ABSTRACT
Growing evidence supports the critical role of tumour microenvironment (TME) in tumour progression, metastases, and treatment response. However, the in-situ interplay among various TME components, particularly between immune and tumour cells, are largely unknown, hindering our understanding of how tumour progresses and responds to treatment. While mainstream single-cell omics techniques allow deep, single-cell phenotyping, they lack crucial spatial information for in-situ cell-cell interaction analysis. On the other hand, tissue-based approaches such as hematoxylin and eosin and chromogenic immunohistochemistry staining can preserve the spatial information of TME components but are limited by their low-content staining. High-content spatial profiling technologies, termed spatial omics, have greatly advanced in the past decades to overcome these limitations. These technologies continue to emerge to include more molecular features (RNAs and/or proteins) and to enhance spatial resolution, opening new opportunities for discovering novel biological knowledge, biomarkers, and therapeutic targets. These advancements also spur the need for novel computational methods to mine useful TME insights from the increasing data complexity confounded by high molecular features and spatial resolution. In this review, we present state-of-the-art spatial omics technologies, their applications, major strengths, and limitations as well as the role of artificial intelligence (AI) in TME studies.
ABSTRACT
This article is an overview of digital pathology (DP) and its myriad applications. In addition, the trajectory of DP in India, with its successes, limitations and barriers is described. Covid pandemic provided new impetus to development and adoption of DP worldwide and India was no exception. With growing interest in Artificial Intelligence based algorithms for diagnosis and abilities to prognosticate and predict, the field of DP continues to evolve relentlessly to provide a new dimension to precision oncology.
ABSTRACT
Digital pathology has gone through considerable technical advances during the past few years and certain aspects of digital diagnostics have been widely and swiftly adopted in many centers, catalyzed by the COVID-19 pandemic. However, analysis of requirements, careful planning, and structured implementation should to be considered in order to reap the full benefits of a digital workflow. The aim of this review is to provide a practical, concise and hands-on summary of issues relevant to implementing and developing digital diagnostics in the pathology laboratory. These include important initial considerations, possible approaches to overcome common challenges, potential diagnostic pitfalls, validation and regulatory issues and an introduction to the emerging field of image analysis in routine.
ABSTRACT
The COVID-19 pandemic has acted as a powerful change driver in the field of pathology and has had relevant consequences on the practice of cytopathology, in terms of changes in workload, rates of malignancy, and the performance of cytology. At the same time, regulatory authorities have relaxed their requirements for the deployment of digital pathology for remote diagnostic reporting. However, most of these improvements have concerned digital histopathology. Data from a literature search show that experiences in digital cytopathology during the pandemic have concerned mainly educational and academic activities. From a broader point of view, when searching for all published literature on digital pathology, only a minority of papers deal with cytopathology, but a noticeable increase in publications has been seen in the last 10 years, with an upward trend toward a maximum of papers in 2021. Indeed, the pandemic has led to greater awareness of the possibility of digital for cytopathology as well.
