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Digital Pathology in Primary Diagnosis LABORATORIES www.hospitalhealthcare.com Digital pathology in primary diagnosis Digital pathology has proved promising so far, and a full scale digitisation of pathology may not be as far in the future as originally thought Gordan Maras MD Department of Clinical Pathology and Cytology, Gävle Hospital, Gävle, Sweden he concept of telepathology was introduced in 1986 by the American pathologist T 1 Ronald S Weinstein and it has gained increasing attention ever since. However, it is only in the last decade that it has gained considerable ground, thanks to technological developments in parallel with the increased interest from pathologists around the world. Although the use of digital pathology for primary diagnosis is still limited in most laboratories, the technology has already proven highly beneficial in sparsely populated regions. A well- known example is the work from Eastern Quebec, Canada.2 More recently, studies have shown that digital pathology microscopic methods.4,5 The need for are very tempting. As for many other can be of great help when it comes to good and safe validation has led to the middle-sized, regional hospitals in quantitative assessments of tissue samples publication of validation guides for Sweden, it is difficult for us to recruit for greater standardisation and more laboratories that are willing to take the pathologists, especially with the overall objective and reliable interpretations of digital step,6 a sign that digital pathology pathologist shortage that exists in the various immunohistochemical analyses, is considered being of true importance. country. A major advantage that the new including the proliferation marker The continued progress and evaluation technology brings, in addition to all of Ki-67.3 With the advancement of digital of digital pathology has further shown the benefits of digital imaging, is the technology, the skepticism towards how it could bring great achievements for option for pathologists to work remotely. digitisation has also declined greatly, not education, research and archiving.7 It would be particularly useful for small least in view of the numerous validation and remote laboratories to recruit a studies that have good results and good Remote work pathologist independent of where he agreement comparing diagnosis made In our laboratory at Gävle Hospital, the or she currently resides, and who works digitally on screen versus conventional possibilities that digitisation opens up for the hospital without having to be HHE 2015 | 191 LABORATORIES www.hospitalhealthcare.com physically present. The working situation offers the possibility to work for multiple thus becomes much more flexible for the laboratories at the same time, where and diagnostician, both in terms of working when needed. place and working hours. Switching from the microscope to the digital screen is not A digital pathology network that difficult, and recent studies show that The implementation of a digital pathology little training is required for pathologists network is the next step in the digitisation to diagnose digitally at an acceptable process at Gävle hospital, as well as level.8 In our daily work at the laboratory, for certain other laboratories around we have seen that interested pathologists Sweden. Although the technology yields were able to quickly assimilate the a good outcome at the local level, it is in knowledge required for working with collaboration with other hospitals that the digital images. Today, one of our full potential is realised. With a number pathologists works part-time from home, of labs in Sweden implementing digital diagnosing digitally. In addition to the pathology, such a collaboration will soon benefit of remote work for the pathologist be possible. A network interaction would in question, the digitisation has also made be useful in many ways. Today, glass slides our delivery of glass slides to her much are sent between laboratories by mail. easier and quicker, which, in turn, has led This leads to extended response times to shortened turnaround time for some and high delivery costs and, above all, the of the cases. Moreover, consultations have risk of glass slides being damaged or lost. been greatly enhanced as the pathologists To build the routine that digitisation of Sending a digital version of the glass slide working in the laboratory have been able pathology requires in daily work takes would eliminate these inconveniences to view digital images simultaneously time, and the sort of positive attitude and risks for both sender and receiver. with her via direct link, for a fast and safe that our pathologists in Gävle display is However a prerequisite for establishing statement. For us, this has resulted in a of course essential for the forthcoming a network is optimisation of the digital more convenient workflow as a whole. development. workflow within every laboratory. A Dutch At our lab, we also stain with team has shown what aspects to bear in Digitisation at Gävle fluorescence for some skin preparations. mind when facing a transition to digital, The digitisation