Rapid Validation of Telepathology by an Academic Neuropathology Practice During the COVID-19 Pandemic

Abstract

Context: The coronavirus disease 19 (COVID-19) pandemic is placing unparalleled burdens on regional and institutional resources in medical facilities across the globe. This disruption is causing unprecedented downstream effects to traditionally established channels of patient care delivery, including those of essential anatomic pathology services. With Washington state being the initial North American COVID-19 epicenter, the University of Washington in Seattle has been at the forefront of conceptualizing and implementing innovative solutions in order to provide uninterrupted quality patient care amidst this growing crisis. Objective: To conduct a rapid validation study assessing our ability to reliably provide diagnostic Neuropathology services via a whole slide imaging (WSI) platform as part of our departmental COVID-19 planning response. Design: This retrospective study assessed diagnostic concordance of neuropathological diagnoses rendered via WSI as compared to those originally established via traditional histopathology in a cohort of 30 cases encompassing a broad range of neurosurgical and neuromuscular entities. This study included the digitalization of 93 slide preparations, which were independently examined by groups of board-certified neuropathologists and neuropathology fellows. Results: There were no major or minor diagnostic discrepancies identified in either the attending neuropathologist or neuropathology trainee groups for either the neurosurgical or neuromuscular case cohorts. Conclusions: Our study demonstrates that accuracy of neuropathological diagnoses and interpretation of ancillary preparations via WSI are not inferior to those generated via traditional microscopy. This study provides a framework for rapid subspecialty validation and deployment of WSI for diagnostic purposes during a pandemic event.

Operational Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic and Early Recovery Trends: University of Washington Anatomic Pathology Experience

“…5 Lastly, in roughly three weeks UW neuropathology conducted and published a rapid validation study aimed at deploying whole slide imaging (WSI) technology for issuing diagnoses at a departmental level as part of our regional COVID-19 response. 3 This minimal resource utilization study was conducted during a time period of relaxed Centers for Medicare and Medicaid Services (CMS) and US Food and Drug Administration (FDA) enforcement of policies regulating remote review of pathology slides. 3 COVID-19 has provided an opportunity for us to retrospectively analyze the impact of a major pandemic on healthcare delivery in anatomic pathology.…”

“…3 This minimal resource utilization study was conducted during a time period of relaxed Centers for Medicare and Medicaid Services (CMS) and US Food and Drug Administration (FDA) enforcement of policies regulating remote review of pathology slides. 3 COVID-19 has provided an opportunity for us to retrospectively analyze the impact of a major pandemic on healthcare delivery in anatomic pathology. Our analysis reveals how necessary governmental and institutional regulations can impact operations, and provides insight into proactive strategies to address that may be of value in resource planning and management.…”

“…1,2 University of Washington (UW) Medicine Anatomic Pathology (AP) in Seattle, WA, was one of the first AP departments to face the effects of the SARS-CoV-2 pandemic within the United States, reflected in rapid service responses to virusassociated autopsies, telepathology services, and both resident and medical student training. 3,4,5 UW Medicine is a major metropolitan hospital system serving the area within and surrounding Seattle, Washington, consisting of four hospitals and several community clinics. It is also a main referral center for Washington State and the Northwestern United States.…”

Loss of fidelity in scanned digital images compared to glass slides of brain tumors resected using cavitron ultrasonic surgical aspirator

“…A few studies evaluating WSI in diagnostic neuropathology have raised concerns such as loss of nuclear detail (8), but the main focus has been on diagnostic accuracy (9,10) and none have commented on scan fidelity. We evaluated a single WSI platform and the vast majority of our cases were gliomas; these results may not be representative of all platforms and neoplasms.…”

Laboratory Medicine and Pathology Education During the COVID-19 Pandemic—Lessons Learned

“… 9 , 10 Advances being made in digital pathology (eg, whole slide imaging) have been noted to be especially useful in the context of a need for physical distancing. 11 , 12 Mukhopadhyay et al have compiled curated lists of online resources that can be used for virtual learning in pathology. 13 …”