.1002/cjp2.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/12/2021] [Accepted: 10/12/2021] [Indexed: 12/21/2022]
Abstract
Digital Pathology (DP) is a platform which has the potential to develop a truly integrated and global pathology community. The generation of DP data at scale creates novel challenges for the histopathology community in managing, processing, and governing the use of these data. The current understanding of, and confidence in, the legal and ethical aspects of DP by pathologists is unknown. We developed an electronic survey (e-survey), comprising 22 questions, with input from the Royal College of Pathologists (RCPath) Digital Pathology Working Group. The e-survey was circulated via e-mail and social media (Twitter) through the RCPath Digital Pathology Working Group network, RCPath Trainee Committee network, the Pathology image data Lake for Analytics, Knowledge and Education (PathLAKE) digital pathology consortium, National Pathology Imaging Co-operative (NPIC), local contacts, and to the membership of both The Pathological Society of Great Britain and Ireland and the British Division of the International Academy of Pathology (BDIAP). Between 14 July 2020 and 6 September 2020, we collected 198 responses representing a cross section of histopathologists, including individuals with experience of DP research. We ascertained that, in the UK, DP is being used for diagnosis, research, and teaching, and that the platform is enabling data sharing. Our survey demonstrated that there is often a lack of confidence and understanding of the key issues of consent, legislation, and ethical guidelines. Of 198 respondents, 82 (41%) did not know when the use of digital scanned slide images would fall under the relevant legislation and 93 (47%) were 'Not confident at all' in their interpretation of consent for scanned slide images in research. With increasing uptake of DP, a working knowledge of these areas is essential but histopathologists often express a lack of confidence in these topics. The need for specific training in these areas is highlighted by the findings of this study.
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Affiliation(s)
- Cheryl Coulter
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Division of Clinical Laboratory Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Francis McKay
- The Wellcome Centre for Ethics and Humanities and the Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nina Hallowell
- The Wellcome Centre for Ethics and Humanities and the Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Philip Macklin
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Tom Sorell
- Department of Politics and International Studies, University of Warwick, Coventry, UK
| | - Muhammad Aslam
- Department of Histopathology, Glangwilli Hospital, Hywel Dda University Health Board, Carmarthen, Wales, UK
| | - Gareth Bryson
- Department of Pathology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Darren Treanor
- Department of Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
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15
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Digital Pathology Transformation in a Supraregional Germ Cell Tumour Network. Diagnostics (Basel) 2021; 11:diagnostics11122191. [PMID: 34943429 PMCID: PMC8700654 DOI: 10.3390/diagnostics11122191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023] Open
Abstract
Background: In this article we share our experience of creating a digital pathology (DP) supraregional germ cell tumour service, including full digitisation of the central laboratory. Methods: DP infrastructure (Philips) was deployed across our hospital network to allow full central digitisation with partial digitisation of two peripheral sites in the supraregional testis germ cell tumour network. We used a survey-based approach to capture the quantitative and qualitative experiences of the multidisciplinary teams involved. Results: The deployment enabled case sharing for the purposes of diagnostic reporting, second opinion, and supraregional review. DP was seen as a positive step forward for the departments involved, and for the wider germ cell tumour network, and was completed without significant issues. Whilst there were challenges, the transition to DP was regarded as worthwhile, and examples of benefits to patients are already recognised. Conclusion: Pathology networks, including highly specialised services, such as in this study, are ideally suited to be digitised. We highlight many of the benefits but also the challenges that must be overcome for such clinical transformation. Overall, from the survey, the change was seen as universally positive for our service and highlights the importance of engagement of the whole team to achieve success.
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16
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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: 35] [Impact Index Per Article: 11.7] [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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17
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Azam AS, Miligy IM, Kimani PKU, Maqbool H, Hewitt K, Rajpoot NM, Snead DRJ. Diagnostic concordance and discordance in digital pathology: a systematic review and meta-analysis. J Clin Pathol 2021; 74:448-455. [PMID: 32934103 PMCID: PMC8223673 DOI: 10.1136/jclinpath-2020-206764] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Digital pathology (DP) has the potential to fundamentally change the way that histopathology is practised, by streamlining the workflow, increasing efficiency, improving diagnostic accuracy and facilitating the platform for implementation of artificial intelligence-based computer-assisted diagnostics. Although the barriers to wider adoption of DP have been multifactorial, limited evidence of reliability has been a significant contributor. A meta-analysis to demonstrate the combined accuracy and reliability of DP is still lacking in the literature. OBJECTIVES We aimed to review the published literature on the diagnostic use of DP and to synthesise a statistically pooled evidence on safety and reliability of DP for routine diagnosis (primary and secondary) in the context of validation process. METHODS A comprehensive literature search was conducted through PubMed, Medline, EMBASE, Cochrane Library and Google Scholar for studies published between 2013 and August 2019. The search protocol identified all studies comparing DP with light microscopy (LM) reporting for diagnostic purposes, predominantly including H&E-stained slides. Random-effects meta-analysis was used to pool evidence from the studies. RESULTS Twenty-five studies were deemed eligible to be included in the review which examined a total of 10 410 histology samples (average sample size 176). For overall concordance (clinical concordance), the agreement percentage was 98.3% (95% CI 97.4 to 98.9) across 24 studies. A total of 546 major discordances were reported across 25 studies. Over half (57%) of these were related to assessment of nuclear atypia, grading of dysplasia and malignancy. These were followed by challenging diagnoses (26%) and identification of small objects (16%). CONCLUSION The results of this meta-analysis indicate equivalent performance of DP in comparison with LM for routine diagnosis. Furthermore, the results provide valuable information concerning the areas of diagnostic discrepancy which may warrant particular attention in the transition to DP.