ABSTRACT
BACKGROUND: The usage of whole-slide images has recently been gaining a foothold in medical education, training, and diagnosis. OBJECTIVES: The first objective of the current study was to compare academic performance on virtual microscopy (VM) and light microscopy (LM) for learning pathology, anatomy, and histology in medical and dental students during the COVID-19 period. The second objective was to gather insight into various applications and usage of such technology for medical education. MATERIALS AND METHODS: Using the keywords "virtual microscopy" or "light microscopy" or "digital microscopy" and "medical" and "dental" students, databases (PubMed, Embase, Scopus, Cochrane, CINAHL, and Google Scholar) were searched. Hand searching and snowballing were also employed for article searching. After extracting the relevant data based on inclusion and execution criteria, the qualitative data were used for the systematic review and quantitative data were used for meta-analysis. The Newcastle Ottawa Scale (NOS) scale was used to assess the quality of the included studies. Additionally, we registered our systematic review protocol in the prospective register of systematic reviews (PROSPERO) with registration number CRD42020205583. RESULTS: A total of 39 studies met the criteria to be included in the systematic review. Overall, results indicated a preference for this technology and better academic scores. Qualitative analyses reported improved academic scores, ease of use, and enhanced collaboration amongst students as the top advantages, whereas technical issues were a disadvantage. The performance comparison of virtual versus light microscopy meta-analysis included 19 studies. Most (10/39) studies were from medical universities in the USA. VM was mainly used for teaching pathology courses (25/39) at medical schools (30/39). Dental schools (10/39) have also reported using VM for teaching microscopy. The COVID-19 pandemic was responsible for the transition to VM use in 17/39 studies. The pooled effect size of 19 studies significantly demonstrated higher exam performance (SMD: 1.36 [95% CI: 0.75, 1.96], p < 0.001) among the students who used VM for their learning. Students in the VM group demonstrated significantly higher exam performance than LM in pathology (SMD: 0.85 [95% CI: 0.26, 1.44], p < 0.01) and histopathology (SMD: 1.25 [95% CI: 0.71, 1.78], p < 0.001). For histology (SMD: 1.67 [95% CI: -0.05, 3.40], p = 0.06), the result was insignificant. The overall analysis of 15 studies assessing exam performance showed significantly higher performance for both medical (SMD: 1.42 [95% CI: 0.59, 2.25], p < 0.001) and dental students (SMD: 0.58 [95% CI: 0.58, 0.79], p < 0.001). CONCLUSIONS: The results of qualitative and quantitative analyses show that VM technology and digitization of glass slides enhance the teaching and learning of microscopic aspects of disease. Additionally, the COVID-19 global health crisis has produced many challenges to overcome from a macroscopic to microscopic scale, for which modern virtual technology is the solution. Therefore, medical educators worldwide should incorporate newer teaching technologies in the curriculum for the success of the coming generation of health-care professionals.
ABSTRACT
Whole-slide images (WSI) are the basis for the application of artificial intelligence/machine learning and other informatics methods to histological diagnosis and will further blur the line separating anatomic and clinical pathology. FDA classified WSI systems for primary diagnosis as class III (highest risk) medical devices until 2017. This discouraged anatomic pathology laboratories at risk-averse domestic institutions like mine from investing in these digital pathology (DP) platforms. In 2017, FDA downgraded WSI to class II (moderate risk) when they de-novo approved a system marketed by Philips. We were not interested in that system at my institution, but the downgrade caused us to reset our perception of the risk of validating a RUO system for primary diagnosis. Cost remained a barrier. In April 2020, FDA issued temporary guidance stating they would not enforce premarket approval of WSI systems to facilitate pathologists working remotely during the SARS-CoV-2 pandemic. The guidance included a statement that laboratories and hospitals consider performing a validation study. In January 2021, FDA proposed making the temporary non-enforcement guidance permanent. So, in a little more than three years, WSI for primary diagnosis had gone from class III to exempted from pre-market approval! This nicely aligned the approval framework for WSI with the approval framework for our conventional optical microscopes, which are statutorily exempted from approval, and further reset our perception of risk. In April 2021, FDA withdrew the proposal to make non-enforcement permanent, but the temporary non-enforcement guidance is still in effect at the time of writing. Amid all this FDA activity, the College of American Pathologists updated and reissued their consensus guidelines for validating WSI systems for diagnostic purposes in March 2021. The narrative mentions the FDA's recent approval of a few WSI systems and anticipates more, but the expert panel recommendations do not include any related to the approval status of systems. The reissue of this document reminded us that, as clinical laboratorians, we are capable of safely validating WSI as a laboratory-developed test and are supported in doing so by consensus guidelines from one of our leading professional organizations. In early 2021 we committed to funding a DP initiative to make WSI part of our routine histological process for 10% of our anatomic pathology cases. The initial capital investment is $1.5M. When realized, the microscope slides for designated pathology services will be transported directly from the cover slipper to a slide scanner and electronically distributed to pathologists using a clinical-grade image management system that we share with our radiology department. We made the decision to fund this in the context of the regulatory (decreased perception of risk), sociological (demand for remote telepathology), and technological (availability of scalable WSI systems) changes that occurred during the pandemic.
