Digital Pathology in Cameroon

PURPOSE Cancer is becoming increasingly prevalent among the group of treatable diseases in African countries. There is a shortage of clinicians and pathologists available for cancer diagnosis and treatment. These limited resources must be efficiently used to maximize the number of patients treated. One of the critical factors in treatment efficiency is the correct and timely diagnosis of specimens by pathologists. However, there is currently a significant shortage of cancer care clinicians in Africa and an even more considerable shortage of pathologists. This article presents an example in which telepathology was used to mitigate the lack of pathologists in Cameroon. METHODS The telepathology workaround was implemented in a district hospital based in Cameroon's Adamawa region, where a European surgeon provides cancer treatment. A small histology laboratory there is run by one histotechnologist who processes surgical biopsies into histology slides. As there are no pathologists on site, these slides are digitally scanned using a mobile phone and a whole slide imaging (WSI) scanner. The slides are then shared electronically with a volunteering pathologist in Europe who provides a diagnostic report. RESULTS From 2018 to July 2019, specimens for 101 patients were photographed through an iPhone connected to a microscope eyepiece producing several individual images per specimen. From July 2019 to December 2020, slides from 282 patients were scanned using WSI and digitally transmitted. CONCLUSION WSI on hematoxylin and eosin histology slides for remote diagnosis can increase cancer treatment efficacy and reduce overtreatment of tumors clinically suspicious for malignancy in under-resourced countries with a lack of pathologists.

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Understanding Inflammasomes and PD-1/PD-L1 Crosstalk to Improve Cancer Treatment Efficiency

Cancers ◽

10.3390/cancers12123550 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3550

Author(s):

Anaïs Perrichet ◽

François Ghiringhelli ◽

Cédric Rébé

Keyword(s):

Cancer Treatment ◽

Checkpoint Inhibitors ◽

Response To Treatment ◽

Immune Checkpoints ◽

Cancer Growth ◽

Inflammasome Activation ◽

Treatment Efficiency ◽

Programmed Death ◽

Number Of Patients ◽

Programmed Death 1

Inflammasomes and immune checkpoints have been shown to participate in carcinogenesis, cancer growth and response to treatment. Thus, targeting cytokines resulting from inflammasome activation, such as interleukin (IL)-1β, has emerged as a new tool in the therapeutic arsenal. Moreover, the use of checkpoint inhibitors such as anti-PD-1 or anti-PD-L1 has revolutionized the treatment of some cancer patients. However, inflammasome activation and consecutive cytokine release only occurs in some chemotherapeutic treatments and immune checkpoint inhibitors only work for a restricted number of patients, thus limiting the use of therapies targeting these pathways. Expanding knowledge about the inefficiency of these therapies recently brought forward the hypothesis of targeting both pathways. In this review, we provide an overview of the crosstalk between inflammasomes and programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) that might explain how these two pathways are mutually dependent, and perhaps why targeting only one of them leads to inefficiency of cancer treatment in some patients.

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A Digital Pathology Solution to Resolve the Tissue Floater Conundrum

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2020-0034-oa ◽

2020 ◽

Author(s):

Liron Pantanowitz ◽

Pamela Michelow ◽

Scott Hazelhurst ◽

Shivam Kalra ◽

Charles Choi ◽

...

Keyword(s):

Digital Pathology ◽

Primary Diagnosis ◽

Image Search ◽

Molecular Tests ◽

Tissue Identification ◽

Digital Database ◽

Glass Slides ◽

Search Tool ◽

Hematoxylin And Eosin ◽

Whole Slide Images

Context.— Pathologists may encounter extraneous pieces of tissue (tissue floaters) on glass slides because of specimen cross-contamination. Troubleshooting this problem, including performing molecular tests for tissue identification if available, is time consuming and often does not satisfactorily resolve the problem. Objective.— To demonstrate the feasibility of using an image search tool to resolve the tissue floater conundrum. Design.— A glass slide was produced containing 2 separate hematoxylin and eosin (H&E)-stained tissue floaters. This fabricated slide was digitized along with the 2 slides containing the original tumors used to create these floaters. These slides were then embedded into a dataset of 2325 whole slide images comprising a wide variety of H&E stained diagnostic entities. Digital slides were broken up into patches and the patch features converted into barcodes for indexing and easy retrieval. A deep learning-based image search tool was employed to extract features from patches via barcodes, hence enabling image matching to each tissue floater. Results.— There was a very high likelihood of finding a correct tumor match for the queried tissue floater when searching the digital database. Search results repeatedly yielded a correct match within the top 3 retrieved images. The retrieval accuracy improved when greater proportions of the floater were selected. The time to run a search was completed within several milliseconds. Conclusions.— Using an image search tool offers pathologists an additional method to rapidly resolve the tissue floater conundrum, especially for those laboratories that have transitioned to going fully digital for primary diagnosis.