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Affiliation(s)
- Ayesha S Azam
- Cellular Pathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
- Tissue Image Analytics Laboratory, Department of Computer Science, University of Warwick, Coventry, West Midlands, UK
| | - Islam M Miligy
- Nottingham Breast Cancer Research Centre (NBCRC), School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Peter K-U Kimani
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Heeba Maqbool
- Cellular Pathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
| | - Katherine Hewitt
- Cellular Pathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
| | - Nasir M Rajpoot
- Tissue Image Analytics Laboratory, Department of Computer Science, University of Warwick, Coventry, West Midlands, UK
| | - David R J Snead
- Cellular Pathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, Coventry, UK
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18
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Breast Digital Pathology: Way of the Future. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Ramaswamy V, Tejaswini BN, Uthaiah SB. Remote Reporting During a Pandemic Using Digital Pathology Solution: Experience from a Tertiary Care Cancer Center. J Pathol Inform 2021; 12:20. [PMID: 34267985 PMCID: PMC8274304 DOI: 10.4103/jpi.jpi_109_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/28/2020] [Accepted: 03/01/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Remote reporting in anatomic pathology is an important advantage of digital pathology that has not been much explored. The COVID-19 pandemic has provided an opportunity to explore this important application of digital pathology system in a tertiary care cancer center to ensure patient care and staff safety. Regulatory guidelines have been described for remote reporting following the pandemic. Herein, we describe our experience of validation of digital pathology workflow for remote reporting to encourage pathologists to utilize this facility which opens door for multiple, multidisciplinary collaborations. Objective: To demonstrate the validation and the operational feasibility of remote reporting using a digital pathology system. Materials and Methods: Our retrospective validation included whole-slide images (WSIs) of 60 cases of histopathology and 20 cases each of frozen sections and a digital image-based breast algorithm after a washout period of 3 months. Three pathologists with different models of consumer-grade laptops reviewed the cases remotely to assess the diagnostic concordance and operational feasibility of the modified workflow. The slides were digitized on a USFDA-approved Philips UFS 300 scanner at ×40 resolution (0.25 μm/pixel) and viewed on the Image Management System through a web browser. All the essential parameters were reported for each case. After successful validation, 886 cases were reported remotely from March 29, 2020, to June 30, 2020, prospectively. Light microscopy formed the gold standard reference in remote reporting. Results: 100% major diagnostic concordance was observed in the validation of remote reporting in the retrospective and prospective studies using consumer-grade laptops. The deferral rate was 0.34%. 97.6% of histopathology and 100% of frozen sections were signed out within the turnaround time. Network speed and a lack of virtual private network did not significantly affect the study. Conclusion: This study of validation and reporting of complete pathology cases remotely, including their operational feasibility during a public health emergency, proves that remote sign-out using a digital pathology system is not inferior to WSIs on medical-grade monitors and light microscopy. Such studies on remote reporting open the door for the use of digital pathology for interinstitutional consultation and collaboration: Its main intended use.
