Implemantation of Digital Pathology Workflow for Routine Primary Diagnosis in a Large Private Hospital Network

Introduction

• Our pathology laboratory serves a private hospital network of 11 hospitals in 5 cities. Biopsies were scanned with two Leica Aperio T2 scanners and shared via the Sectra system. 6977 biopsies were scanned and archived during a-ten-month period and used in consultation, second opinion, and meetings. To start using the system as a primary diagnostic tool, a validation study is initiated.

Materials and Methods

• 17 pathologists (median 17 years (3-33) in practice) have participated. Each has diagnosed routine cases first with digital slides then under microscope. Either 60 cases or as many as the pathologist feels comfortable with the interface and feels safe to give primary diagnosis is aimed. Organ system, both diagnoses, difference if any, causes of difference, and challenges are noted.

Results

• 830 biopsies were reached until this preliminary analysis. Re-scanning was required in 3%, microscopic examination in 5%. There was no difference in the diagnosis in 90% of the cases. The challenges on diagnosis were due to counting mitosis, microorganism (H.pylori) detection, IHC intensity optimisation (HER2), missed tissues in scanning area, dysplasia vs reactive, grading dysplasia, tumor subtyping, missing small tumor foci, focus problems, nuclear details.

Conclusions

• Currently two pathologists work completely digitally and others in a hybrid model. Adding digital pathology to our workflow is still in progress and will be suitable for everyday use with a proper implementation, validation, and quality control.