scholarly journals Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider From the Perspective of Early Adopters

2017 ◽  
Vol 141 (7) ◽  
pp. 944-959 ◽  
Author(s):  
Andrew J. Evans ◽  
Mohamed E. Salama ◽  
Walter H. Henricks ◽  
Liron Pantanowitz
Keyword(s):  
Transition Period ◽  
Clinical Laboratory ◽  
Panel Discussion ◽  
Digital Pathology ◽  
Primary Diagnosis ◽  
Glass Slide ◽  
Whole Slide Imaging ◽  
Early Adopters ◽  
Implementation Team ◽  
Intended Use

Context.— There is growing interest in the use of digital pathology, especially whole slide imaging, for diagnostic purposes. Many issues need to be considered when incorporating this technology into a clinical laboratory. The College of American Pathologists (CAP) established a Digital Pathology Committee to support the development of CAP programs related to digital pathology. One of its many initiatives was a panel discussion entitled “Implementing Whole-Slide Imaging for Clinical Use: What to Do and What to Avoid,” given for 3 years at the CAP annual meetings starting in 2014. Objectives.— To review major issues to consider when implementing whole slide imaging for clinical purposes as covered during the panel discussion. Design.— The views expressed and recommendations given are based primarily on the personal experience of the authors as early adopters of this technology. It is not intended to be an exhaustive review of digital pathology. Results.— Implementation is best approached in phases. Early efforts are directed toward identifying initial clinical applications and assembling an implementation team. Scanner selection should be based on intended use and budget. Recognizing pathologist concerns over the use of digital pathology for diagnostic purposes, ensuring adequate training, and performing appropriate validation studies will enhance adoption. Once implemented, the transition period from glass slide to image-based diagnostics will be associated with challenges, especially those related to a hybrid glass slide–digital slide workflow. Conclusions.— With appropriate preparation, planning, and stepwise implementation, whole slide imaging can be used safely and reliably for frozen sections, consultation, quality assurance, and 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 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.

scholarly journals DeepScope: Nonintrusive Whole Slide Saliency Annotation and Prediction from Pathologists at the Microscope

2016 ◽  
Author(s):  
Andrew J. Schaumberg ◽  
S. Joseph Sirintrapun ◽  
Hikmat A. Al-Ahmadie ◽  
Peter J. Schüffler ◽  
Thomas J. Fuchs
Keyword(s):  
Large Scale ◽  
Digital Pathology ◽  
Image Data ◽  
Clinical Work ◽  
The United States ◽  
Saliency Map ◽  
Primary Diagnosis ◽  
Observation Time ◽  
Glass Slide ◽  
Treasure Chest

AbstractModern digital pathology departments have grown to produce whole-slide image data at petabyte scale, an unprecedented treasure chest for medical machine learning tasks. Unfortunately, most digital slides are not annotated at the image level, hindering large-scale application of supervised learning. Manual labeling is prohibitive, requiring pathologists with decades of training and outstanding clinical service responsibilities. This problem is further aggravated by the United States Food and Drug Administration’s ruling that primary diagnosis must come from a glass slide rather than a digital image. We present the first end-to-end framework to overcome this problem, gathering annotations in a nonintrusive manner during a pathologist’s routine clinical work: (i) microscope-specific 3D-printed commodity camera mounts are used to video record the glass-slide-based clinical diagnosis process; (ii) after routine scanning of the whole slide, the video frames are registered to the digital slide; (iii) motion and observation time are estimated to generate a spatial and temporal saliency map of the whole slide. Demonstrating the utility of these annotations, we train a convolutional neural network that detects diagnosis-relevant salient regions, then report accuracy of 85.15% in bladder and 91.40% in prostate, with 75.00% accuracy when training on prostate but predicting in bladder, despite different pathologists examining the different tissues. When training on one patient but testing on another, AUROC in bladder is 0.7929±0.1109 and in prostate is 0.9568±0.0374. Our tool is available at https://bitbucket.org/aschaumberg/deepscope.

scholarly journals US Food and Drug Administration Approval of Whole Slide Imaging for Primary Diagnosis: A Key Milestone Is Reached and New Questions Are Raised

