Journal Article
. 2016 Apr; 7:11.
doi: 10.4103/2153-3539.177689.

Consultation on urological specimens from referred cancer patients using real-time digital microscopy: Optimizing the workflow

Henrik Holten-Rossing 1 Lise Grupe Larsen 2 Birgitte Grønkær Toft 1 Anand Loya 1 Ben Vainer 1 
  • PMID: 27076989
  •     9 References
  •     6 citations


Introduction: Centralization of cancer treatment entails a reassessment of the diagnostic tissue specimens. Packaging and shipment of glass slides from the local to the central pathology unit means that the standard procedure is time-consuming and that it is difficult to comply with governmental requirements. The aim was to evaluate whether real-time digital microscopy for urological cancer specimens during the primary diagnostic process can replace subsequent physical slide referral and reassessment without compromising diagnostic safety.

Methods: From May to October 2014, tissue specimens from 130 patients with urological cancer received at Næstved Hospital's Pathology Department, and expected to be referred for further treatment at cancer unit of a university hospital, were diagnosed using standard light microscopy. In the event of diagnostic uncertainty, the VisionTek digital microscope (Sakura Finetek) was employed. The Pathology Department at Næstved Hospital was equipped with a digital microscope and three consultant pathologists were stationed at Rigshospitalet with workstations optimized for digital microscopy. Representative slides for each case were selected for consultation and live digital consultation took place over the telephone using remote access software. Time of start and finish for each case was logged. For the physically referred cases, time from arrival to sign-out was logged in the national pathology information system, and time spent on microscopy and reporting was noted manually. Diagnosis, number of involved biopsies, grade, and stage were compared between digital microscopy and conventional microscopy.

Results: Complete data were available for all 130 cases. Standard procedure with referral of urological cancer specimens took a mean of 8 min 56 s for microscopy, reporting and sign-out per case. For live digital consultations, a mean of 18 min 37 s was spent on each consultation with 4 min 43 s for each case, depending on the number of digital slides included. Only in two cases could a consensus regarding the diagnosis not be reached during live consultation; this did not, it should be noted, affect patient treatment. Complete agreement between conventional and digital histopathology diagnosis was reached in all the 53 patients referred to central pathology units. The participating pathologists were in general comfortable using live digital microscopy, but they emphasized that a fast internet connection was essential for a smooth consultation.

Discussion And Conclusion: An almost perfect agreement between live digital and conventional microscopy was observed in this study. Live digital consultation allowed cases to be referred from local hospitals to central cancer units without the standard delay caused by shipment. Only a few preselected specimen slides for each patient were presented in live consultation, which reduced the time spent on diagnosis compared to using the conventional method. Implementation of real-time digital microscopy would result in quicker turnaround and patient referral time, and with careful selection of relevant specimen slides for consultation, diagnostic safety would not be compromised.

Keywords: Digital pathology; digitalization; real-time consultation; telemedicine; telepathology; virtual microscopy.

Validation of whole slide imaging for primary diagnosis in surgical pathology.
Thomas W Bauer, Lynn Schoenfield, +3 authors, Walter H Henricks.
Arch Pathol Lab Med, 2013 Jan 18; 137(4). PMID: 23323732
Interinstitutional whole slide imaging teleconsultation service development: assessment using internal training and clinical consultation cases.
Nicholas C Jones, Rosalynn M Nazarian, +10 authors, David C Wilbur.
Arch Pathol Lab Med, 2014 Nov 22; 139(5). PMID: 25415180
Validating whole-slide imaging for consultation diagnoses in surgical pathology.
Thomas W Bauer, Renee J Slaw.
Arch Pathol Lab Med, 2014 May 21; 138(11). PMID: 24840034
Can digital pathology result in cost savings? A financial projection for digital pathology implementation at a large integrated health care organization.
Jonhan Ho, Stefan M Ahlers, +6 authors, Anil V Parwani.
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Interobserver and intraobserver reproducibility in digital and routine microscopic assessment of prostate needle biopsies.
Paula A Rodriguez-Urrego, Angel M Cronin, +4 authors, Samson W Fine.
Hum Pathol, 2010 Oct 26; 42(1). PMID: 20970164
Validation of a whole slide imaging system for primary diagnosis in surgical pathology: A community hospital experience.
Thomas P Buck, Rebecca Dilorio, Lauren Havrilla, Dennis G O'Neill.
J Pathol Inform, 2014 Dec 24; 5(1). PMID: 25535591    Free PMC article.
Validation of digital pathology imaging for primary histopathological diagnosis.
David R J Snead, Yee-Wah Tsang, +16 authors, Ian A Cree.
Histopathology, 2015 Sep 27; 68(7). PMID: 26409165
Digital pathology consultations-a new era in digital imaging, challenges and practical applications.
Gonzalo Romero Lauro, William Cable, +4 authors, Liron Pantanowitz.
J Digit Imaging, 2013 Jan 30; 26(4). PMID: 23359091    Free PMC article.
Validating whole slide imaging for diagnostic purposes in pathology: guideline from the College of American Pathologists Pathology and Laboratory Quality Center.
Liron Pantanowitz, John H Sinard, +8 authors, College of American Pathologists Pathology and Laboratory Quality Center.
Arch Pathol Lab Med, 2013 May 03; 137(12). PMID: 23634907    Free PMC article.
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Digital pathology in the time of corona.
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[Current developments on digitalization : Analysis of quality and economics in healthcare].
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