process in Gävle began These stainings are delicate and quickly and the importance of doing it right from in earnest in 2012 with the purchase of fade, which is why a pathologist must be the beginning.11 scanners and software needed for the present physically to assess the sample. As mentioned earlier, the work and workstation. Since May 2013, we have Even these types of samples will benefit development of telepathology in Eastern scanned glass slides in increasing amounts from digital technology because the Quebec has shown very good results. With and today we scan almost all of our scanned digital image is not affected by a primary focus on diagnosis of frozen produced material. At the moment, our fading colouration. Also, with the image sections, it was noticed that pathologists focus lies especially on how to organise scanned, the diagnosing pathologist does working in remote and isolated places and integrate the procedure of scanning not need to be physically present in the were well disposed to the fact that contact acute samples. Right from the start, we lab but can receive the scanned image and consultation with colleagues in other have been working to improve both the seconds after the procedure.9 A further parts of the region was quick and easy. quality of the scanned images and the advantage for the pathologist working In parallel, the surgeons working in the efficiency of the scanning procedure so as remotely is operating multidisciplinary smaller remote hospitals were more likely to avoid unnecessary time loss. In order to rounds digitally, although not yet a to remain there, knowing they could achieve this we have, for example, trained reality at our hospital. When it comes to perform more complete surgery thanks to special medical laboratory scientists who multidisciplinary rounds, it has been seen the increased availability of pathologists.2 are responsible for scanning and the in Linköping, Sweden, that the efficiency Similar demographics to Eastern quality assurance of the scanned result. of the rounds increase when the screening Quebec can be found in the northland Additionally, we have a working group is made digitally instead of conventionally of Sweden, although on a smaller scale. consisting of a group leader, pathologists, with a microscope.10 This, in turn, leads to The promising effects described above IT consultants and others who collaborate additional patients being reviewed every are worth pursuing given the current and discuss the digital work regularly. given session and an earlier initiation of distribution of both pathologists and A number of our pathologists use the treatment. surgeons in Sweden. One obvious impact digital image for primary diagnosis with We believe that the sort of telework would be faster and more accessible increasing frequency. Others, not yet described above is promising in the sense health care for patients in the sparsely primarily diagnosing on the digital screen, that more pathologists will choose to work populated parts of the country. are instead utilising the morphometric for smaller sized laboratories, such as Digital pathology also offers the functions that the technology offers. ours. For the individual pathologist, this prospect of sharing interesting cases for HHE 2015 | 192 LABORATORIES www.hospitalhealthcare.com educational purposes. In Gävle, we have patients. Also, a fully digitised laboratory 4. Buck TP et al. Validation of a whole begun extracting such cases and adding is not required. Today, there are mobile slide imaging system for primary them to a database. A national network, phone applications that enable digital diagnosis in surgical pathology: and by extension perhaps an international pathology images to be shared and viewed A community hospital experience. network, would simplify the exchange from facilities that cannot afford the J Pathol Informat 2014;5:43. of knowledge, making it an invaluable costly equipment required for digitisation 5. Houghton JP et al. Concordance source for new resident pathologists, of the workflow.13 With mobile apps between digital pathology and among others. As another example, it like these, there are already ways to light microscopy in general surgical would be easy to organise digital-based interconnect regions where the digital pathology: a pilot study of 100 cases. pathology courses for participants from evolution of pathology would probably J Clin Pathol 2014;67:1052–5. all around the world, who may not have take additional time. 6. Pantanowitz L et al. Validating whole the time or the finances to travel long slide imaging for diagnostic purposes distances to assimilate the knowledge they Conclusions in pathology: Guideline from the need for their further development. This The ongoing technological improvements College of American Pathologists would indeed be of exceptional benefit in digital pathology have all the makings Pathology and Laboratory Quality for both residents in training, as well as of a flexible, more standardised and Center. Arch Pathol Lab Med for experienced professionals who need interconnected way of working, both 2013;137:1710–22.
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