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Affiliation(s)
- Veena Ramaswamy
- Department of Histopathology, Strand Life Sciences - Health Care Global Cancer Hospital, Bengaluru, Karnataka, India
| | - B N Tejaswini
- Department of Histopathology, Strand Life Sciences - Health Care Global Cancer Hospital, Bengaluru, Karnataka, India
| | - Sowmya B Uthaiah
- Department of Histopathology, Strand Life Sciences - Health Care Global Cancer Hospital, Bengaluru, Karnataka, India
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20
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Guiter GE, Sapia S, Wright AI, Hutchins GGA, Arayssi T. Development of a Remote Online Collaborative Medical School Pathology Curriculum with Clinical Correlations, across Several International Sites, through the Covid-19 Pandemic. MEDICAL SCIENCE EDUCATOR 2021; 31:549-556. [PMID: 33495717 PMCID: PMC7815444 DOI: 10.1007/s40670-021-01212-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Due to the Covid-19 social distancing restrictions, in March 2020, Weill Cornell Medicine-Qatar decided to replace students' clinical instruction with novel online electives. Hence, we implemented an innovative online and remote pathology curriculum, anchored on virtual microscopy and Zoom videoconferencing: ideal tools to support online teaching. OBJECTIVE To assess a new curriculum implementation at Weill Cornell Medicine-Qatar. MATERIALS AND METHODS This for-credit, 2-week elective included 6 synchronous Zoom sessions where complex clinicopathological cases were discussed in small groups. We used open access digital microscopy slides from the University of Leeds' Virtual Pathology Library (http://www.virtualpathology.leeds.ac.uk/slides/library/). Students independently prepared for these sessions by reviewing cases, slides, readings, and questions in advance (asynchronous self-directed learning anchored on a flipped classroom model), and wrote a final review of a case. An assessment and feedback were given to each student. RESULTS Four elective iterations were offered to a total of 29 students, with learners and faculty spread over 4 countries. During the Zoom sessions, students controlled the digital slides and offered their own diagnoses, followed by group discussions to strengthen autonomy and confidence. We surveyed learners about the elective's performance (program evaluation). Students conveyed high levels of satisfaction about the elective's overall quality, their pathology learning and online interactions, with minimal challenges related to the remote nature of the course. DISCUSSION AND CONCLUSIONS Technological innovations mitigate sudden disruptions in medical education. A remote curriculum allows instruction at any distance, at any time, from anywhere, enhancing educational exchanges, flexibility and globalization in medical education.
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Affiliation(s)
- Gerardo E. Guiter
- Division of Medical Education, Weill Cornell Medicine-Qatar, 445 East 69 Street, RM 432, New York, NY 10021 USA
| | - Sandra Sapia
- Division of Medical Education, Weill Cornell Medicine- Qatar, Qatar Foundation - Education City, P.O. Box 24144, Doha, Qatar
| | - Alexander I. Wright
- Section of Pathology, Leeds Institute of Medical Research, University of Leeds, 4.11 Wellcome Trust Brenner Building, St James’s University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Gordon G. A. Hutchins
- Leeds Teaching Hospitals NHS Trust/University of Leeds. Histopathology and Molecular Pathology, St James’ University Hospital, Beckett Street, Leeds, LS9 7TF UK
| | - Thurayya Arayssi
- Division of Medical Education, Weill Cornell Medicine-Qatar, 445 East 69 Street, RM 432, New York, NY 10021 USA
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21
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Fully digital pathology laboratory routine and remote reporting of oral and maxillofacial diagnosis during the COVID-19 pandemic: a validation study. Virchows Arch 2021; 479:585-595. [PMID: 33713188 PMCID: PMC7955219 DOI: 10.1007/s00428-021-03075-9] [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: 01/13/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
The role of digital pathology in remote reporting has seen an increase during the COVID-19 pandemic. Recently, recommendations had been made regarding the urgent need of reorganizing head and neck cancer diagnostic services to provide a safe work environment for the staff. A total of 162 glass slides from 109 patients over a period of 5 weeks were included in this validation and were assessed by all pathologists in both analyses (digital and conventional) to allow intraobserver comparison. The intraobserver agreement between the digital method (DM) and conventional method (CM) was considered almost perfect (κ ranged from 0.85 to 0.98, with 95% CI, ranging from 0.81 to 1). The most significant and frequent disagreements within trainees encompassed epithelial dysplasia grading and differentiation among severe dysplasia (carcinoma in situ) and oral squamous cell carcinoma. The most frequent pitfall from DM was lag in screen mirroring. The lack of details of inflammatory cells and the need for a higher magnification to assess dysplasia were pointed in one case each. The COVID-19 crisis has accelerated and consolidated the use of online meeting tools, which would be a valuable resource even in the post-pandemic scenario. Adaptation in laboratory workflow, the advent of digital pathology and remote reporting can mitigate the impact of similar future disruptions to the oral and maxillofacial pathology laboratory workflow avoiding delays in diagnosis and report, to facilitate timely management of head and neck cancer patients. Graphical abstract ![]()
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22
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Gavrielides MA, Ronnett BM, Vang R, Barak S, Lee E, Staats PN, Jenson E, Skaria P, Sheikhzadeh F, Miller M, Hagemann IS, Petrick N, Seidman JD. Pathologist Concordance for Ovarian Carcinoma Subtype Classification and Identification of Relevant Histologic Features Using Microscope and Whole Slide Imaging: A Multisite Observer Study. Arch Pathol Lab Med 2021; 145:1516-1525. [PMID: 33635941 DOI: 10.5858/arpa.2020-0579-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Despite several studies focusing on the validation of whole slide imaging (WSI) across organ systems or subspecialties, the use of WSI for specific primary diagnosis tasks has been underexamined. OBJECTIVE.— To assess pathologist performance for the histologic subtyping of individual sections of ovarian carcinomas using the light microscope and WSI. DESIGN.— A panel of 3 experienced gynecologic pathologists provided reference subtype diagnoses for 212 histologic sections from 109 ovarian carcinomas based on optical microscopy review. Two additional attending pathologists provided diagnoses and also identified the presence of a set of 8 histologic features important for ovarian tumor subtyping. Two experienced gynecologic pathologists and 2 fellows reviewed the corresponding WSI images for subtype classification and feature identification. RESULTS.— Across pathologists specialized in gynecologic pathology, concordance with the reference diagnosis for the 5 major ovarian carcinoma subtypes was significantly higher for a pathologist reading on microscope than each of 2 pathologists reading on WSI. Differences were primarily due to more frequent classification of mucinous carcinomas as endometrioid with WSI. Pathologists had generally low agreement in identifying histologic features important to ovarian tumor subtype classification, with either optical microscopy or WSI. This result suggests the need for refined histologic criteria for identifying such features. Interobserver agreement was particularly low for identifying intracytoplasmic mucin with WSI. Inconsistencies in evaluating nuclear atypia and mitoses with WSI were also observed. CONCLUSIONS.— Further research is needed to specify the reasons for these diagnostic challenges and to inform users and manufacturers of WSI technology.
