scholarly journals A Survival Guide for the Rapid Transition to a Fully Digital Workflow: The “Caltagirone Example”

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1916
Author(s):  
Filippo Fraggetta ◽  
Alessandro Caputo ◽  
Rosa Guglielmino ◽  
Maria Giovanna Pellegrino ◽  
Giampaolo Runza ◽  
...  
Keyword(s):  
Digital Pathology ◽  
Primary Diagnosis ◽  
Pathology Laboratory ◽  
Digital Workflow ◽  
Pathology Department ◽  
Health Level 7 ◽  
2D Barcode ◽  
Glass Slides ◽  
Rapid Transition ◽  
Routine Assessment

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.

scholarly journals Best Practice Recommendations for the Implementation of a Digital Pathology Workflow in the Anatomic Pathology Laboratory by the European Society of Digital and Integrative Pathology (ESDIP)

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2167
Author(s):  
Filippo Fraggetta ◽  
Vincenzo L’Imperio ◽  
David Ameisen ◽  
Rita Carvalho ◽  
Sabine Leh ◽  
...  
Keyword(s):  
European Society ◽  
Best Practice ◽  
Digital Pathology ◽  
Primary Diagnosis ◽  
Real World Data ◽  
Pathology Laboratory ◽  
Digital Workflow ◽  
Anatomic Pathology ◽  
Fda Approval ◽  
Slide Image

The interest in implementing digital pathology (DP) workflows to obtain whole slide image (WSI) files for diagnostic purposes has increased in the last few years. The increasing performance of technical components and the Food and Drug Administration (FDA) approval of systems for primary diagnosis led to increased interest in applying DP workflows. However, despite this revolutionary transition, real world data suggest that a fully digital approach to the histological workflow has been implemented in only a minority of pathology laboratories. The objective of this study is to facilitate the implementation of DP workflows in pathology laboratories, helping those involved in this process of transformation to identify: a) the scope and the boundaries of the DP transformation; b) how to introduce automation to reduce errors; c) how to introduce appropriate quality control to guarantee the safety of the process and d) the hardware and software needed to implement DP systems inside the pathology laboratory. The European Society of Digital and Integrative Pathology (ESDIP) provided consensus-based recommendations developed through discussion among members of the Scientific Committee. The recommendations are thus based on the expertise of the panel members and on the agreement obtained after virtual meetings. Prior to publication, the recommendations were reviewed by members of the ESDIP Board. The recommendations comprehensively cover every step of the implementation of the digital workflow in the anatomic pathology department, emphasizing the importance of interoperability, automation and tracking of the entire process before the introduction of a scanning facility. Compared to the available national and international guidelines, the present document represents a practical, handy reference for the correct implementation of the digital workflow in Europe.

scholarly journals A Digital Pathology Solution to Resolve the Tissue Floater Conundrum

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.

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

2018 ◽  
Vol 143 (2) ◽  
pp. 222-234 ◽  
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.

scholarly journals Digital Pathology Workflow Implementation at IPATIMUP

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2111
Author(s):  
Catarina Eloy ◽  
João Vale ◽  
Mónica Curado ◽  
António Polónia ◽  
Sofia Campelos ◽  
...  
Keyword(s):  
Digital Pathology ◽  
Digital Transformation ◽  
Careful Planning ◽  
Pathology Laboratory ◽  
Digital Workflow ◽  
Processing Pipeline ◽  
Time Space ◽  
Sample Management

The advantages of the digital methodology are well known. In this paper, we provide a detailed description of the process for the digital transformation of the pathology laboratory at IPATIMUP, the major modifications that operate throughout the processing pipeline, and the advantages of its implementation. The model of digital workflow implementation at IPATIMUP demonstrates that careful planning and adoption of simple measures related to time, space, and sample management can be adopted by any pathology laboratory to achieve higher quality and easy digital transformation.

scholarly journals Digital Whole Slide Imaging Compared With Light Microscopy for Primary Diagnosis in Surgical Pathology

2020 ◽  
Vol 144 (10) ◽  
pp. 1245-1253 ◽  
Author(s):  
Alexander D. Borowsky ◽  
Eric F. Glassy ◽  
William Dean Wallace ◽  
Nathash S. Kallichanda ◽  
Cynthia A. Behling ◽  
...  
Keyword(s):  
Digital Pathology ◽  
Diagnostic Category ◽  
Primary Diagnosis ◽  
Current Standard ◽  
Diagnostic Categories ◽  
Standard Glass ◽  
Specific Subset ◽  
Glass Slides ◽  
Major Discrepancy ◽  
Whole Slide Images

