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Turashvili G, Gjeorgjievski SG, Wang Q, Ewaz A, Ai D, Li X, Badve SS. Intraoperative assessment of axillary sentinel lymph nodes by telepathology. Breast Cancer Res Treat 2023; 202:423-434. [PMID: 37688667 DOI: 10.1007/s10549-023-07101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/17/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE Although axillary dissection is no longer indicated for many breast cancer patients with 1-2 positive axillary sentinel lymph nodes (ASLN), intraoperative ASLN assessment is still performed in many institutions for patients undergoing mastectomy or neoadjuvant therapy. With recent advancements in digital pathology, pathologists increasingly evaluate ASLN via remote telepathology. We aimed to compare the performance characteristics of remote telepathology and conventional on-site intraoperative ASLN assessment. METHODS Data from ASLN evaluation for breast cancer patients performed at two sites between April 2021 and October 2022 was collated. Remote telepathology consultation was conducted via the Aperio eSlideManager system. RESULTS A total of 385 patients were identified during the study period (83 telepathology, 302 on-site evaluations). Although not statistically significant (P = 0.20), the overall discrepancy rate between intraoperative and final diagnoses was slightly higher at 9.6% (8/83) for telepathology compared with 5.3% (16/302) for on-site assessment. Further comparison of performance characteristics of ASLN assessment between telepathology and conventional on-site evaluation revealed no statistically significant differences between deferral rates, discrepancy rates, interpretive or sampling errors, major or minor disagreements, false negative or false positive results as well as clinical impact and turn-around time (P ≥ 0.12). CONCLUSION ASLN assessment via telepathology is not significantly different from conventional on-site evaluation, although it shows a slightly higher overall discrepancy rate between intraoperative and final diagnoses (9.6% vs. 5.3%). Further studies are warranted to ensure accuracy of ASLN assessment via telepathology.
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Affiliation(s)
- Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Sandra Gjorgova Gjeorgjievski
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Qun Wang
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Abdulwahab Ewaz
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Di Ai
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Emory University Hospital, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
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Kaushal RK, Yadav S, Sahay A, Karnik N, Agrawal T, Dave V, Singh N, Shah A, Desai SB. Validation of Remote Digital Pathology based diagnostic reporting of Frozen Sections from home. J Pathol Inform 2023; 14:100312. [PMID: 37214151 PMCID: PMC10192998 DOI: 10.1016/j.jpi.2023.100312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/24/2023] Open
Abstract
Background Despite the promising applications of whole-slide imaging (WSI) for frozen section (FS) diagnosis, its adoption for remote reporting is limited. Objective To assess the feasibility and performance of home-based remote digital consultation for FS diagnosis. Material & Method Cases accessioned beyond regular working hours (5 pm-10 pm) were reported simultaneously using optical microscopy (OM) and WSI. Validation of WSI for FS diagnosis from a remote site, i.e. home, was performed by 5 pathologists. Cases were scanned using a portable scanner (Grundium Ocus®40) and previewed on consumer-grade computer devices through a web-based browser (http://grundium.net). Clinical data and diagnostic reports were shared through a google spreadsheet. The diagnostic concordance, inter- and intra-observer agreement for FS diagnosis by WSI versus OM, and turnaround time (TAT), were recorded. Results The overall diagnostic accuracy for OM and WSI (from home) was 98.2% (range 97%-100%) and 97.6% (range 95%-99%), respectively, when compared with the reference standard. Almost perfect inter-observer (k = 0.993) and intra-observer (k = 0.987) agreement for WSI was observed by 4 pathologists. Pathologists used consumer-grade laptops/desktops with an average screen size of 14.58 inches (range = 12.3-17.7 inches) and a network speed of 64 megabits per second (range: 10-90 Mbps). The mean diagnostic assessment time per case for OM and WSI was 1:48 min and 5:54 min, respectively. Mean TAT of 27.27 min per case was observed using WSI from home. Seamless connectivity was observed in approximately 75% of cases. Conclusion This study validates the role of WSI for remote FS diagnosis for its safe and efficient adoption in clinical use.
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Affiliation(s)
- Rajiv Kumar Kaushal
- Corresponding author at: Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr Ernest Borges Marg, Parel, Mumbai 400 012, India.
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Desai S. Digital pathology: an overview. CSI TRANSACTIONS ON ICT 2023. [PMCID: PMC10042104 DOI: 10.1007/s40012-023-00376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Diagnostic validation of a portable whole slide imaging scanner for lymphoma diagnosis in resource-constrained setting: A cross-sectional study. J Pathol Inform 2023; 14:100188. [PMID: 36714453 PMCID: PMC9874079 DOI: 10.1016/j.jpi.2023.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Background Telepathology utilizing high-throughput static whole slide image scanners is proposed to address the challenge of limited pathology services in resource-restricted settings. However, the prohibitive equipment costs and sophisticated technologies coupled with large amounts of space to set up the devices make it impractical for use in resource-limited settings. Herein, we aimed to address this challenge by validating a portable whole slide imaging (WSI) device against glass slide microscopy (GSM) using lymph node biopsies from suspected lymphoma cases from Sub-Saharan Africa. Material and methods This was part of a multicenter prospective case-control head-to-head comparison study of liquid biopsy against conventional pathology. For the portable WSI scanner validation, the study pathologists evaluated 105 surgical lymph node specimens initially confirmed by gold-standard pathology between February and December 2021. The tissues were processed according to standard protocols for Hematoxylin and Eosin (H&E) and Immunohistochemistry (IHC) staining by well-trained histotechnicians, then digitalized the H& E and IHC slides at each center. The digital images were anonymized and uploaded to a HIPAA-compliant server by the histotechnicians. Three study pathologists independently accessed and reviewed the images after a 6-week washout. The agreement between diagnoses established on GSM and WSI across the pathologists was described and measured using Cohens' kappa coefficient (κ). Results On GSM, 65.5% (n=84) of specimens were lymphoma; 25% were classified as benign, while 9.5% were metastatic. Morphological quality assessment on GSM and WSI established that 79.8% and 53.6% of cases were of high quality, respectively. When diagnoses by GSM were compared to WSI, the overall concordance for various diagnostic categories was 93%, 100%, and 86% for lymphoma, metastases, and benign conditions respectively. The sensitivity and specificity of WSI for the detection of lymphoma were 95.2% and 85.7%, respectively, with an overall inter-observer agreement (κ) of 0.86; 95% CI (0.70-0.95). Conclusions We demonstrate that mobile whole slide imaging (WSI) is non-inferior to conventional glass slide microscopy (GSM) for the primary diagnosis of malignant infiltration of lymph node specimens. Our results further provide proof of concept that mobile WSI can be adapted to resource-restricted settings for primary surgical pathology and would significantly improve patient outcomes.