2018 ◽  
Vol 142 (11) ◽  
pp. 1383-1387 ◽  
Author(s):  
Andrew J. Evans ◽  
Thomas W. Bauer ◽  
Marilyn M. Bui ◽  
Toby C. Cornish ◽  
Helena Duncan ◽  
...  
Keyword(s):  
United States ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
Digital Pathology ◽  
The United States ◽  
Primary Diagnosis ◽  
Clinical Applications ◽  
Whole Slide Imaging ◽  
The Us ◽  
Available Information

April 12, 2017 marked a significant day in the evolution of digital pathology in the United States, when the US Food and Drug Administration announced its approval of the Philips IntelliSite Pathology Solution for primary diagnosis in surgical pathology. Although this event is expected to facilitate more widespread adoption of whole slide imaging for clinical applications in the United States, it also raises a number of questions as to the means by which pathologists might choose to incorporate this technology into their clinical practice. This article from the College of American Pathologists Digital Pathology Committee reviews frequently asked questions on this topic and provides answers based on currently available information.

scholarly journals Predicting Opportunities and Challenges Prior to Transitioning to Digital Pathology: An Interview Envisioning Study with 11 Pathologists

2019 ◽  
Vol 8 (1) ◽  
pp. 9-12
Author(s):  
Emily S. Patterson ◽  
Lauren Mansour ◽  
Metin N. Gurcan ◽  
Zaibo Li ◽  
Anil Parwani
Keyword(s):  
Digital Libraries ◽  
Medical Center ◽  
Academic Medical Center ◽  
Digital Pathology ◽  
Structured Interview ◽  
Primary Diagnosis ◽  
Whole Slide Imaging ◽  
Implementation Challenges ◽  
Academic Medical ◽  
A Current

There is growing interest in implementing whole-slide imaging (WSI) for primary diagnosis. Ten subspecialized pathologists (2-39 years of experience) were interviewed from diverse subspecialty areas in a large academic medical center. Relevant semi-structured interview questions included image quality, workflow, and usability during clinical use. Analysis revealed that WSI implementation would raise some concerns: 1) delaying turn-around time for preliminary diagnoses as well as final reports, 2) delaying access to order ancillary tests, which could impact scheduling for some patients for follow-on surgery, 3) making it hard to track what has been reviewed and at what level of magnification, 4) potentially increase wrist pain from using a mouse or neck pain while viewing the monitor, and 5) increase vulnerability when a computer, monitor, or network goes down. However, WSI implementation would enable 1) increased flexibility for slide access remotely during nights, weekends, and work trips, 2) easier consults among peers and with mentors, 3) easier detection and recovery when images are routed to the wrong person, 4) creating digital libraries, including previous slides from a current patient, and 5) giving greater access to images for presentations, publications, and to other clinical personnel. Implementing digital slides and associated workflow will introduce many challenges and barriers. Studies such as the current one are much needed to explore the pathologist’s perspective on these workflow and implementation challenges prior to and during the installation of the digital pathology systems. These perspectives are important to understand in order to improve the experience of the pathologists and lab personnel as they interact with these systems.

scholarly journals Digital immunohistochemistry implementation, training and validation: experience and technical notes from a large clinical laboratory

2019 ◽  
Vol 72 (5) ◽  
pp. 373-378 ◽  
Author(s):  
Bethany Jill Williams ◽  
Dharshana Jayewardene ◽  
Darren Treanor
Keyword(s):  
Light Microscope ◽  
Clinical Laboratory ◽  
Digital Pathology ◽  
Glass Slide ◽  
Value Proposition ◽  
Digital Assessment ◽  
Difficult Time ◽  
Digital Microscope ◽  
Careful Assessment ◽  
Laboratory Workflow

AimsTo consider the value proposition of digitisation of clinical immunohistochemistry services, and to develop an approach to digital immunohistochemistry implementation and validation in a large clinical laboratory.MethodsA methodology for slide scanning in the laboratory was developed, in addition to a novel validation exercise, to allow pathologists to identify the strengths and weaknesses of digital immunohistochemistry reporting, and train in digital immunohistochemistry slide assessment.ResultsA total of 1480 digital immunohistochemistry slides were assessed by 24 consultant pathologists, with complete clinical concordance between the digital and the glass slide assessment observed. Certain stains were identified as being difficult/time consuming to assess using ×20 digital slides. These stains were rescanned at ×40, which improved the confidence of the pathologists to make a digital assessment. Full digitisation of immunohistochemistry slides was achieved, introducing six new steps into the pre-existing laboratory workflow.ConclusionsWhile initially encountering challenges in terms of workflow, our experience showed that a well-designed, adequately resourced and well-managed scanning process can minimise the delay in slides being made available for review. Our approach to validation highlighted the need for careful assessment of a digital pathology system and scanning protocols before pathologists are expected to transfer from the light microscope to the digital microscope for routine immunohistochemistry assessment.

