Pathology
Digital pathology facilitates a number of prospective and retrospective pathology applications in healthcare by providing new capabilities, increasing efficiency and improving existing processes.
This technology is being widely adopted by hospitals and reference labs in a phased approach over time. As additional uses are adopted, the value of digital pathology will be more fully leveraged to gain efficiencies in pathology workflow.
Intraoperative Consultation
Digital pathology provides value for intraoperative consultations by enabling real-time remote review of live microscopic images and scanned digital slides. Digital slide access reduces travel costs and simplifies scheduling of surgeries.
It also increases access to and frequency of consultations due to increased availability of remote, subspecialty pathologists, giving hospitals better, faster access to needed pathology expertise.
Internal, External Consultation
Pathology is by nature a consultative field, and digital pathology improves patient care by making internal consultations between members of a group more efficient. With digital pathology, a colleague receives a link to the case, views it and sends back their opinion instantly. Cases can also be viewed simultaneously, as if through a multi-headed microscope. Annotations, case notes as well as digital images can be shared.
Using digital pathology for external consultations eliminates shipping costs, travel time and the expense of re-cuts. Further, the danger of sent slides not being returned is eliminated, and the chance of misrouting and privacy violations are greatly reduced.
Digitized consultation cases can be reviewed within minutes, as conveniently as reading email, significantly improving turnaround time for patients. In addition, consultant and referring pathologists can review cases together, for better communication and transfer of specialty expertise.
Digital IHC
Immunohistochemistry (IHC) is an important lab technique yielding valuable prognostic information for certain cases, such as breast cancer. Digital pathology enables digitized slides to be automatically analyzed with computer algorithms to make exact measurements of the intensity and distribution of IHC-labeled proteins in cells. This improves accuracy and consistency of measurements and yields informative reports for clinicians that guide personalized care.
Tumor Boards
The workflow for tumor board preparation typically involves selection of cases, retrieval of slides and a laborious review of the slides and capture of photomicrographs. Digital pathology reduces preparation time by making whole-slide images of every slide in a case easily available, eliminating time-consuming photomicrograph capture and assembly of presentations. Slides can be annotated easily, and archived cases can be obtained as needed without laborious physical retrieval from slide archives.
Risk Management
Traditional physical slide archives may be difficult to access and search, and are often remotely located. Slides can deteriorate or break, and stains can fade.
However, digital pathology slide archives are permanently available and easily retrievable. Institutions can organize archived slides based on risk parameters and assessments of how likely information will be needed.
And maintenance of an instantly accessible digital archive can offer less-expensive offsite storage of physical objects, such as tissue blocks and glass slides.
CAP, CLIA Compliance
For clinical labs, compliance with College of American Pathologist (CAP) and Clinical Laboratory Improvement Amendments (CLIA) guidelines is an important part of everyday workflow. Records must be kept of turnaround times, prior case retrieval, quality assurance (QA) over-reads and autopsies. Significant and/or unexpected findings must be tracked and made accessible to CAP/CLIA auditors. Digital pathology enables consistent and automatic record keeping of all consult activity and allows significant findings to be flagged for tracking purposes.
QA, Decision Support
Digital pathology paves the way for fast quality assurance. Prior cases can be easily routed for review and over-read to geographically dispersed pathologists within a group, resulting in improved decision making and patient care.
Digital pathology also reduces the need for shipping and re-cuts, and eliminates the chance of lost or broken slides.
And it offers tremendous decision support potential. Access to libraries of standard images are a huge benefit when a pathologist is performing case review; healthcare institutions can establish and digitize reference sets to support the pathologist and help improve diagnostic accuracy.
Continuing Education
Digital pathology provides educational value since teaching sets can be readily created and maintained. It provides access to digital slide archives for self-study, including unusual cases that might not arise in everyday lab workflow. Such cases can be annotated to indicate regions of interest, and archives can be searchable. Digital pathology also facilitates proficiency testing, reducing the burden of sharing glass slide teaching sets and making it easy to prepare internal exams. Results can be stored and maintained for permanent records and ongoing improvement.
Chrystal Adams is senior product manager for Healthcare at Aperio.