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Integrated Pathology Informatics Enables High-Quality Personalized and Precision Medicine: Digital Pathology and Beyond

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0139-oa ◽

2017 ◽

Vol 142 (3) ◽

pp. 369-382 ◽

Cited By ~ 9

Author(s):

Zoya Volynskaya ◽

Hung Chow ◽

Andrew Evans ◽

Alan Wolff ◽

Cecilia Lagmay-Traya; ◽

...

Keyword(s):

Data Collection ◽

Precision Medicine ◽

Critical Role ◽

Digital Pathology ◽

Geographic Area ◽

Whole Slide Imaging ◽

High Quality ◽

Pathology Informatics ◽

Prognosis And Prediction ◽

The Right

Context.— The critical role of pathology in diagnosis, prognosis, and prediction demands high-quality subspecialty diagnostics that integrates information from multiple laboratories. Objective.— To identify key requirements and to establish a systematic approach to providing high-quality pathology in a health care system that is responsible for services across a large geographic area. Design.— This report focuses on the development of a multisite pathology informatics platform to support high-quality surgical pathology and hematopathology using a sophisticated laboratory information system and whole slide imaging for histology and immunohistochemistry, integrated with ancillary tools, including electron microscopy, flow cytometry, cytogenetics, and molecular diagnostics. Results.— These tools enable patients in numerous geographic locations access to a model of subspecialty pathology that allows reporting of every specimen by the right pathologist at the right time. The use of whole slide imaging for multidisciplinary case conferences enables better communication among members of patient care teams. The system encourages data collection using a discrete data synoptic reporting module, has implemented documentation of quality assurance activities, and allows workload measurement, providing examples of additional benefits that can be gained by this electronic approach to pathology. Conclusion.— This approach builds the foundation for accurate big data collection and high-quality personalized and precision medicine.

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A Practical Guide to Whole Slide Imaging: A White Paper From the Digital Pathology Association

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0343-ra ◽

2018 ◽

Vol 143 (2) ◽

pp. 222-234 ◽

Cited By ~ 54

Author(s):

Mark D. Zarella ◽

Douglas Bowman; ◽

Famke Aeffner ◽

Navid Farahani ◽

Albert Xthona; ◽

...

Keyword(s):

Practical Knowledge ◽

Digital Pathology ◽

Executive Leadership ◽

The United States ◽

White Paper ◽

Primary Diagnosis ◽

Basic Function ◽

Whole Slide Imaging ◽

Interinstitutional Collaboration ◽

Glass Slides

Context.— Whole slide imaging (WSI) represents a paradigm shift in pathology, serving as a necessary first step for a wide array of digital tools to enter the field. Its basic function is to digitize glass slides, but its impact on pathology workflows, reproducibility, dissemination of educational material, expansion of service to underprivileged areas, and intrainstitutional and interinstitutional collaboration exemplifies a significant innovative movement with far-reaching effects. Although the benefits of WSI to pathology practices, academic centers, and research institutions are many, the complexities of implementation remain an obstacle to widespread adoption. In the wake of the first regulatory clearance of WSI for primary diagnosis in the United States, some barriers to adoption have fallen. Nevertheless, implementation of WSI remains a difficult prospect for many institutions, especially those with stakeholders unfamiliar with the technologies necessary to implement a system or who cannot effectively communicate to executive leadership and sponsors the benefits of a technology that may lack clear and immediate reimbursement opportunity. Objectives.— To present an overview of WSI technology—present and future—and to demonstrate several immediate applications of WSI that support pathology practice, medical education, research, and collaboration. Data Sources.— Peer-reviewed literature was reviewed by pathologists, scientists, and technologists who have practical knowledge of and experience with WSI. Conclusions.— Implementation of WSI is a multifaceted and inherently multidisciplinary endeavor requiring contributions from pathologists, technologists, and executive leadership. Improved understanding of the current challenges to implementation, as well as the benefits and successes of the technology, can help prospective users identify the best path for success.