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Affiliation(s)
- Marios A Gavrielides
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories (Gavrielides and Petrick)
| | - Brigitte M Ronnett
- the Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland (Ronnett, Vang, Jenson)
| | - Russell Vang
- the Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland (Ronnett, Vang, Jenson)
| | - Stephanie Barak
- the Department of Pathology, The George Washington University, Washington, District of Columbia (Barak, Lee)
| | - Elsie Lee
- Gavrielides is currently at AstraZeneca, Gaithersburg, Maryland.,the Department of Pathology, The George Washington University, Washington, District of Columbia (Barak, Lee)
| | - Paul N Staats
- the Department of Pathology, University of Maryland School of Medicine, Baltimore (Staats)
| | - Erik Jenson
- Lee is currently at HNL Lab Medicine, Allentown, Pennsylvania.,the Departments of Pathology and Gynecology & Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland (Ronnett, Vang, Jenson)
| | - Priya Skaria
- the Departments of Pathology and Immunology (Skaria and Hagemann), Washington University School of Medicine, St Louis, Missouri
| | - Fahime Sheikhzadeh
- Jenson is now with Hospital Pathology Associates, Minneapolis/St Paul, Minnesota.,the Electrical and Computer Engineering Department, University of British Columbia, Vancouver, Canada (Sheikhzadeh)
| | - Meghan Miller
- and the Department of Bioengineering, University of Maryland, College Park (Miller)
| | - Ian S Hagemann
- the Departments of Pathology and Immunology (Skaria and Hagemann), Washington University School of Medicine, St Louis, Missouri.,and Obstetrics and Gynecology (Hagemann), Washington University School of Medicine, St Louis, Missouri
| | - Nicholas Petrick
- From the Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories (Gavrielides and Petrick)
| | - Jeffrey D Seidman
- and the Division of Molecular Genetics and Pathology, Office of In Vitro Diagnostics and Radiological Health (Seidman), Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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23
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Cellular pathology practice in the era of COVID-19 pandemic-related lockdowns - Experience from a tertiary hospital: A retrospective observational study. Ann Med Surg (Lond) 2021; 63:102155. [PMID: 33614022 PMCID: PMC7877811 DOI: 10.1016/j.amsu.2021.02.001] [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: 01/17/2021] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background The COVID-19 pandemic had many implications on healthcare services, including cellular pathology. The pandemic-related lockdown was applied in Jordan from March to May 2020. King Abdullah University Hospital (KAUH) was chosen to provide care for COVID-19 patients during that period. Since there was no experience in dealing with COVID-19 patients, the hospital maintained some essential services but canceled elective surgeries and procedures. The rationale was to prioritize care for COVID-19 patients and to provide better adherence to infection control policies and protect non-infected patients and healthcare workers. The purpose of the present study is to investigate the impact of COVID-19 pandemic restrictions on cellular pathology practice patterns at KAUH. Methods This is a retrospective observational study conducted at KAUH. All cellular pathology reports during the 2020 national lockdown were retrieved. The total numbers of specimens including types and procedures were recorded. Data were compared with the corresponding data in 2019 when there was no pandemic and when hospital and laboratory services were run in full capacity. Results 2020 lockdown period showed a 57.9% reduction in the total number of specimens received at the cellular pathology laboratory as compared to the corresponding period of 2019 (1400 versus 3322). Emergency procedures have represented 99.1% of the service during the lockdown with a remarkable diversity shift. Conclusion There was a significant drop in the number of specimens dealt with at KAUH cellular pathology laboratory during the COVID-19 pandemic-related national lockdown. We learned from this pandemic how to adapt to such circumstances by adjusting our way of working to reach the best level of staff safety while maintaining highly productive work. Implementing digital pathology platforms, working from home strategies and alternative training methodologies have emerged as an essential need. COVID-19 pandemic-related lockdown had a major influence on healthcare services. Pathology services and training of residents were influenced by the lockdown, too. The pandemic taught us how to adapt to such circumstances by adjusting way of working. Digital pathology platforms and strategies to work from home emerged as essential needs.
