Digital pathology in the time of corona

Stathonikos, Nikolas; Varsseveld, Nadege C van; Vink, Aryan; Dijk, Marijke R. van; Nguyen, Tri Q.; Leng, Wendy W.J. de; Goldschmeding, Roel; Vreuls, Celien P.H.; Diest, Paul J. van

doi:10.1136/jclinpath-2020-206845

Cited by 25 publications

(25 citation statements)

References 17 publications

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“…Starting in calendar week 13 in 2020, all hospitals were asked to postpone all elective procedures to keep ICUs free for COVID-19 patients and minimize the risk of transmission to patients within the hospital. This was reflected in a 12% reduction in pathology specimens received at our center compared with the same time in previous years (data not shown), which has also been reported previously (Stathonikos, et al, 2020). Besides, the surgical staff was reduced to minimize potential exposure to infection, and many patients were also reluctant to seek medical attention during this time (Dinmohamed, et al, 2020).…”

Section: Limitationssupporting

confidence: 87%

SARS-CoV-2 RNA screening in routine pathology specimens

Stillfried

Villwock

Djudjaj

et al. 2021

Preprint

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SummaryVirus detection methods are important to cope with the SARS-CoV-2 pandemics. Apart from the lung, SARS-CoV-2 was detected in multiple organs in severe cases. Less is known on organ tropism in patients developing mild or no symptoms, and some of such patients might be missed in symptom-indicated swab testing.Here we tested and validated several approaches and selected the most reliable RT-PCR protocol for the detection of SARS-CoV-2 RNA in patients’ routine diagnostic formalin-fixed and paraffin-embedded (FFPE) specimens available in pathology, to assess a) organ tropism in samples from COVID-19-positive patients, b) unrecognized cases in selected tissues from negative or not-tested patients during a pandemic peak, and c) retrospectively, pre-pandemic lung samples.We identified SARS-CoV-2 RNA in four samples from confirmed COVID-19 patients, in two gastric biopsies, one colon resection, and one pleural effusion specimen, while all other specimens, particularly from patients with mild COVID-19 disease course, were negative. In the pandemic peak cohort, we identified one previously unrecognized COVID-19 case in tonsillectomy samples. All pre-pandemic lung samples were negative.In conclusion, SARS-CoV-2 RNA detection in FFPE pathology specimens can potentially improve surveillance of COVID-19, allow retrospective studies, and advance our understanding of SARS-CoV-2 organ tropism and effects.

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Section: Limitationssupporting

confidence: 87%

SARS-CoV-2 RNA screening in routine pathology specimens

Stillfried

Villwock

Djudjaj

et al. 2021

Preprint

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“…The utility of digital techniques has been highlighted in unique ways during the recent COVID-19 pandemic, as remote work and other adaptations have been permitted; it is likely that digital pathology, AI, and other techniques will help to address future threats to clinical services, research, and education. [99][100][101][102][103] We highlight transplant renal pathology as an area of particular interest for these techniques; however, it is likely that they will be extended to essentially all pathology subspecialties to at least some degree. Regulatory hurdles may need to be overcome for widespread application of AI algorithms, addressing consensus recommendations and legal concerns (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Computational techniques are likely to be more widely used in the future, as shown by our search of the literature, which showed an increase in the number of citations in recent years (Table 1; Figures 1 and 2). The utility of digital techniques has been highlighted in unique ways during the recent COVID‐19 pandemic, as remote work and other adaptations have been permitted; it is likely that digital pathology, AI, and other techniques will help to address future threats to clinical services, research, and education 99–103 . We highlight transplant renal pathology as an area of particular interest for these techniques; however, it is likely that they will be extended to essentially all pathology subspecialties to at least some degree.…”

Section: Discussionmentioning

confidence: 99%

Artificial intelligence and algorithmic computational pathology: an introduction with renal allograft examples

