Implementation of large-scale routine diagnostics using whole slide imaging in Sweden: Digital pathology experiences 2006-2013

Abstract

Recent technological advances have improved the whole slide imaging (WSI) scanner quality and reduced the cost of storage, thereby enabling the deployment of digital pathology for routine diagnostics. In this paper we present the experiences from two Swedish sites having deployed routine large-scale WSI for primary review. At Kalmar County Hospital, the digitization process started in 2006 to reduce the time spent at the microscope in order to improve the ergonomics. Since 2008, more than 500,000 glass slides have been scanned in the routine operations of Kalmar and the neighboring Linköping University Hospital. All glass slides are digitally scanned yet they are also physically delivered to the consulting pathologist who can choose to review the slides on screen, in the microscope, or both. The digital operations include regular remote case reporting by a few hospital pathologists, as well as around 150 cases per week where primary review is outsourced to a private clinic. To investigate how the pathologists choose to use the digital slides, a web-based questionnaire was designed and sent out to the pathologists in Kalmar and Linköping. The responses showed that almost all pathologists think that ergonomics have improved and that image quality was sufficient for most histopathologic diagnostic work. 38 ± 28% of the cases were diagnosed digitally, but the survey also revealed that the pathologists commonly switch back and forth between digital and conventional microscopy within the same case. The fact that two full-scale digital systems have been implemented and that a large portion of the primary reporting is voluntarily performed digitally shows that large-scale digitization is possible today.

Functional Assessment of Synoptic Pathology Reporting for Ovarian Cancer

“…Many pathology laboratories have questioned if digital pathology should be considered for large-scale implementation in routine clinical practice. The number of institutions that adopt digital pathology is limited because of the high costs and the complexity of digital pathology equipment [11,20,29]. …”

“…The concept of digital pathology refers to the use of information technology that supports the creation, sharing or exchange of information, including data and images, in order to support the complex workflow from clinician requests to the pathomorphological reporting [10,11,12]. …”

Interinstitutional Whole Slide Imaging Teleconsultation Service Development: Assessment Using Internal Training and Clinical Consultation Cases

“…Similar quality-control processes have been described in WSI operations at the University of Pittsburgh Medical Center 19 and in 2 facilities in Sweden. 10 Furthermore, the College of American Pathologists' guidelines recommend this assessment as part of the validation process 17 ; our recommendation is to include this assessment as part of the clinical scanning workflow as well. Finally, the quality of WSIs is known to be linked to the quality of the GS preparation.…”

“…Improvements in the technology during the past several years, coupled with better understanding of pitfalls and caveats of the digital pathology environment and reduced costs for instrumentation, networking, and memory, have allowed for a greater understanding of the promise and the remaining challenges. Many studies have shown potential alternatives or improvements to traditional pathology practice through use of WSI technology in intraoperative frozen section interpretations, [1][2][3] image analysis applications with hematoxylin-eosin stains 4 and immunohistochemical and special stains, 5 in archiving and quality assurance programs, 6,7 for primary diagnosis, 8,9 for potential laboratory workflow improvements and pathologist ergonomics, 10 with laser-capture microdissection 11 (and thus burgeoning molecular testing methods), and for consultation purposes. 12 Teleconsultation with WSI could improve consultation services by dramatically decreasing the turnaround time, compared with shipping glass slides; decrease the amount of pathologist labor required in interpretation versus nonrobotic or robotic, dynamic (video) telepathology (using either remote personnel or a robotic control of the microscope, respectively); remove the selection bias of static telepathology (transmission of micrographs); improve collaboration between the consult requestor and the consultant (through use of annotation features within WSI viewing software); and provide greater opportunities for quality assurance, archiving, and education.…”

International Clinical Guidelines for the Adoption of Digital Pathology: A Review of Technical Aspects

“…However, WSI technology is only emerging in clinical practice, and, until now, it is mainly employed in education and research in pathology [4,5,6]. …”