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

Abstract

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.

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“…We have also shown manual markup and measurement is an easy technique that can be implemented in any laboratory. While slide scanning and digital pathology are used by many departments, including our own [21,22], there is variation in use across the UK [23]. As GUSTO is recruiting from 20 UK centres with potentially varying digital pathology access, manual markup will be used in GUSTO.…”

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“… 37 Nonetheless, there are some recently published studies with a similar design as ours with telepathology FS compared to definitive diagnosis on permanent section, showing similar results in terms of overall concordance rate. Interestingly, these studies focus on other specific pathology setting such as pancreatobiliary and liver pathology 39 or lung and thoracic pathology 40 , 41 and show concordance rates ranging 92.9–96.7%. Other recent studies are focused specifically on lymph nodes assessment and show slightly higher concordance rate, but with all the issues of discrepancy concerning indeed micrometastases of breast cancer.…”

Introducing Digital Pathology in Fast-Frozen Section by Validating the Whole Slide Imaging Scanner Slideview VS200 Research Slide Scanner

“…They are on their way to total digitization (1)(2)(3)(4)(5). One area of pathology, intraoperative consultation (fast-frozen section), has the potential of becoming digitalized but this has not yet been fully investigated or well documented in the literature (6)(7)(8)(9). It has previously been shown that slides from frozen sections, can be scanned successfully and a correct diagnosis can be made from the scans (6)(7)(8)(9).…”

“…One area of pathology, intraoperative consultation (fast-frozen section), has the potential of becoming digitalized but this has not yet been fully investigated or well documented in the literature (6)(7)(8)(9). It has previously been shown that slides from frozen sections, can be scanned successfully and a correct diagnosis can be made from the scans (6)(7)(8)(9). However, only very few studies are based on glass slides where the mounting glue still is wet (wet slides) or within a time frame of minutes, which is the most realistic condition for working with fast-frozen sections in a clinical pathology setting.…”