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Update on the current opinion, status and future development of digital pathology in Switzerland in light of COVID-19

Journal of Clinical Pathology ◽

10.1136/jclinpath-2021-207768 ◽

2021 ◽

pp. jclinpath-2021-207768

Author(s):

Viktor Hendrik Koelzer ◽

Rainer Grobholz ◽

Inti Zlobec ◽

Andrew Janowczyk

Keyword(s):

Early Stage ◽

Digital Pathology ◽

Primary Diagnosis ◽

Imaging Systems ◽

Whole Slide Imaging ◽

University Hospitals ◽

Primary Diagnostics ◽

Personal Experiences ◽

Standard Operating ◽

Analogue To Digital

AimsThe transition from analogue to digital pathology (DP) in Switzerland has coincided with the COVID-19 crisis. The Swiss Digital Pathology Consortium conducted a national survey to assess the experience of pathologists in dealing with the challenges of the pandemic and how this has influenced the outlook and adoption of DP.MethodsA survey containing 20 questions relating to DP, personal experiences and challenges during the pandemic was addressed to Swiss pathologists at different experience stages in private practice, community and university hospitals.ResultsAll 74 respondents were pathologists, with 81.1% reporting more than 5 years of diagnostic service experience. 32.5% reported having read 100 digital slides or more in a diagnostic context. 39.2% reported using whole slide imaging systems at their primary workplace. Key DP use cases before the COVID-19 lockdown were tumour boards (39.2%), education (60.8%) and research (44.6%), with DP used for primary diagnosis in 13.5%. During the COVID-19 crisis, the use of DP for primary diagnostics more than doubled (30% vs 13.5%), with internal consults as important drivers (22.5% vs 16.5%), while research use (25% vs 44.6%) and external consults (17.5% vs 41.9%) strongly decreased. Key challenges identified included a lack of established standard operating procedures and availability of specialised hardware and software.ConclusionsThis survey indicates that the crisis acted as a catalyst in promoting DP adoption in centres where basic workflows were already established while posing major technical and organisational challenges in institutions that were at an early stage of DP implementation.

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Digital Imaging and Communications in Medicine Whole Slide Imaging Connectathon at Digital Pathology Association Pathology Visions 2017

Journal of Pathology Informatics ◽

10.4103/jpi.jpi_1_18 ◽

2018 ◽

Vol 9 (1) ◽

pp. 6 ◽

Cited By ~ 16

Author(s):

Liron Pantanowitz ◽

David Clunie ◽

Dan Hosseinzadeh ◽

Mikael Wintell ◽

David De Mena ◽

...

Keyword(s):

Digital Imaging ◽

Digital Pathology ◽

Whole Slide Imaging

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Characterization of color normalization methods in digital pathology whole slide imaging

Medical Imaging 2020: Digital Pathology ◽

10.1117/12.2550585 ◽

2020 ◽

Author(s):

Dorsa Ziaei ◽

Weizhe Li ◽

Samuel Lam ◽

Wei-Chung Cheng ◽

Weijie Chen

Keyword(s):

Digital Pathology ◽

Whole Slide Imaging ◽

Normalization Methods

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Toxicologic Pathology Forum*: Opinion on Integrating Innovative Digital Pathology Tools in the Regulatory Framework

Toxicologic Pathology ◽

10.1177/0192623319827485 ◽

2019 ◽

Vol 47 (4) ◽

pp. 436-443 ◽

Cited By ~ 6

Author(s):

Béatrice E. Gauthier ◽

Frédéric Gervais ◽

Gregory Hamm ◽

Donal O’Shea ◽

Alain Piton ◽

...

Keyword(s):

Digital Pathology ◽

Whole Slide Imaging ◽

Software Validation ◽

French Society ◽

Laboratory Practice ◽

Qualitative And Quantitative ◽

Annual Congress ◽

Good Laboratory ◽

Practice Framework ◽

Opinion Article

Digital pathology is defined as the ability to examine digitized microscopic slides and to generate qualitative and quantitative data. The field of digital pathology is rapidly evolving and has the potential to revolutionize toxicologic pathology. Techniques such as automated 2-D image analysis, whole slide imaging, and telepathology are already considered “mature” technologies and have been used for decades in exploratory studies; however, many organizations are reluctant to use digital pathology in regulatory toxicology studies. Innovative technologies using digitized slides including high-content imaging modalities and artificial intelligence are still under development but are increasingly used in toxicologic pathology. While software validation requirements are already described, clear guidance for application of these rules to the digital pathology field are few and the acceptance of these technologies by regulatory authorities remains necessary for successful adoption of digital pathology into the mainstream of toxicologic pathology. This topic was discussed during a roundtable at the 2018 Annual Congress of the French Society of Toxicologic Pathology. This opinion article summarizes the discussion regarding the current questions and challenges on the integration of innovative digital pathology tools within a good laboratory practice framework and is meant to stimulate further discussion among the toxicologic pathology community. [Box: see text]

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