ABSTRACT
Background In-person pathologist trainings during the COVID- 19 pandemic became impossible, necessitating a shift to remote-digital whole slide image (WSI) training. High concordance between WSI and glass slide scores from the same specimens stained with PD-L1 IHC 22C3 pharmDx (SK006) across multiple tumor indications supported the validity of digital training.1 However, in-person microscope (glass-slide) training versus remote-digital (WSI) training effectiveness must be assessed. Collated testing data on specimens (SK006 stained) spanning multiple indications scored by external pathologists during Agilent led training and testing (T&T) sessions via glass slides were compared to sessions utilizing WSIs. Methods Stained slides (30 unique specimens per tumor indication) were scanned on an Aperio AT2 scanner to generate WSIs for digital T&T. Remote T&T sessions used WebEx and PathcoreScholar's online platform to discuss scoring guidelines and WSI training cases. Subsequently, external pathologists evaluated WSIs in PathcoreScholar for PD-L1 expression using either Tumor Proportion Score (TPS) or Combined Positive Score (CPS) scoring algorithms and interpreted these scores at predefined cutoffs (figure 1). In both glass and WSI scoring test modalities, passing is defined as inter and intra-observer overall agreement (OA) >=85%. Training effectiveness pass rates from glass slide data (2018-2020) and WSI data (2021- 2022) spanning multiple indications and scoring algorithms were calculated and then compared using the Fisher-Freeman- Halton test, with a significance threshold of 0.05. Only data from initial pathologist tests were included in the pass rate calculation;data from re-tests executed after initial test failure were excluded. Results The differences between pass rates for microscope (glass slide) and digital (WSI) testing were not statistically significant (p-value > 0.05) (tables 1 and 2). Testing pass rates for indications scored with TPS or CPS using microscope glass slide vs digital WSI T&T was not statistically significant (pvalue > 0.05) (table 3). Conclusions No statistically significant differences in pathologist training effectiveness for PD-L1 were observed between remote and in-person trainings across multiple tumor indications, scoring algorithms, and cutoffs. These results demonstrate the effectiveness and equivalency of remote-digital pathologist trainings for evaluation of PD-L1 expression as detected by PD-L1 IHC 22C3 pharmDx in multiple tumor indications when compared to in-person-microscope glass slide T&T. Use of digital training and scoring proficiency testing can provide pathologists around the world with access to high-quality, interactive training from leading experts in PD-L1 expression evaluation.
ABSTRACT
Purpose: The selection of a specific medical specialty is crucial to medical students and is increasingly associated with future job satisfaction and success in the medical field. We aim to evaluate the perception of medical students at Jazan University towards choosing pathology as a future career and the factors influencing their decisions in order to better the employability of graduates and provide information to both the labor force and curriculum designers. Methods: An observational cross-sectional study was conducted among a random sample of (391) students at the faculty of medicine, Jazan University, from the 2nd to 6th year who registered as a formal student in the academic year 2021/2022. Data was collected via (web-based) a self-administered questionnaire because of COVID-19 pandemic. Chi-squared tests and regression analysis were performed. Results: In this investigation, 92.9% of participants responded. Only 16.2% of undergraduates selected pathology as a future career choice. Among the participants who desired to choose pathology as a career, 28.6% preferred hematopathology as a future sub-specialty. Around 16% considered the most crucial reason for not choosing pathology is the preference for direct patient contact. The differences in age groups, academic level, GPA, and educational level of father between respondents who having a desire to choose pathology as a future career were found to be significantly different. Conclusion: Among the respondents involved in this study, only 16.2% were interested in pathology, while 3.1% chose the field as their first future career choice. Our findings can be applied to help undergraduate better prepare for the future and encourage them to apply to the pathology program to address the shortage of pathologists in the area. Qualitative research is a need to explore the perceptions of current pathology residents and the reasons that can encourage them to choose this important specialization as a future career.