Context.— The adoption of digital capture of pathology slides as whole slide images (WSI) for educational and research applications has proven utility. Objective.— To compare pathologists' primary diagnoses derived from WSI versus the standard microscope. Because WSIs differ in format and method of observation compared with the current standard glass slide microscopy, this study is critical to potential clinical adoption of digital pathology. Design.— The study enrolled a total of 2045 cases enriched for more difficult diagnostic categories and represented as 5849 slides were curated and provided for diagnosis by a team of 19 reading pathologists separately as WSI or as glass slides viewed by light microscope. Cases were reviewed by each pathologist in both modalities in randomized order with a minimum 31-day washout between modality reads for each case. Each diagnosis was compared with the original clinical reference diagnosis by an independent central adjudication review. Results.— The overall major discrepancy rates were 3.64% for WSI review and 3.20% for manual slide review diagnosis methods, a difference of 0.44% (95% CI, −0.15 to 1.03). The time to review a case averaged 5.20 minutes for WSI and 4.95 minutes for glass slides. There was no specific subset of diagnostic category that showed higher rates of modality-specific discrepancy, though some categories showed greater discrepancy than others in both modalities. Conclusions.— WSIs are noninferior to traditional glass slides for primary diagnosis in anatomic pathology.

scholarly journals Complete Digital Pathology for Routine Histopathology Diagnosis in a Multicenter Hospital Network

2019 ◽  
Vol 144 (2) ◽  
pp. 221-228 ◽  
Author(s):  
Juan Antonio Retamero ◽  
Jose Aneiros-Fernandez ◽  
Raimundo G. del Moral
Keyword(s):  
Management System ◽  
Digital Pathology ◽  
Primary Diagnosis ◽  
Computer Assisted ◽  
Image Management ◽  
University Hospitals ◽  
Implementation Phase ◽  
Sample Tracking ◽  
Glass Slides ◽  
Image Management System

Context.— Complete digital pathology and whole slide imaging for routine histopathology diagnosis is currently in use in few laboratories worldwide. Granada University Hospitals, Spain, which comprises 4 hospitals, adopted full digital pathology for primary histopathology diagnosis in 2016. Objective.— To describe the methodology adopted and the resulting experience at Granada University Hospitals in transitioning to full digital diagnosis. Design.— All histopathology glass slides generated for routine diagnosis were digitized at ×40 using the Philips IntelliSite Pathology Solution, which includes an ultrafast scanner and an image management system. All hematoxylin-eosin–stained preparations and immunohistochemistry and histochemistry slides were digitized. The existing sample-tracking software and image management system were integrated to allow data interchange through the Health Level 7 protocol. Results.— Circa 160 000 specimens have been signed out using digital pathology for primary diagnosis. This comprises more than 800 000 digitized glass slides. The scanning error rate during the implementation phase was below 1.5%, and subsequent workflow optimization rendered this rate negligible. Since implementation, Granada University Hospitals pathologists have signed out 21% more cases per year on average. Conclusions.— Digital pathology is an adequate medium for primary histopathology diagnosis. Successful digitization relies on existing sample tracking and integration of the information technology infrastructure. Rapid and reliable scanning at ×40 equivalent was key to the transition to a fully digital workflow. Digital pathology resulted in efficiency gains in the preanalytical and analytical phases, and created the basis for computational pathology: the use of computer-assisted tools to aid diagnosis.

Clinical Examination and Validation of Primary Diagnosis in Anatomic Pathology Using Whole Slide Digital Images

2011 ◽  
Vol 135 (3) ◽  
pp. 372-378
Author(s):  
Drazen M Jukić ◽  
Laura M Drogowski ◽  
Jamie Martina ◽  
Anil V Parwani
Keyword(s):  
Clinical Examination ◽  
Digital Images ◽  
Digital Pathology ◽  
Primary Diagnosis ◽  
Anatomic Pathology ◽  
Glass Slides ◽  
Diagnostic Certainty ◽  
Low Rate ◽  
Diagnostic Consistency

