Ramaswamy Veena, Tejaswini B N, Uthaiah Sowmya B
Department of Histopathology, Strand Life Sciences - Health Care Global Cancer Hospital, Bengaluru, Karnataka, India.
J Pathol Inform. 2021 Apr 8;12:20. doi: 10.4103/jpi.jpi_109_20. eCollection 2021.
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.
To demonstrate the validation and the operational feasibility of remote reporting using a digital pathology system.
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.
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.
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.
解剖病理学中的远程报告是数字病理学的一项重要优势，但尚未得到充分探索。新冠疫情为在三级医疗癌症中心探索数字病理学系统的这一重要应用提供了契机，以确保患者护理和工作人员安全。疫情后已出台远程报告的监管指南。在此，我们描述了远程报告数字病理工作流程的验证经验，以鼓励病理学家利用这一设施，为多学科协作打开大门。
证明使用数字病理系统进行远程报告的有效性和操作可行性。
我们的回顾性验证包括60例组织病理学全切片图像（WSIs）、20例冰冻切片以及经过3个月洗脱期后的基于数字图像的乳腺算法。三名使用不同型号消费级笔记本电脑的病理学家远程审查这些病例，以评估修改后工作流程的诊断一致性和操作可行性。切片在美国食品药品监督管理局（USFDA）批准的飞利浦UFS 300扫描仪上以×40分辨率（0.25μm/像素）数字化，并通过网络浏览器在图像管理系统上查看。报告每个病例的所有基本参数。成功验证后，从2020年3月29日至2020年6月30日对886例病例进行了前瞻性远程报告。光学显微镜检查是远程报告的金标准参考。
在回顾性和前瞻性研究中，使用消费级笔记本电脑进行远程报告验证时，主要诊断一致性达100%。延期率为0.34%。97.6%的组织病理学报告和100%的冰冻切片报告在周转时间内完成签署。网络速度和缺乏虚拟专用网络对研究没有显著影响。
这项对完整病理病例进行远程验证和报告的研究，包括其在公共卫生紧急情况下的操作可行性，证明使用数字病理系统进行远程签署报告并不逊色于在医学级显示器上查看的WSIs和光学显微镜检查。此类远程报告研究为数字病理在机构间咨询和协作中的应用打开了大门：这是其主要预期用途。
