Journal Article
. 2021 Jul; 12:20.
doi: 10.4103/jpi.jpi_109_20.

Remote Reporting During a Pandemic Using Digital Pathology Solution: Experience from a Tertiary Care Cancer Center

Veena Ramaswamy 1 B N Tejaswini 1 Sowmya B Uthaiah 1 
  • PMID: 34267985
  •     22 References


Background: Remote reporting in anatomic pathology is an important advantage of digital pathology that has not been much explored. The COVID-19 pandemic has provided an opportunity to explore this important application of digital pathology system in a tertiary care cancer center to ensure patient care and staff safety. Regulatory guidelines have been described for remote reporting following the pandemic. Herein, we describe our experience of validation of digital pathology workflow for remote reporting to encourage pathologists to utilize this facility which opens door for multiple, multidisciplinary collaborations.

Objective: To demonstrate the validation and the operational feasibility of remote reporting using a digital pathology system.

Materials And Methods: Our retrospective validation included whole-slide images (WSIs) of 60 cases of histopathology and 20 cases each of frozen sections and a digital image-based breast algorithm after a washout period of 3 months. Three pathologists with different models of consumer-grade laptops reviewed the cases remotely to assess the diagnostic concordance and operational feasibility of the modified workflow. The slides were digitized on a USFDA-approved Philips UFS 300 scanner at ×40 resolution (0.25 μm/pixel) and viewed on the Image Management System through a web browser. All the essential parameters were reported for each case. After successful validation, 886 cases were reported remotely from March 29, 2020, to June 30, 2020, prospectively. Light microscopy formed the gold standard reference in remote reporting.

Results: 100% major diagnostic concordance was observed in the validation of remote reporting in the retrospective and prospective studies using consumer-grade laptops. The deferral rate was 0.34%. 97.6% of histopathology and 100% of frozen sections were signed out within the turnaround time. Network speed and a lack of virtual private network did not significantly affect the study.

Conclusion: This study of validation and reporting of complete pathology cases remotely, including their operational feasibility during a public health emergency, proves that remote sign-out using a digital pathology system is not inferior to WSIs on medical-grade monitors and light microscopy. Such studies on remote reporting open the door for the use of digital pathology for interinstitutional consultation and collaboration: Its main intended use.

Keywords: COVID-19; Consumer-grade laptop; image management system; laboratory information system; local area network; quality control; remote reporting; virtual private network; whole-slide image.

A Point-of-Use Quality Assurance Tool for Digital Pathology Remote Working.
Alexander I Wright, Emily L Clarke, +3 authors, David S Brettle.
J Pathol Inform, 2020 Oct 10; 11. PMID: 33033654    Free PMC article.
Digital Whole Slide Imaging Compared With Light Microscopy for Primary Diagnosis in Surgical Pathology.
Alexander D Borowsky, Eric F Glassy, +34 authors, Thomas W Bauer.
Arch Pathol Lab Med, 2020 Feb 15; 144(10). PMID: 32057275
Practical guide to training and validation for primary diagnosis with digital pathology.
Bethany Jill Williams, Darren Treanor.
J Clin Pathol, 2019 Dec 01; 73(7). PMID: 31784420
Digital pathology for the primary diagnosis of breast histopathological specimens: an innovative validation and concordance study on digital pathology validation and training.
Bethany Jill Williams, Andrew Hanby, +3 authors, Darren Treanor.
Histopathology, 2017 Sep 25; 72(4). PMID: 28940580
Evaluating the benefits of digital pathology implementation: time savings in laboratory logistics.
Alexi Baidoshvili, Anca Bucur, +3 authors, Paul J van Diest.
Histopathology, 2018 Jun 21; 73(5). PMID: 29924891
Development and Evaluation of a Novel Point-of-Use Quality Assurance Tool for Digital Pathology.
Emily L Clarke, David Brettle, +3 authors, Darren Treanor.
Arch Pathol Lab Med, 2019 Apr 26; 143(10). PMID: 31021658
Distance reporting in digital pathology: A study on 950 cases.
Aleksandar Vodovnik.
J Pathol Inform, 2015 May 15; 6. PMID: 25969793    Free PMC article.
Whole Slide Imaging Versus Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter Blinded Randomized Noninferiority Study of 1992 Cases (Pivotal Study).
Sanjay Mukhopadhyay, Michael D Feldman, +31 authors, Clive R Taylor.
Am J Surg Pathol, 2017 Sep 30; 42(1). PMID: 28961557    Free PMC article.
Clinical digital neuropathology: experience and observations from a departmental digital pathology training programme, validation and deployment.
Bethany Jill Williams, Azzam Ismail, Arundhati Chakrabarty, Darren Treanor.
J Clin Pathol, 2020 Mar 07; 74(7). PMID: 32139375
Validation of a digital pathology system including remote review during the COVID-19 pandemic.
Matthew G Hanna, Victor E Reuter, +21 authors, Meera Hameed.
Mod Pathol, 2020 Jun 24; 33(11). PMID: 32572154    Free PMC article.
Detection of SARS-CoV-2 in Different Types of Clinical Specimens.
Wenling Wang, Yanli Xu, +4 authors, Wenjie Tan.
JAMA, 2020 Mar 12; 323(18). PMID: 32159775    Free PMC article.
Highly Cited.
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.
Highly Cited. Review.
Guidance for Remote Reporting of Digital Pathology Slides During Periods of Exceptional Service Pressure: An Emergency Response from the UK Royal College of Pathologists.
Bethany Jill Williams, David Brettle, +8 authors, Darren Treanor.
J Pathol Inform, 2020 Jun 02; 11. PMID: 32477618    Free PMC article.
Display evaluation for primary diagnosis using digital pathology.
Emily L Clarke, Craig Munnings, +2 authors, Darren Treanor.
J Med Imaging (Bellingham), 2020 Apr 29; 7(2). PMID: 32341938    Free PMC article.
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.
Routine Digital Pathology Workflow: The Catania Experience.
Filippo Fraggetta, Salvatore Garozzo, +2 authors, Esther Diana Rossi.
J Pathol Inform, 2018 Feb 09; 8. PMID: 29416914    Free PMC article.
Coronavirus disinfection in histopathology.
Anthony F Henwood.
J Histotechnol, 2020 Mar 03; 43(2). PMID: 32116147
US Food and Drug Administration Approval of Whole Slide Imaging for Primary Diagnosis: A Key Milestone Is Reached and New Questions Are Raised.
Andrew J Evans, Thomas W Bauer, +12 authors, Liron Pantanowitz.
Arch Pathol Lab Med, 2018 May 01; 142(11). PMID: 29708429
Concordance between whole-slide imaging and light microscopy for routine surgical pathology.
W Scott Campbell, Subodh M Lele, +3 authors, Steven H Hinrichs.
Hum Pathol, 2012 May 18; 43(10). PMID: 22591912
Complete Routine Remote Digital Pathology Services.
Aleksandar Vodovnik, Mohammad Reza F Aghdam.
J Pathol Inform, 2018 Dec 07; 9. PMID: 30505622    Free PMC article.
Complete Digital Pathology for Routine Histopathology Diagnosis in a Multicenter Hospital Network.
Juan Antonio Retamero, Jose Aneiros-Fernandez, Raimundo G Del Moral.
Arch Pathol Lab Med, 2019 Jul 12; 144(2). PMID: 31295015
Remote autopsy services: A feasibility study on nine cases.
Aleksandar Vodovnik, Mohammad Reza F Aghdam, Dan Gøran Espedal.
J Telemed Telecare, 2017 May 26; 24(7). PMID: 28537510