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24
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Rao V, Kumar R, Rajaganesan S, Rane S, Deshpande G, Yadav S, Patil A, Pai T, Menon S, Shah A, Rabade K, Ramadwar M, Panjwani P, Mittal N, Sahay A, Rekhi B, Bal M, Sakhadeo U, Gujral S, Desai S. Remote Reporting from Home for Primary Diagnosis in Surgical Pathology: A Tertiary Oncology Center Experience during the COVID-19 Pandemic. J Pathol Inform 2021; 12:3. [PMID: 34012707 PMCID: PMC8112339 DOI: 10.4103/jpi.jpi_72_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the widespread adoption of digital pathology (DP) for primary diagnosis in surgical pathology. This paradigm shift is likely to influence how we function routinely in the postpandemic era. We present learnings from early adoption of DP for a live digital sign-out from home in a risk-mitigated environment. MATERIALS AND METHODS We aimed to validate DP for remote reporting from home in a real-time environment and evaluate the parameters influencing the efficiency of a digital workflow. Eighteen pathologists prospectively validated DP for remote use on 567 biopsy cases including 616 individual parts from 7 subspecialties over a duration from March 21, 2020, to June 30, 2020. The slides were digitized using Roche Ventana DP200 whole-slide scanner and reported from respective homes in a risk-mitigated environment. RESULTS Following re-review of glass slides, there was no major discordance and 1.2% (n = 7/567) minor discordance. The deferral rate was 4.5%. All pathologists reported from their respective homes from laptops with an average network speed of 20 megabits per second. CONCLUSION We successfully validated and adopted a digital workflow for remote reporting with available resources and were able to provide our patients, an undisrupted access to subspecialty expertise during these unprecedented times.
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Affiliation(s)
- Vidya Rao
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gauri Deshpande
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aekta Shah
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Katha Rabade
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Poonam Panjwani
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Uma Sakhadeo
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sangeeta Desai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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25
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Bracey T, Arif S, Ralte AM, Shaaban AM, Ganesan R. Histopathology during the COVID-19 pandemic: resilience through adaptation and innovation. ACTA ACUST UNITED AC 2020; 27:108-115. [PMID: 33391394 PMCID: PMC7772581 DOI: 10.1016/j.mpdhp.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Histopathology departments have adapted to the challenges posed by the COVID-19 pandemic by a variety of changes including working pattern alterations, technology adoptions and incorporation of techniques. This article summarizes these adaptations and provides references to guide pathologists through the continuing pandemic.
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Affiliation(s)
- Tim Bracey
- Consultant Pathologist and Peninsula Clinical Lead, Department of Diagnostic and Molecular Pathology, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Consultant Pathologist, Princess Alexandra Hospital NHS Trust, Harlow, UK.,Consultant Pathologist, The NHS Pathology Centre, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.,Diploma Health Research Consultant Pathologist/Honorary Senior Lecturer, Queen Elizabeth Hospital Birmingham and University of Birmingham, UK.,Consultant Gynaecological Pathologist, Department of Cellular Pathology, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Saimah Arif
- Consultant Pathologist and Peninsula Clinical Lead, Department of Diagnostic and Molecular Pathology, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Consultant Pathologist, Princess Alexandra Hospital NHS Trust, Harlow, UK.,Consultant Pathologist, The NHS Pathology Centre, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.,Diploma Health Research Consultant Pathologist/Honorary Senior Lecturer, Queen Elizabeth Hospital Birmingham and University of Birmingham, UK.,Consultant Gynaecological Pathologist, Department of Cellular Pathology, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Angela Mercy Ralte
- Consultant Pathologist and Peninsula Clinical Lead, Department of Diagnostic and Molecular Pathology, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Consultant Pathologist, Princess Alexandra Hospital NHS Trust, Harlow, UK.,Consultant Pathologist, The NHS Pathology Centre, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.,Diploma Health Research Consultant Pathologist/Honorary Senior Lecturer, Queen Elizabeth Hospital Birmingham and University of Birmingham, UK.,Consultant Gynaecological Pathologist, Department of Cellular Pathology, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Abeer M Shaaban