Abstract Context.—Novel anatomic pathology technologies allow pathologists to digitally view and diagnose cases. Although digital pathology advocates champion its strengths and move to integrate it into practice and workflow, the capabilities and limitations of digital slides have not been fully investigated. Objectives.—To estimate intrapathologist diagnostic discrepancy between glass and digital slides and to determine pathologists' diagnostic certainty when diagnosing with the 2 formats. Design.—Intrapathologist diagnostic consistency between glass and digital slides was measured. Three pathologists diagnosed 101 cases digitally and with corresponding glass slides. Discrepancies between formats were evaluated, and diagnostic precision and certainty were compared. Results.—A total of 606 diagnoses were evaluated in pairs (202 per pathologist). Seven cases did not transfer to the database and were eliminated from further study. We report no discrepancies between media in 75%, 87%, and 83% of the cases diagnosed by the 3 pathologists, respectively; significant discrepancies were identified in 3%, 3%, and 7% of cases by each pathologist. In total, we identified significant clinical and therapeutic discrepancies in 13 of 296 cases (4.4%). The certainty values provided by each pathologist were similar between formats. Conclusions.—This study did not detect significant differences between diagnoses based on digital and glass slides. We believe that this study further supports the integration of digital slides into pathology workflow, particularly considering the low rate of discrepancy documented here.

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

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.

Detection of Helicobacter pylori in virtual slides requires high resolution digitalisation

2021 ◽  
pp. jclinpath-2020-207378
Author(s):  
Arnaud Uguen
Keyword(s):  
Helicobacter Pylori ◽  
High Resolution ◽  
Digital Pathology ◽  
Histopathological Analysis ◽  
Histopathological Diagnosis ◽  
Low Resolution ◽  
Glass Slides ◽  
Sydney System ◽  
Kappa Value ◽  
Gastric Biopsies

To diagnose Helicobacter pylori (HP) infection and its related mucosal injuries requires the histopathological analysis of gastric biopsies. The move from glass slides interpretation towards digital pathology implies technical choices to maintain the performances of histopathological diagnosis. The intra-rater agreement in assessing gastritis diagnostic criteria between glass slides, low resolution and high resolution digital slides in the subject of the present study. One hundred gastric biopsies were re-assessed by a single digestive pathologist on glass slides and digitalised slides at low resolution (ie, x20 magnification and single focus without z-stack) and high resolution (ie, x40 magnification with seven focus levels and z-stack) about the criteria of the updated Sydney system and the detection of HP. Inter-analyses agreement were very good (Kappa values>0.81) for every criteria but slightly inferior (ie, Kappa values<0.9) comparing glass slides interpretations with low resolution digital slides-based ones. Indeed, some HP infections were misdiagnosed using x20 magnification histochemical stained digitalised slides (p<0.05). At the opposite, anti-HP immunohistochemistry slides and/or x40 magnification digitalisation permitted to maintain almost perfect concordance in diagnosis (Kappa value>0.9). As mentioned in current guidelines, a high resolution x40 magnification digitalisation must be favoured in order to avoid some misdetection of microorganisms as HP.

Cutting Injuries in an Academic Pathology Department

2005 ◽  
Vol 129 (8) ◽  
pp. 1022-1026
Author(s):  
Bobbi S. Pritt ◽  
Brenda L. Waters
Keyword(s):  
Lymph Nodes ◽  
Mechanism Of Injury ◽  
Pathology Laboratory ◽  
Surgical Specimen ◽  
Pathology Department ◽  
Hospital Report ◽  
Time Period ◽  
Sufficient Detail ◽  
Needle Stick Injuries ◽  
Attending Physicians

Abstract Context.—Cutting injuries pose an infrequent but serious threat to anatomic pathology personnel. Although cut-resistant gloves may reduce this danger, it is imperative to recognize specific behaviors that increase the chance of an injury. Objective.—To examine the incidence of cutting injuries in an academic pathology department and the mechanisms by which such injuries occurred. Design.—Hospital Report of Event forms completed for laboratory incidents of cutting injury from March 1998 to September 2003 were evaluated. Further information regarding the incidents was obtained, when possible, by interviews with those personnel involved. Setting.—A university-based pathology laboratory was the setting for this study. On average, 505 autopsies and 29 000 surgical specimens were processed each year during the 5.5-year time period. Participants.—Pathology attending physicians, residents, dieners, and pathologists' assistants who performed autopsies and surgical specimen examinations. Results.—Eight scalpel injuries occurred during the study period. No needle-stick injuries were reported. Searching for lymph nodes and cutting firm tissue each accounted for 3 of the injuries. Only 2 of the 8 individuals were in compliance with the departmental policy regarding protective glove wear. Hospital Report of Event forms alone failed to elicit sufficient detail regarding the mechanism of injury. Conclusions.—A laboratory-based form may be necessary to supplement the hospital form, so as to obtain full details of each injury. This information may then be disseminated to all who handle blades, with the goal of preventing future cutting injuries.

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