Digital pathology in the diagnostic setting: beyond technology into best practice and service management

Abstract

Digital pathology (DP) and whole-slide imaging (WSI) technology have matured substantially over the last few years and there is growing evidence from validation studies that WSI is comparable to glass slides for histopathology diagnosis, although with some limitations, which can be appropriately minimised. Whether the controlled environment of validation studies translates to the same level of robustness when WSI is used in the actual diagnostic setting depends on the technical quality of WSI acquisition and on factors that influence the pre-image acquisition variables including the quality of glass slide inputs, and postimage acquisition variables such as access and use of WSI. The concept of 'DP service management' is introduced to fulfil the holistic needs of a laboratory intending to use the DP solution incorporating WSI for diagnostic purposes. The DP service management team should be an integral part of the diagnostic laboratory as it plays a central role undertaking responsibility to address an extensive range of issues from technical and training to governance and accreditation, hence ensuring a viable and sustainable diagnostic DP integration and usage. The pathologist as a specialist in the field and key decision maker of histopathology diagnoses has the duty and responsibility to acquaint and familiarise with DP and WSI when using the technology, especially on their indications and limitations, so as to take full advantage of these tools to enhance diagnostic quality.

Utility of Scanning Electron Microscopy Elemental Analysis Using the ‘NanoSuit’ Correlative Light and Electron Microscopy Method in the Diagnosis of Lanthanum Phosphate Deposition in the Esophagogastroduodenal Mucosa

“…After SEM observation, re-staining with H&E enables us to store the slide. If exact original H&E images are needed, use of the digital pathology system (also called whole slide imaging system) [20], before SEM-EDS analysis, would be helpful.…”

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

“…The most significant short-term benefit is the adoption of WSI for primary diagnosis by laboratories in the United States. Those institutions that transition to using WSI for primary diagnosis will likely soon join laboratories in Canada, 9,10 Europe, 11,12 and Singapore 13,14 that have been doing this for several years. The early experience from these laboratories indicates that, with proper preparation and planning, at least 95% of cases can be reported digitally without the need to defer to glass slides.…”

“…The corollary is that review of glass slides with a light microscope will still be required in a small number of cases, as per the April 2017 FDA approval announcement. Cheng et al 14 in Singapore implemented WSI with a primary focus on the reporting of small biopsies. In addition to workflow benefits and minimizing (if not eliminating) the chance of valuable biopsy slides becoming lost or damaged, this laboratory found the implementation of WSI was associated with a need for continual service management.…”

Validation of a whole‐slide image‐based teleconsultation network

“…Regulatory issues and the high costs associated with scanning slides and storing the digital images still impede large scale introduction of ‘digital pathology’. At the same time, most pathologists now recognise the advantages of a fully digitised workflow: increased efficiency and ergonomics, better patient safety and higher quality of diagnostics …”

“…At the same time, most pathologists now recognise the advantages of a fully digitised workflow: increased efficiency and ergonomics, better patient safety and higher quality of diagnostics. [1][2][3] Remote digital revision and consultation is an important use of digital pathology and is used increasingly in the United States and a few other countries, but has not been studied widely. [4][5][6] In cases where a patient is referred from one hospital to another for further treatment, the pathology material (glass slides and possibly tissue blocks) is usually shipped by regular mail to the other hospital.…”