scholarly journals Whole-Slide Imaging Digital Pathology as a Platform for Teleconsultation: A Pilot Study Using Paired Subspecialist Correlations

2009 ◽  
Vol 133 (12) ◽  
pp. 1949-1953 ◽  
Author(s):  
David C. Wilbur ◽  
Kalil Madi ◽  
Robert B. Colvin ◽  
Lyn M. Duncan ◽  
William C. Faquin ◽  
...  
Keyword(s):  
Digital Pathology ◽  
Glass Slide ◽  
Whole Slide Imaging ◽  
Improve Performance ◽  
Standard Glass ◽  
Digital Format ◽  
Glass Slides ◽  
Technical Issues ◽  
Fine Resolution ◽  
Whole Slide Images

Abstract Context.—Whole-slide imaging technology offers promise for rapid, Internet-based telepathology consultations between institutions. Before implementation, technical issues, pathologist adaptability, and morphologic pitfalls must be well characterized. Objective.—To determine whether interpretation of whole-slide images differed from glass-slide interpretation in difficult surgical pathology cases. Design.—Diagnostically challenging pathology slides from a variety of anatomic sites from an outside laboratory were scanned into whole digital format. Digital and glass slides were independently diagnosed by 2 subspecialty pathologists. Reference, digital, and glass-slide interpretations were compared. Operator comments on technical issues were gathered. Results.—Fifty-three case pairs were analyzed. There was agreement among digital, glass, and reference diagnoses in 45 cases (85%) and between digital and glass diagnoses in 48 (91%) cases. There were 5 digital cases (9%) discordant with both reference and glass diagnoses. Further review of each of these cases indicated an incorrect digital whole-slide interpretation. Neoplastic cases showed better correlation (93%) than did cases of nonneoplastic disease (88%). Comments on discordant cases related to digital whole technology focused on issues such as fine resolution and navigating ability at high magnification. Conclusions.—Overall concordance between digital whole-slide and standard glass-slide interpretations was good at 91%. Adjustments in technology, case selection, and technology familiarization should improve performance, making digital whole-slide review feasible for broader telepathology subspecialty consultation applications.

Digital pathology for intraoperative frozen section diagnosis of thoracic specimens: an evaluation of a system using remote sampling and whole slide imaging diagnosis

2019 ◽  
Vol 73 (8) ◽  
pp. 503-506
Author(s):  
Jon Griffin ◽  
Panagiota Kitsanta ◽  
Branko Perunovic ◽  
S Kim Suvarna ◽  
Jonathan Bury
Keyword(s):  
Critical Incident ◽  
Frozen Section ◽  
Digital Pathology ◽  
Ground Truth ◽  
Final Diagnosis ◽  
Glass Slide ◽  
Whole Slide Imaging ◽  
Digital Slide ◽  
Frozen Section Diagnosis ◽  
Service Reorganisation

BackgroundDigital pathology is now used for primary diagnostic work as well as teaching, research and consultation. In our multisite institution service reorganisation led to histopathology being located in a separate hospital from some surgical specialities. We implemented remotely supervised specimen sampling and frozen section diagnosis using digital pathology. In this study we assessed the concordance of glass and digital slide diagnosis using this system.MethodsWe reviewed cases from the first 2 years of digital frozen section reporting at our institution. Cases with potential digital to glass slide discordance were reviewed by three experienced thoracic histopathologists. The reasons for discordance were determined and common themes identified. We also reviewed critical incidents relating to digital pathology during the study period.ResultsThe study population comprised 211 cases. Frozen section to final diagnosis concordance between digital and glass slide diagnosis was found in 196 (92.6%) cases. The 15 potentially discordant cases were reviewed. Intraobserver concordance between glass and digital slide review ranged from 9/15 to 12/15 cases across the three pathologists. Glass slide review diagnosis showed better concordance with ground truth in two cases; digital slide review was more accurate in two cases. One relevant critical incident was identified during the study period.DiscussionThis is the largest study to examine digital pathology for thoracic frozen section diagnosis and shows that this is a safe and feasible alternative to glass slide diagnosis. Discordance between digital and glass slide diagnoses were unrelated to the processes of whole slide imaging and digital microscopy.

