What is Essential is (No More) Invisible to the Eyes: The Introduction of BlocDoc in the Digital Pathology Workflow

Abstract

Background: The implementation of a fully digital workflow in any anatomic pathology department requires a complete conversion to a tracked system. Ensuring the strict correspondence of the material submitted for the analysis, from the accessioning to the reporting phase, is mandatory in the anatomic pathology laboratory, especially when implementing the digital pathology for primary histological diagnosis. The proposed solutions, up to now, rely on the verification that all the materials present in the glass slide are also present in the whole slide images (WSIs). Although different methods have already been implemented for this purpose (e.g., the “macroimage” of the digital slide, representing the overview of the glass slide), the recent introduction of a device to capture the cut surface of paraffin blocks put the quality control of the digital workflow a step forward, allowing to match the digitized slide with the corresponding block. This system may represent a reliable, easy-to-use alternative to further reduce tissue inconsistencies between material sent to the lab and the final glass slides or WSIs. Methods: The Anatomic Pathology of the Gravina Hospital in Caltagirone, Sicily, Italy, has implemented the application of the BlocDoc devices (SPOT Imaging, Sterling Heights, USA) in its digital workflow. The instruments were positioned next to every microtome/sectioning station, with the possibility to capture the “normal” and the polarized image of the cut surface of the blocks directly by the technician. The presence of a monitor in the BlocDoc device allowed the technician to check the concordance between the cut surface of the block and the material on the corresponding slide. The link between BlocDoc and the laboratory information system, through the presence of the 2D barcode, allowed the pathologists to access the captured image of the cut surface of the block at the pathologist workstation, thus enabling the direct comparison between this image and the WSI (thumbnail and “macroimage”). Results: During the implementation period, more than 10.000 (11.248) blocks were routinely captured using the BlocDoc. The employment of this approach allowed a drastic reduction of the discordances and tissue inconsistencies. The implementation of the BlocDoc in the routine allowed the detection of two different types of “errors,” the so-called “systematic” and “occasional” ones. The first type was intrinsic of some specific specimens (e.g., transurethral resection of the prostate, nasal polypectomies, and piecemeal uterine myomectomies) characterized by the three-dimensional nature of the fragments and affected almost 100% of these samples. On the other hand, the “occasional” errors, mainly due to inexperience or extreme caution of the technicians in handling tiny specimens, affected 98 blocks (0.9%) of these samples and progressively reduced with the rising confidence with the BlocDoc. One of these cases was clinically relevant. No problems ...

The slow-paced digital evolution of pathology: lights and shadows from a multifaceted board

“…This transition can include a fully tracked and automated workflow 1 , 6 starting even before the sample arrives at the pathology department, with the integration of the pathology laboratory information system (LIS) with the hospital’s Electronic Medical Record (EMR) Software 15 and the use of 2D barcodes for automated, paperless sampling 6 . Subsequent phases, such as grossing and archiving, can also be tracked and automated using macro capture cameras, speech-to-text devices, barcodes and BlocDoc 2 , 16 , 17 . The selection of the appropriate scanning device for routine diagnostics should be based on the specific needs of each department 7 , 18 , such as workload and field of interests.…”

“…DP can also facilitate cyto-histological correlation, as demonstrated in cervical cancer screening 30 , optimising costs and effort involved 30 , 35 . In addition, a streamlined workflow with barcodes and barcode readers significantly reduces laboratory errors 36 such as identify and mix-up problems 1 ; transcription errors can be avoided with automated printers, and reading and matching errors thanks to the integration of patient information, gross images, BlocDoc images and digital slides on the same page through Laboratory Information System 2 . Finally, DP can improve reproducibility and accuracy in tasks such as estimating the percentage of Ki-67-positive cells or evaluating PD-L1 immunohistochemistry 37 , 38 by automatic validated web-based tools.…”

“…As discussed in the recent literature 1-4 , the implementation of DP involves a fully tracked and automated pathology workflow, as well as the standardisation and interoperability of processes with the potential use of artificial intelligence (AI) tools for primary diagnosis with WSI. A gradual integration of hardware 5 and software 1 , 6 modifications and the implementation of quality control (QC) checkpoints 2 , 7 during sample processing can ease the transition to DP. Although some guidelines and recommendations exist 8 , few pathology departments have completed a full transition to DP 9-11 , in Italy like in the rest of the world.…”

Real-world digital pathology: considerations and ruminations of four young pathologists

“…For example, digital pictures document each stage of specimen life (figure 2). 2 4 5 These are automatically shown in the laboratory information system (LIS), giving operators an opportunity to (1) quickly notice if an error occurs, (2) determine exactly when it happened and thus (3) amend it and take actions to prevent similar future errors. Common errors thus detected include not cutting deep enough into the paraffin to reveal all fragments in the block and malfunctions in the scanner excluding pieces of tissue from the digital slide.…”

Digital pathology all stars

“…This allows all digitized slides to be matched and tracked with their corresponding blocks. 9 The barcode on the block is used to upload these images directly into the case within the laboratory image system (LIS). For high-volume scanning to succeed and have all digital slides linked to the correct cases in the LIS, all glass slides must ideally have a barcode.…”