ABSTRACT
BACKGROUND: Digital pathology (DP) using whole slide imaging is a recently emerging game changer technology that can fundamentally change the way of working in pathology. The Digital Pathology Study Group (DPSG) of the Korean Society of Pathologists (KSP) published a consensus report on the recommendations for pathologic practice using DP. Accordingly, the need for the development and implementation of a quality assurance program (QAP) for DP has been raised. METHODS: To provide a standard baseline reference for internal and external QAP for DP, the members of the Committee of Quality Assurance of the KSP developed a checklist for the Redbook and a QAP trial for DP based on the prior DPSG consensus report. Four leading institutes participated in the QAP trial in the first year, and we gathered feedback from these institutes afterwards. RESULTS: The newly developed checklists of QAP for DP contain 39 items (216 score): eight items for quality control of DP systems; three for DP personnel; nine for hardware and software requirements for DP systems; 15 for validation, operation, and management of DP systems; and four for data security and personal information protection. Most participants in the QAP trial replied that continuous education on unfamiliar terminology and more practical experience is demanding. CONCLUSIONS: The QAP for DP is essential for the safe implementation of DP in pathologic practice. Each laboratory should prepare an institutional QAP according to this checklist, and consecutive revision of the checklist with feedback from the QAP trial for DP needs to follow.
ABSTRACT
Background: This article describes how a simple slide scanner with remote viewing software enabled a remote "nomadic" pathologist to continue his role as specialist lead for a regional gastrointestinal multidisciplinary team meeting (MDTM) after relocating to another site in the 5 hospital Southwest UK Peninsula cancer network just prior to the COVID-19 pandemic. Materials and methods: The author used digital pathology (DP) to supplement a conventional workflow as a way of minimising delay in reporting and reviewing slides for a regional specialist Oesophagogastric MDTM (the OGSMDT). The specialist centre at University Hospital Plymouth (UHP) is 58 miles from the author's new workplace at Royal Cornwall Hospital (RCHT). Slides from the 44 cases (10% of this specialist annual workload) in this validation study were reported or reviewed digitally using the slide scanner. All were listed for the OGSMDT due to being clinically suspicious for upper gastrointestinal malignancy, having been processed at UHP, or one of the other hospitals in the cancer network. Results: The scanner allowed the author who was only on site at UHP 1 day per week to prevent delays in reporting/reviewing glass slides, using remote DP. Confidence in digital diagnosis was assessed using the Royal College of Pathologists recommendations. The author was the primary pathologist signing out 31, and second opinion for the remaining 13 cases. These comprised a mixture of biopsies as well as endoscopic and surgical excision specimens. The DP system enabled the author to report the cases digitally with an equivalent degree of confidence to glass slides and no significant discrepancies were identified between the author's digital and final glass slide diagnosis. Conclusions: The scanner was found to be safe and effective for remote reporting and review for OGSMDT cases. It was recognised that DP was advantageous to enable this role to continue remotely but that a fully integrated digital reporting system capable of high-capacity scanning would be preferable to the simple system used.
ABSTRACT
Background: Pathology services experienced a surge in demand during the COVID-19 pandemic. Digitalisation of pathology workflows can help to increase throughput, yet many existing digitalisation solutions use non-standardised workflows captured in proprietary data formats and processed by black-box software, yielding data of varying quality. This study presents the views of a UK-led expert group on the barriers to adoption and the required input of measurement science to improve current practices in digital pathology. Methods: With an aim to support the UK's efforts in digitalisation of pathology services, this study comprised: (1) a review of existing evidence, (2) an online survey of domain experts, and (3) a workshop with 42 representatives from healthcare, regulatory bodies, pharmaceutical industry, academia, equipment, and software manufacturers. The discussion topics included sample processing, data interoperability, image analysis, equipment calibration, and use of novel imaging modalities. Findings: The lack of data interoperability within the digital pathology workflows hinders data lookup and navigation, according to 80% of attendees. All participants stressed the importance of integrating imaging and non-imaging data for diagnosis, while 80% saw data integration as a priority challenge. 90% identified the benefits of artificial intelligence and machine learning, but identified the need for training and sound performance metrics.Methods for calibration and providing traceability were seen as essential to establish harmonised, reproducible sample processing, and image acquisition pipelines. Vendor-neutral data standards were seen as a "must-have" for providing meaningful data for downstream analysis. Users and vendors need good practice guidance on evaluation of uncertainty, fitness-for-purpose, and reproducibility of artificial intelligence/machine learning tools. All of the above needs to be accompanied by an upskilling of the pathology workforce. Conclusions: Digital pathology requires interoperable data formats, reproducible and comparable laboratory workflows, and trustworthy computer analysis software. Despite high interest in the use of novel imaging techniques and artificial intelligence tools, their adoption is slowed down by the lack of guidance and evaluation tools to assess the suitability of these techniques for specific clinical question. Measurement science expertise in uncertainty estimation, standardisation, reference materials, and calibration can help establishing reproducibility and comparability between laboratory procedures, yielding high quality data and providing higher confidence in diagnosis.