- Consultant Pathologist and Peninsula Clinical Lead, Department of Diagnostic and Molecular Pathology, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Consultant Pathologist, Princess Alexandra Hospital NHS Trust, Harlow, UK.,Consultant Pathologist, The NHS Pathology Centre, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.,Diploma Health Research Consultant Pathologist/Honorary Senior Lecturer, Queen Elizabeth Hospital Birmingham and University of Birmingham, UK.,Consultant Gynaecological Pathologist, Department of Cellular Pathology, Birmingham Women's and Children's NHS Trust, Birmingham, UK
| | - Raji Ganesan
- Consultant Pathologist and Peninsula Clinical Lead, Department of Diagnostic and Molecular Pathology, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Consultant Pathologist, Princess Alexandra Hospital NHS Trust, Harlow, UK.,Consultant Pathologist, The NHS Pathology Centre, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK.,Diploma Health Research Consultant Pathologist/Honorary Senior Lecturer, Queen Elizabeth Hospital Birmingham and University of Birmingham, UK.,Consultant Gynaecological Pathologist, Department of Cellular Pathology, Birmingham Women's and Children's NHS Trust, Birmingham, UK
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26
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Bakhribah H, Zeitouni M, Daghistani RA, Almaghraby HQ, Khankan AA, Alkattan KM, Alshehri SM, Jazieh AR. Implications of COVID-19 pandemic on lung cancer management: A multidisciplinary perspective. Crit Rev Oncol Hematol 2020; 156:103120. [PMID: 33099232 PMCID: PMC7546967 DOI: 10.1016/j.critrevonc.2020.103120] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/27/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023] Open
Abstract
Treatment of patients with lung cancer during the current COVID-19 pandemic is challenging. Lung cancer is a heterogenous disease with a wide variety of therapeutic options. Oncologists have to determine the risks and benefits of modifying the treatment plans of patients especially in situation where the disease biology and treatment are complex. Health care visits carry a risk of transmission of SARS-CoV-2 and the similarities of COVID-19 symptoms and lung cancer manifestations represent a dominant problem. Efforts to modify treatment of lung cancer during the current pandemic have been adapted by many healthcare institutes to reduce exposure of lung cancer patients to SARS-CoV-2. We summarized the implications of COVID-19 pandemic on the management of lung cancer from the perspective of different specialties of thoracic oncology multidisciplinary team.
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Affiliation(s)
- Hatoon Bakhribah
- Oncology Center, King Fahad Medical City, Riyadh, KSA, Saudi Arabia
| | - Mohammad Zeitouni
- Pulmonary Division, King Faisal Specialist Hospital and Research Center, Riyadh, KSA, Saudi Arabia
| | | | - Hatim Q Almaghraby
- Dept. of Pathology and Laboratory Medicine, King Abdulaziz Medical City and King Saud University for Health Sciences, MNGHA, Jeddah, KSA, Saudi Arabia
| | - Azzam A Khankan
- Interventional Radiology, Imaging Department, King Abdulaziz Medical City, Jeddah, KSA, Saudi Arabia
| | | | - Salem M Alshehri
- Oncology Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, KSA, Saudi Arabia
| | - Abdul Rahman Jazieh
- Oncology Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, KSA, Saudi Arabia.
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27
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Jahn SW, Plass M, Moinfar F. Digital Pathology: Advantages, Limitations and Emerging Perspectives. J Clin Med 2020; 9:E3697. [PMID: 33217963 PMCID: PMC7698715 DOI: 10.3390/jcm9113697] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022] Open
Abstract
Digital pathology is on the verge of becoming a mainstream option for routine diagnostics. Faster whole slide image scanning has paved the way for this development, but implementation on a large scale is challenging on technical, logistical, and financial levels. Comparative studies have published reassuring data on safety and feasibility, but implementation experiences highlight the need for training and the knowledge of pitfalls. Up to half of the pathologists are reluctant to sign out reports on only digital slides and are concerned about reporting without the tool that has represented their profession since its beginning. Guidelines by international pathology organizations aim to safeguard histology in the digital realm, from image acquisition over the setup of work-stations to long-term image archiving, but must be considered a starting point only. Cost-efficiency analyses and occupational health issues need to be addressed comprehensively. Image analysis is blended into the traditional work-flow, and the approval of artificial intelligence for routine diagnostics starts to challenge human evaluation as the gold standard. Here we discuss experiences from past digital pathology implementations, future possibilities through the addition of artificial intelligence, technical and occupational health challenges, and possible changes to the pathologist's profession.
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Affiliation(s)
- Stephan W. Jahn
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (M.P.); (F.M.)
| | - Markus Plass
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (M.P.); (F.M.)
| | - Farid Moinfar
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria; (M.P.); (F.M.)