Farris¹,

Vizcarra

Amgad

et al. 2021

Histopathology

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Artificial intelligence and algorithmic computational pathology: an introduction with renal allograft examplesWhole slide imaging, which is an important technique in the field of digital pathology, has recently been the subject of increased interest and avenues for utilisation, and with more widespread whole slide image (WSI) utilisation, there will also be increased interest in and implementation of image analysis (IA) techniques. IA includes artificial intelligence (AI) and targeted or hypothesis-driven algorithms. In the overall pathology field, the number of citations related to these topics has increased in recent years. Renal pathology is one anatomical pathology subspecialty that has utilised WSIs and IA algorithms; it can be argued that renal transplant pathology could be particularly suited for whole slide imaging and IA, as renal transplant pathology is frequently classified by use of the semiquantitative Banff classification of renal allograft pathology. Hypothesis-driven/targeted algorithms have been used in the past for the assessment of a variety of features in the kidney (e.g. interstitial fibrosis, tubular atrophy, inflammation); in recent years, the amount of research has particularly increased in the area of AI/machine learning for the identification of glomeruli, for histological segmentation, and for other applications. Deep learning is the form of machine learning that is most often used for such AI approaches to the 'big data' of pathology WSIs, and deep learning methods such as artificial neural networks (ANNs)/convolutional neural networks (CNNs) are utilised. Unsupervised and supervised AI algorithms can be employed to accomplish image or semantic classification. In this review, AI and other IA algorithms applied to WSIs are discussed, and examples from renal pathology are covered, with an emphasis on renal transplant pathology.

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“…Up to the best of our knowledge, there is no published literature reporting the influence of COVID-19 related measures on the level of service in pathology laboratories in terms of numbers of specimens dealt with during pandemic lockdowns. However, Stathonikos et al wrote a comprehensive review on their modified way of working in their laboratory during the COVID-19 pandemic; where they adopted a way somehow similar to ours, in adapting to the pandemic restrictions [ 19 ]. They reduced the number of on-the-premises staff team present in the laboratory to the minimum each working day.…”

Section: Discussionmentioning

confidence: 99%

“…They noticed a reduced emergency department volume and decreased residents' clinical exposure and advised to adjust the training programs and utilize ancillary methods of learning to ensure adequate training [ 20 ]. In pathology, Stathonikos et al discussed in their review some measures that they followed to improve this, including utilization of digital pathology in training [ 19 ]. We have adopted several strategies to compensate for this shortcoming by asking the residents to review archived interesting cases, slide collections and ‘black box’ cases, and to register in the different virtual pathology activities taking place during that time.…”

Section: Discussionmentioning

confidence: 99%

Cellular pathology practice in the era of COVID-19 pandemic-related lockdowns - Experience from a tertiary hospital: A retrospective observational study

Alorjani

Matalka

Baker

et al. 2021

Annals of Medicine &Amp; Surgery

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Background The COVID-19 pandemic had many implications on healthcare services, including cellular pathology. The pandemic-related lockdown was applied in Jordan from March to May 2020. King Abdullah University Hospital (KAUH) was chosen to provide care for COVID-19 patients during that period. Since there was no experience in dealing with COVID-19 patients, the hospital maintained some essential services but canceled elective surgeries and procedures. The rationale was to prioritize care for COVID-19 patients and to provide better adherence to infection control policies and protect non-infected patients and healthcare workers. The purpose of the present study is to investigate the impact of COVID-19 pandemic restrictions on cellular pathology practice patterns at KAUH. Methods This is a retrospective observational study conducted at KAUH. All cellular pathology reports during the 2020 national lockdown were retrieved. The total numbers of specimens including types and procedures were recorded. Data were compared with the corresponding data in 2019 when there was no pandemic and when hospital and laboratory services were run in full capacity. Results 2020 lockdown period showed a 57.9% reduction in the total number of specimens received at the cellular pathology laboratory as compared to the corresponding period of 2019 (1400 versus 3322). Emergency procedures have represented 99.1% of the service during the lockdown with a remarkable diversity shift. Conclusion There was a significant drop in the number of specimens dealt with at KAUH cellular pathology laboratory during the COVID-19 pandemic-related national lockdown. We learned from this pandemic how to adapt to such circumstances by adjusting our way of working to reach the best level of staff safety while maintaining highly productive work. Implementing digital pathology platforms, working from home strategies and alternative training methodologies have emerged as an essential need.

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Digital pathology in the time of corona

Cited by 25 publications

References 17 publications

SARS-CoV-2 RNA screening in routine pathology specimens

SARS-CoV-2 RNA screening in routine pathology specimens

Artificial intelligence and algorithmic computational pathology: an introduction with renal allograft examples

Cellular pathology practice in the era of COVID-19 pandemic-related lockdowns - Experience from a tertiary hospital: A retrospective observational study

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