Clinical digital neuropathology: experience and observations from a departmental digital pathology training programme, validation and deployment

2020 ◽  
pp. jclinpath-2019-206343 ◽  
Author(s):  
Bethany Jill Williams ◽  
Azzam Ismail ◽  
Arundhati Chakrabarty ◽  
Darren Treanor
Keyword(s):  
Frozen Section ◽  
Digital Pathology ◽  
Ground Truth ◽  
Training Programme ◽  
Primary Diagnosis ◽  
Glass Slide ◽  
Digital Slide ◽  
Neuropathological Diagnosis ◽  
Pathology Training ◽  
Diagnostic Pitfalls

AimTo train and individually validate the neuropathologists in digital primary diagnosis and frozen section reporting using a novel protocol endorsed by the Royal College of Pathologists. The protocol allows early exposure to live digital reporting in a risk mitigated environment.MethodsTwo specialist neuropathologists completed training in the use of a digital microscopy system for primary neuropathological diagnosis and frozen section assessment. Participants were exposed to training sets of 20 histology cases and 10 frozen sections designed to help them identify their personal digital diagnostic pitfalls. Following this, the pathologists viewed 340 live, complete neuropathology cases. All primary diagnoses were made on digital slides with immediate glass slide reconciliation before final case sign-out.ResultsThere was 100% clinical concordance between the digital slide and glass slide assessment of frozen section cases for each pathologist, and these assessments corresponded with the ground truth diagnoses obtained from examination of definitive histology. For primary diagnosis, there was complete clinical concordance between digital slide and glass slide diagnosis in 98.1% of cases. The majority of discordances were related to grading differences attributable to mitotic count differences.ConclusionNeuropathologists can develop the ability to make primary digital diagnosis competently and confidently following a course of individual training and validation.

scholarly journals Validating Whole Slide Imaging Systems for Diagnostic Purposes in Pathology: Guideline Update From the College of American Pathologists in Collaboration With the American Society for Clinical Pathology and the Association for Pathology Informatics

2021 ◽  
Author(s):  
Andrew J. Evans ◽  
Richard W. Brown ◽  
Marilyn M. Bui ◽  
Elizabeth A. Chlipala ◽  
Christina Lacchetti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Expert Panel ◽  
Good Practice ◽  
Digital Pathology ◽  
Clinical Pathology ◽  
Glass Slide ◽  
Whole Slide Imaging ◽  
Assessment Development ◽  
Evaluation Approach ◽  
Diagnostic Concordance

Context.— The original guideline, “Validating Whole Slide Imaging for Diagnostic Purposes in Pathology,” was published in 2013 and included 12 guideline statements. The College of American Pathologists convened an expert panel to update the guideline following standards established by the National Academies of Medicine for developing trustworthy clinical practice guidelines. Objective.— To assess evidence published since the release of the original guideline and provide updated recommendations for validating whole slide imaging (WSI) systems used for diagnostic purposes. Design.— An expert panel performed a systematic review of the literature. Frozen sections, anatomic pathology specimens (biopsies, curettings, and resections), and hematopathology cases were included. Cytology cases were excluded. Using the Grading of Recommendations Assessment, Development, and Evaluation approach, the panel reassessed and updated the original guideline recommendations. Results.— Three strong recommendations and 9 good practice statements are offered to assist laboratories with validating WSI digital pathology systems. Conclusions.— Systematic review of literature following release of the 2013 guideline reaffirms the use of a validation set of at least 60 cases, establishing intraobserver diagnostic concordance between WSI and glass slides and the use of a 2-week washout period between modalities. Although all discordances between WSI and glass slide diagnoses discovered during validation need to be reconciled, laboratories should be particularly concerned if their overall WSI–glass slide concordance is less than 95%.

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