- Department of Pathology, Ordensklinikum/Hospital of the Sisters of Charity, Seilerstätte 4, 4010 Linz, Austria
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28
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Misra V, Agrawal R, Kumar H, Kar A, Kini U, Poojary A, Chakrabarti I, Rai S, Singhal A, Shankar SV, Iyengar JN. Guidelines for various laboratory sections in view of COVID-19: Recommendations from the Indian Association of Pathologists and Microbiologists. INDIAN J PATHOL MICR 2020; 63:350-357. [PMID: 32769321 DOI: 10.4103/ijpm.ijpm_857_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Declared as a pandemic by WHO on March 11, 2020, COVID-19 has brought about a dramatic change in the working of different laboratories across the country. Diagnostic laboratories testing different types of samples play a vital role in the treatment management. Irrespective of their size, each laboratory has to follow strict biosafety guidelines. Different sections of the laboratory receive samples that are variably infectious. Each sample needs to undergo a proper and well-designed processing system so that the personnel involved are not infected and also their close contacts. It takes a huge effort so as to limit the risk of exposure of the working staff during the collection, processing, reporting or dispatching of biohazard samples. Guidelines help in preventing the laboratory staff and healthcare workers from contracting the disease which has a known human to human route of transmission and high rate of mortality. A well-knit approach is the need of the hour to combat this fast spreading disease. We anticipate that the guidelines described in this article will be useful for continuing safe work practices by all the laboratories in the country.
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Affiliation(s)
- Vatsala Misra
- Pathology, MLN Medical College, Prayagraj, Uttar Pradesh, India
| | - Ranjan Agrawal
- Pathology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Harendra Kumar
- Pathology, SN Medical College, Agra, Uttar Pradesh, India
| | - Asaranti Kar
- Pathology, SCB Medical College, Cuttack, Odisha, India
| | - Usha Kini
- Pathology, St.John's Medical College and Oncquest Laboratories, Bengaluru, Karnataka, India
| | - Aruna Poojary
- Pathology and Microbiology, Breach Candy Hospital Trust, Mumbai, Maharashtra, India
| | | | - Sharada Rai
- Pathology, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - S Vijay Shankar
- Pathology, Adichunchanagiri Institute of Medical Sciences, B G Nagara, Mandya, Karnataka, India
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29
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Vodovnik A, Riste TB, Sund BS. Digital Pathology During a Pandemic. J Pathol Inform 2020; 11:24. [PMID: 33042603 PMCID: PMC7518197 DOI: 10.4103/jpi.jpi_44_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
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30
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Rakha EA, Toss M, Shiino S, Gamble P, Jaroensri R, Mermel CH, Chen PHC. Current and future applications of artificial intelligence in pathology: a clinical perspective. J Clin Pathol 2020; 74:409-414. [PMID: 32763920 DOI: 10.1136/jclinpath-2020-206908] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
During the last decade, a dramatic rise in the development and application of artificial intelligence (AI) tools for use in pathology services has occurred. This trend is often expected to continue and reshape the field of pathology in the coming years. The deployment of computational pathology and applications of AI tools can be considered as a paradigm shift that will change pathology services, making them more efficient and capable of meeting the needs of this era of precision medicine. Despite the success of AI models, the translational process from discovery to clinical applications has been slow. The gap between self-contained research and clinical environment may be too wide and has been largely neglected. In this review, we cover the current and prospective applications of AI in pathology. We examine its applications in diagnosis and prognosis, and we offer insights for considerations that could improve clinical applicability of these tools. Then, we discuss its potential to improve workflow efficiency, and its benefits in pathologist education. Finally, we review the factors that could influence adoption in clinical practices and the associated regulatory processes.
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Affiliation(s)
- Emad A Rakha
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | - Michael Toss
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | - Sho Shiino
- Histopathology, University of Nottingham School of Medicine, Nottingham, UK
| | - Paul Gamble
- Google Health, Google, Palo Alto, California, USA
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31
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Cimadamore A, Lopez-Beltran A, Scarpelli M, Cheng L, Montironi R. Digital pathology and COVID-19 and future crises: pathologists can safely diagnose cases from home using a consumer monitor and a mini PC. J Clin Pathol 2020; 73:695-696. [PMID: 32732339 DOI: 10.1136/jclinpath-2020-206943] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of Marche Region, School of Medicine, United Hospitals, Ancona, Marche, Italy
| | - Antonio Lopez-Beltran
- Department of Surgery, Universidad de Cordoba Facultad de Medicina y Enfermeria, Cordoba, Spain
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of Marche Region, School of Medicine, United Hospitals, Ancona, Marche, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of Marche Region, School of Medicine, United Hospitals, Ancona, Marche, Italy
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32
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Wright AI, Clarke EL, Dunn CM, Williams BJ, Treanor DE, Brettle DS. A Point-of-Use Quality Assurance Tool for Digital Pathology Remote Working. J Pathol Inform 2020; 11:17. [PMID: 33033654 PMCID: PMC7513773 DOI: 10.4103/jpi.jpi_25_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/24/2020] [Accepted: 05/05/2020] [Indexed: 01/29/2023] Open
Abstract
Pathology services are facing pressures due to the COVID-19 pandemic. Digital pathology has the capability to meet some of these unprecedented challenges by allowing remote diagnoses to be made at home, during periods of social distancing or self-isolation. However, while digital pathology allows diagnoses to be made on standard computer screens, unregulated home environments may not be conducive for optimal viewing conditions. There is also a paucity of experimental evidence available to support the minimum display requirements for digital pathology. This study presents a Point-of-Use Quality Assurance (POUQA) tool for remote assessment of viewing conditions for reporting digital pathology slides. The tool is a psychophysical test combining previous work from successfully implemented quality assurance tools in both pathology and radiology to provide a minimally intrusive display screen validation task, before viewing digital slides. The test is specific to pathology assessment in that it requires visual discrimination between colors derived from hematoxylin and eosin staining, with a perceptual difference of ±1 delta E (dE). This tool evaluates the transfer of a 1 dE signal through the digital image display chain, including the observers’ contrast and color responses within the test color range. The web-based system has been rapidly developed and deployed as a response to the COVID-19 pandemic and may be used by anyone in the world to help optimize flexible working conditions at: http://www. virtualpathology.leeds.ac.uk/res earch/systems/pouqa/.