ABSTRACT
Digital pathology was developed decades ago to allow pathologists to remotely collaborate on cases and improve the accuracy of diagnostic techniques by sharing digital images across laboratories. Before the COVID-19 pandemic, the United States lagged behind most other developed countries in terms of digital pathology adoption due to strict federal regulations of the US Food and Drug Administration (FDA) and the Clinical Laboratory Improvement Amendments (CLIA) from the Centers for Medicare & Medicaid Services (CMS). The FDA relaxed some of its requirements to approve and validate digital pathology-related technology to meet the pandemic response's needs. Similarly, the CMS waived restrictive CLIA rules that now allowed pathologists to use digital pathology platforms from home. Thereby, the COVID-19 pandemic accelerated the broad adoption of digital pathology for remotely rendering pathology diagnoses. This imaging technology has provided pathologists and pathologists-in-training with a variety of resources to help them continue to remotely care for patients, collaborate, and support virtual education. This paradigm shift will impact not only how we routinely work in the postpandemic era but also how we will virtually teach pathology in the future and possibly even modify regulations that govern how digital pathology systems can be used and get approved for diagnostic use. The focus of this chapter is on digital pathology concerning the COVID-19 pandemic. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
Diagnostic devices, methodological approaches, and traditional constructs of clinical pathology practice, cultivated throughout centuries, have transformed radically in the wake of explosive technological growth and other, e.g., environmental, catalysts of change. Ushered into the fray of modern laboratory medicine are digital imaging devices and machine-learning (ML) software fashioned to mitigate challenges, e.g., practitioner shortage while preparing clinicians for emerging interconnectivity of environments and diagnostic information in the era of big data. As computer vision shapes new constructs for the modern world and intertwines with clinical medicine, cultivating clarity of our new terrain through examining the trajectory and current scope of computational pathology and its pertinence to clinical practice is vital. Through review of numerous studies, we find developmental efforts for ML migrating from research to standardized clinical frameworks while overcoming obstacles that have formerly curtailed adoption of these tools, e.g., generalizability, data availability, and user-friendly accessibility. Groundbreaking validatory efforts have facilitated the clinical deployment of ML tools demonstrating the capacity to effectively aid in distinguishing tumor subtype and grade, classify early vs. advanced cancer stages, and assist in quality control and primary diagnosis applications. Case studies have demonstrated the benefits of streamlined, digitized workflows for practitioners alleviated by decreased burdens.
ABSTRACT
The rate of digital pathology adoption had been slow until the COVID-19 pandemic served as catalyst, demonstrating the possibilities of saving time and money by converting glass slides into whole slide images (WSI) and thus making them available to all staff pathologist immediately after, regardless of where the pathologists are located, in their office, at home or travel location. Regardless of the cataclysmic proportions of this event in health care and in pathology specifically speaking, the transition is still slow. After the COVID 19 pandemic, there was an increase in interest among laboratories and pathology groups. We recognize two periods, pre COVID 19 with low interest and low conversion rates;and during COVID 19 where the interest grew exponentially but not much so the adoption. Right now, we are on this high interest, but low adoption period. Since it is not for lack of interest from pathologists and administrators, now the issue is that all these interested parties have found out that the transition process is intrinsically slow and full of challenges. In this paper we are reviewing the main challenges that laboratories are facing in the adoption process, some are obvious, other are not so much. Those challenges can be divided in financial, technical, and perhaps the most difficult to overcome, changing management. All these challenges are not insurmountable, and the key is not to tackle them when they appear, but far in advance, this is accomplished by a thorough investigation of the variables and the particular use cases of the institution and to start educating medical and non-medical stakeholders about the benefits of a digital workflow, how these benefits will definitively pay off the investment and will render the laboratory not only prepared for other disruptive event like COVID 19, but it will also make them ready for the fast growing trend of utilizing machine learning and artificial intelligence to analyze images and finetune the diagnosis.
