Remote digital pathology allows healthcare systems to maintain pathology operations during public health emergencies. Existing Clinical Laboratory Improvement Amendments regulations require pathologists to electronically verify patient reports from a certified facility. During the 2019 pandemic of COVID-19 disease, caused by the SAR-CoV-2 virus, this requirement potentially exposes pathologists, their colleagues, and household members to the risk of becoming infected. Relaxation of government enforcement of this regulation allows pathologists to review and report pathology specimens from a remote, non-CLIA certified facility. The availability of digital pathology systems can facilitate remote microscopic diagnosis, although formal comprehensive (case-based) validation of remote digital diagnosis has not been reported. All glass slides representing routine clinical signout workload in surgical pathology subspecialties at Memorial Sloan Kettering Cancer Center were scanned on an Aperio GT450 at ×40 equivalent resolution (0.26 µm/pixel). Twelve pathologists from nine surgical pathology subspecialties remotely reviewed and reported complete pathology cases using a digital pathology system from a non-CLIA certified facility through a secure connection. Whole slide images were integrated to and launched within the laboratory information system to a custom vendor-agnostic, whole slide image viewer. Remote signouts utilized consumer-grade computers and monitors (monitor size, 13.3-42 in.; resolution, 1280 × 800-3840 × 2160 pixels) connecting to an institution clinical workstation via secure virtual private network. Pathologists subsequently reviewed all corresponding glass slides using a light microscope within the CLIA-certified department. Intraobserver concordance metrics included reporting elements of top-line diagnosis, margin status, lymphovascular and/or perineural invasion, pathology stage, and ancillary testing. The median whole slide image file size was 1.3 GB; scan time/slide averaged 90 s; and scanned tissue area averaged 612 mm 2. Signout sessions included a total of 108 cases, comprised of 254 individual parts and 1196 slides. Major diagnostic equivalency was 100% between digital and glass slide diagnoses; and overall concordance was 98.8% (251/254). This study reports validation of primary diagnostic review and reporting of complete pathology cases from a remote site during a public health emergency. Our experience shows high (100%) intraobserver digital to glass slide major diagnostic concordance when reporting from a remote site. This randomized, prospective study successfully validated remote use of a digital pathology system including operational feasibility supporting remote review and reporting of pathology specimens, and evaluation of remote access performance and usability for remote signout.

Elevated Oxidative Damage in KitchenWorkers in Chinese Restaurants: Jiajia Wang, et al. School of Public Health, Sun Yat-Sen University, China-Objectives: To investigate associations between occupational exposure to cooking oil fumes (COFs) and potential oxidative and genotoxic effects in kitchen workers. Methods: Sixty-seven male kitchen workers and 43 male controls from Chinese restaurants in Guangzhou were recruited. For all the participants, the levels of 1-hydroxypyrene (1-OHP) and 8-hydroxy-2-deoxyguanosine (8-oxodG) in urine, binucleated micronucleus (BNMN) frequency, comet tail length and tail DNA% in peripheral blood lymphocytes (PBLs) and malondialdehyde (MDA) and superoxide dismutase (SOD) in serum were measured. The inhalable particulates (PM 10 ) in their workplaces were also monitored. Results: Our results showed that the exposed group had a significantly higher median level of urinary 1-OHP than that of the control group (p<0.01). In addition, the median levels of 8-oxodG, BNMNs, tail length and MDA in the exposed group were markedly higher than those of the controls (p<0.01). These differences, except that of MDA, appeared not to be modified by the potential confounders: age, BMI, smoking and alcohol consumption. A univariate regression analysis showed that greater 1-OHP, 8-oxodG, BNMNs, tail length and MDA were associated with years working in a kitchen and cooking time per day. All these positive associations remained after adjusting for the four confounders in a subsequent multivariate linear regression analysis. Conclusions: Occupational exposure to COFs led to increased oxidative damage in Chinese kitchen workers. The health consequences of these oxidative changes need further investgation. Urinary 1-OHP and 8-oxodG are noninvasive and effective biomarkers for assessment of oxidative damage in restaurants workers. (J Occup Health 2011; 53: 327-333)

In this study, PF, location of tumor, and age were significant predictors of clear-cell RCC histopathology. The correlation of PF and histopathology may be useful in preoperative decision-making and surgical planning in the management of small RCN.

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