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Key Words
- BL, Burkitt Lymphoma
- CAP, College of American Pathologists
- DLBCL, Diffuse Large B-cell Lymphoma
- GSM, Glass slide microscopy
- H&E, Hematoxylin and Eosin staining
- HL, Hodgkin’s Lymphoma
- IHC, Immunohistochemistry
- LMICs, Low-and-middle income countries
- Lymphoma diagnosis
- NPV, Negative predictive value
- PPV, Positive predictive value
- Portable whole slide imaging scanner
- Resource-limited setting
- Validation
- WSI, Whole slide imaging
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Kantasiripitak C, Laohawetwanit T, Apornvirat S, Niemnapa K. Validation of whole slide imaging for frozen section diagnosis of lymph node metastasis: A retrospective study from a tertiary care hospital in Thailand. Ann Diagn Pathol 2022; 60:151987. [PMID: 35700561 DOI: 10.1016/j.anndiagpath.2022.151987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The use of whole slide imaging (WSI) for frozen section (FS) diagnosis is helpful, particularly in the context of pathologist shortages. However, there is minimal data on such usage in resource-limited settings. This study aims to validate the use of WSI for FS diagnosis of lymph node metastasis using a low-cost virtual microscope scanner with consumer-grade laptops at a tertiary care hospital in Thailand. METHODS FS slides were retrieved for which the clinical query was to evaluate lymph node metastasis. They were digitized by a virtual microscope scanner (MoticEasyScan, Hong Kong) using up to 40× optical magnification. Three observers with different pathology experience levels diagnosed each slide, reviewing glass slides (GS) followed by digital slides (DS) after two weeks of a wash out period. WSI and GS diagnoses were compared. The time used for scanning and diagnosis of each slide was recorded. RESULTS 295 FS slides were retrieved and digitized. The first-time successful scanning rate was 93.6 %. The mean scanning time was 2 min per slide. Both intraobserver agreement and interobserver agreement of WSI and GS diagnoses were high (Cohen's K; kappa value >0.84). The time used for DS diagnosis decreased as the observer's experience with WSI increased. CONCLUSIONS Despite varying pathological experiences, observers using WSI provided accurate FS diagnoses of lymph node metastasis. The time required for DS diagnoses decreased with additional observer's experience with WSI. Therefore, a WSI system containing low-cost scanners and consumer-grade laptops could be used for FS services in hospital laboratories lacking pathologists.
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Affiliation(s)
| | - Thiyaphat Laohawetwanit
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Sompon Apornvirat
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kongkot Niemnapa
- Advanced Digital Simulation Center, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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Girolami I, Neri S, Eccher A, Brunelli M, Hanna M, Pantanowitz L, Hanspeter E, Mazzoleni G. Frozen section telepathology service: Efficiency and benefits of an e-health policy in South Tyrol. Digit Health 2022; 8:20552076221116776. [PMID: 35923756 PMCID: PMC9340333 DOI: 10.1177/20552076221116776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objective/Background Telepathology has been widely adopted to allow intraoperative pathology
examinations to be performed remotely and for obtaining second opinion
teleconsultation. In the Italian northern region of South Tyrol, the
widespread geographical distances and consequent cost for the health system
of having a travelling pathologist cover intraoperative consultations in
peripheral hospitals was a key driver for the implementation of a
telepathology system. Methods In 2010, four Menarini D-Sight whole slide scanners to digitize entire
pathology slides were placed in the peripheral hospitals of Merano,
Bressanone, Brunico, and in the hub hospital of Bolzano. Digital
workstations were also installed to allow pathologists to remotely perform
intraoperative consultations with digital slides. This study reviews the
outcome after 12 years of telepathology for this intended clinical use. Results After an initial validation phase with 100 cases which yielded a sensitivity
of 65% (CI 43–84%) and specificity of 100% (CI 95–100%), there were 2058
intraoperative consultations handled by telepathology. The cases evaluated
were mainly breast sentinel lymph nodes, followed by urological,
gynecological and general surgical pathology frozen section specimens. There
were no false-positive cases and 165 (8%) false-negative cases, yielding an
overall sensitivity and specificity of 65% (CI 61–69%) and 100% (CI
99–100%), respectively. Conclusion Telepathology is reliable for remote intraoperative diagnosis and, despite
technical issues and initial acquaintance issues, proved beneficial for
patient care in satellite hospitals, improved standardization, promoted
innovation, and resulted in cost savings for the health system.
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Affiliation(s)
- Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Stefania Neri
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Diagnostics and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Mattew Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Liron Pantanowitz
- Department of Pathology & Clinical Labs, University of Michigan, Ann Arbor, MI, USA
| | - Esther Hanspeter
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Guido Mazzoleni
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
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