ABSTRACT
The COVID-19 pandemic shifted pathology education in medical schools worldwide towards online delivery. To achieve this goal, various innovative platforms were used by pathology educators and medical students, facilitating both synchronous and asynchronous learning. The aim of this study was to review the published evidence regarding remote pathology teaching at the medical school level during this period, present our own experience, and provide some perspectives regarding the best mode of pathology teaching post-pandemic. Among its advantages, virtual pathology education was considered among students and educators as convenient, flexible, and engaging, while learning outcomes were met and students' academic performance was in general satisfactory. However, several challenges were faced. For instance, suboptimal internet connection compromised the flow of classes and was even associated with a lower academic performance. The lack of hands-on laboratory activities, such as operating the light microscope and tissue grossing, and the reduced student interactions among themselves and their instructors, were also pointed out as significant drawbacks of remote pathology education. Whereas online education has multiple advantages, experiencing the physical university environment, in-person interactions and teamwork, exposure to the "hidden curriculum", and hands-on activities are vital for medical school education and future student development. In conclusion, the implementation of a blended approach in pathology education-where online and face-to-face sessions are jointly used to promote students' engagement, interaction with their instructors and peers, and learning-could be the most optimal approach to pathology teaching in medical schools post-pandemic.
ABSTRACT
The transition towards digital pathology and an extensive selection of video conferencing platforms have helped provide continuity to education even during the COVID-19 pandemic. Innovative approaches for pathology education, will likely persist beyond the pandemic, as they have powerful didactic potential. While there is a wide selection of software for use as educational tools, an environment to access all resources with ease is clearly lacking. In this technical note, we highlight our customized educational applications built using a low-code approach. Our applications, developed with Microsoft Power Apps, serve both educational and examination purposes and are launched using Microsoft Teams. Building applications using a low-code approach has made our applications very specific to our use and enabled daily distanced education. Combined with existing features on Teams, such as file sharing, meeting scheduling, and messaging, the applications serve as a unique and customizable pathology educational platform.
ABSTRACT
Digital workflow transformation continues to sweep throughout a diversity of pathology departments spanning the globe following catalyzation of whole slide imaging (WSI) adoption by the SARS-CoV-2 (COVID-19) pandemic. The utility of WSI for a litany of use cases including primary diagnosis has been emphasized during this period, with WSI scanning devices gaining the approval of healthcare regulatory bodies and practitioners alike for clinical applications following extensive validatory efforts. As successful validation for WSI is predicated upon pathologist diagnostic interpretability of digital images with high glass slide concordance, departmental adoption of WSI is tantamount to the reliability of such images often predicated upon quality assessment notwithstanding image interpretability but extending to quality of practice following WSI adoption. Metrics of importance within this context include failure rates inclusive of different scanning errors that result in poor image quality and the potential such errors may incur upon departmental turnaround time (TAT). We sought to evaluate the impact of WSI implementation through retrospective evaluation of scan failure frequency in archival versus newly prepared slides, types of scanning error, and impact upon TAT following commencement of live WSI operation in May 2017 until the present period within a fully digitized high-volume academic institution. A 1.19% scan failure incidence rate was recorded during this period, with re-scanning requested and successfully executed for 1.19% of cases during the reported period of January 2019 until present. No significant impact upon TAT was deduced, suggesting an outcome which may be encouraging for departments considering digital workflow adoption.
ABSTRACT
There has been particular interest in the deployment of digital pathology (DP) and artificial intelligence (AI) in the diagnosis of prostate cancer, but little is known about the views of the public on their use. Prostate Cancer UK supporters were invited to an online survey which included quantitative and qualitative questions exploring views on the use of DP and AI in histopathological assessment. A total of 1276 responses to the survey were analysed (response rate 12.5%). Most respondents were supportive of DP (87%, 1113/1276) and of testing AI in clinical practice as a diagnostic adjunct (83%, 1058/1276). Respondents saw DP as potentially increasing workflow efficiency, facilitating research, education/training and fostering clinical discussions between clinician and patient. Some respondents raised concerns regarding data security, reliability and the need for human oversight. Among those who were unsure about AI, information was requested regarding its performance and others wanted to defer the decision to use it to an expert. Although most are in favour of its use, some are unsure, and their concerns could be addressed with more information or better communication. A small minority (<1%) are not in favour of the testing of the use of AI in histopathology for reasons which are not easily addressed.