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Affiliation(s)
- Alexander I Wright
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Emily L Clarke
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Catriona M Dunn
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Bethany J Williams
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Darren E Treanor
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David S Brettle
- Section of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
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33
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Browning L, Colling R, Rakha E, Rajpoot N, Rittscher J, James JA, Salto-Tellez M, Snead DRJ, Verrill C. Digital pathology and artificial intelligence will be key to supporting clinical and academic cellular pathology through COVID-19 and future crises: the PathLAKE consortium perspective. J Clin Pathol 2020; 74:443-447. [PMID: 32620678 PMCID: PMC8223667 DOI: 10.1136/jclinpath-2020-206854] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022]
Abstract
The measures to control the COVID-19 outbreak will likely remain a feature of our working lives until a suitable vaccine or treatment is found. The pandemic has had a substantial impact on clinical services, including cancer pathways. Pathologists are working remotely in many circumstances to protect themselves, colleagues, family members and the delivery of clinical services. The effects of COVID-19 on research and clinical trials have also been significant with changes to protocols, suspensions of studies and redeployment of resources to COVID-19. In this article, we explore the specific impact of COVID-19 on clinical and academic pathology and explore how digital pathology and artificial intelligence can play a key role to safeguarding clinical services and pathology-based research in the current climate and in the future.
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Affiliation(s)
- Lisa Browning
- Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Richard Colling
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Emad Rakha
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Nasir Rajpoot
- Tissue Image Analytics Laboratory, Department of Computer Science, University of Warwick, Coventry, West Midlands, UK.,Department of Pathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, West Midlands, UK
| | - Jens Rittscher
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.,Department of Engineering Science and Big Data Institute, Oxford University, Oxford, Oxfordshire, UK
| | - Jacqueline A James
- Precision Medicine Centre of Excellence, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Belfast, UK.,Cellular Pathology, Belfast Health and Social Care Trust, Belfast, Belfast, UK
| | - Manuel Salto-Tellez
- Precision Medicine Centre of Excellence, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Belfast, UK.,Cellular Pathology, Belfast Health and Social Care Trust, Belfast, Belfast, UK
| | - David R J Snead
- Department of Pathology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, West Midlands, UK
| | - Clare Verrill
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK .,Nuffield Department of Surgical Sciences, Oxford University, Oxford, Oxfordshire, UK
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34
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Browning L, Fryer E, Roskell D, White K, Colling R, Rittscher J, Verrill C. Role of digital pathology in diagnostic histopathology in the response to COVID-19: results from a survey of experience in a UK tertiary referral hospital. J Clin Pathol 2020; 74:129-132. [PMID: 32616541 PMCID: PMC7841475 DOI: 10.1136/jclinpath-2020-206786] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/05/2020] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has challenged our diagnostic services at a time when many histopathology departments already faced a diminishing workforce and increasing workload. Digital pathology (DP) has been hailed as a potential solution to at least some of the challenges faced. We present a survey of pathologists within a UK National Health Service cellular pathology department with access to DP, in which we ascertain the role of DP in clinical services during this current pandemic and explore challenges encountered. This survey indicates an increase in uptake of diagnostic DP during this period, with increased remote access. Half of respondents agreed that DP had facilitated maintenance of diagnostic practice. While challenges have been encountered, these are remediable, and none have impacted on the uptake of DP during this period. We conclude that in our institution, DP has demonstrated current and future potential to increase resilience in diagnostic practice and have highlighted some of the challenges that need to be considered.
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Affiliation(s)
- Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK .,NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK
| | - Eve Fryer
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Derek Roskell
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Kieron White
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Richard Colling
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jens Rittscher
- NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.,Department of Engineering Science, University of Oxford, Oxford, Oxfordshire, UK
| | - Clare Verrill
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,NIHR Oxford Biomedical Research Centre, Oxford, Oxfordshire, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
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