ABSTRACT
Background: Digital pathology adoption for clinical diagnostics continues to increase due to favorable regulatory environment and need for remote diagnosis during COVID-19 pandemic. Whole slide imaging (WSI) scan failure is fairly uncommon. However, there is limited literature about the true incidence of WSI scan failure rates and the impact on the daily operations in a setting of complete digital workflow. Our digital pathology scanning facility is one of the largest clinical digital pathology operating the world. Our facility routinely monitors scan failure data as a part of quality control and quality assurance. This study was undertaken to address the issues related to scan failure and to assess impact on turn-around times (TATs). This data would be beneficial to health care providers considering transition to a complete digital work-flow. Design: In 2017, we transitioned from scanning of archival slides to mostly new slides for primary diagnosis. We have operated 13 different Philips UFS scanners and scanned 2,289,266 slides representing nearly 233,864 cases. Scan failure data was collected from 3 resources (1) Errors detected by machine, (2) Retrospective quality control review and (3) Errors reported by pathologists. Every slide image is appraised by the scanner for defects including failed region of interest (ROI) detections, slides skipped, slides dropped, tissue not detected, and other faults. Each image is also checked by scan technician to determine if the ROI was correctly captured or not. Routinely 1.5% of the daily scans are inspected by senior staff for quality assurance. Slides are scored on a scale of 1 to 10 using different parameters and scans scoring <8 are designated as failed scans and slides typically get rescan. Total scan failure rates, re-scan (since 2019) rates were recorded and monitored. Results: Table 1 summarizes WSI scan failure data at our facility. Overall scan failure rate was just 1.19% with majority of the failures were attributable to machine error followed by failures due to slide preparation features. Most common machine error was failed ROI followed by skipped tissue error. Conclusions: WSI scan failure is extremely uncommon (1.19%) in a facility with experienced slide scanning staff and optimal slide preparations. Re-scanning was requested only for 1.19% cases and was feasible in 100% cases. Scanning of archival versus newly prepared slides did not have an impact on scan failure rates. Scan failure is not frequent enough to impact TATs and therefore need not be a concern for institutions considering transitioning to digital workflow. (Table Presented).
ABSTRACT
Background: Digital pathology has enormous potential to make routine pathology practice more efficient and accurate, however, full adoption has been slow. We aimed to identify driving factors that encourage pathologists to adopt digital pathology for their daily practice at our institution. Design: We have collected data on four indicators of pathologist adoption since the implementation of digital pathology: (1) number of pathologists receiving training and certification for primary diagnosis using digital whole slide images (WSI);(2) average daily number of users logged in imaging managing system (IMS);(3) average daily number of primary diagnosis slides scanned;and (4) average daily number of slides scanned for immediate pathologist use (including consultation, urgent cases, etc.) Since adoption of digital workflow was voluntary and slides were only scanned for pathologists who have indicated to use WSIs for routine practice, these are accurate indicators of pathologists' transition from glass slides to digital workflow. These data were correlated with potential events during the study period. Results: The data of four indicators were summarized in the table. We observed two spikes: the first one was from July to September 2019 and the second was from March to May 2020 (Figure 1). The first spike correlates with our pathology laboratory information system (LIS) transition from Sunquest Copath to Epic Beaker, which enables single-click access to WSIs in IMS from case working drafts. Previously, pathologists had to switch from pathology LIS to IMS and type in case numbers in order to access WSIs. The second spike correlates with the beginning of COVID-19 pandemic when many academic activities transitioned from live to remote using digital platforms. The need to work remotely, conduct education and consultation at distance, and minimize interaction with others appears to have driven many fence-sitting pathologists to adopt digital pathology. CMS waiver to loosen regulatory requirements during this pandemic has hastened pathologists' decision to switch to digital pathology for primary diagnosis. Conclusions: Our data suggests that ease of use and the ability to work remotely are the most powerful drivers of digital pathology adoption. (Table Presented).