with digital pathology Dr K Dasgupta Complaints from analogue - - PowerPoint PPT Presentation

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with digital pathology Dr K Dasgupta Complaints from analogue - - PowerPoint PPT Presentation

Dec 29, 2022 856 likes •1.08k views

Lessons from my tryst with digital pathology Dr K Dasgupta Complaints from analogue pathology Uncertainty of measurement (MoU 0.01mm accuracy for melanoma) Ergonomic and work flow problems Rooted Delayed collaboration Approaches

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SLIDE 1

Lessons from my tryst with digital pathology

Dr K Dasgupta

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SLIDE 2

Complaints from analogue pathology

  • Uncertainty of measurement (MoU

0.01mm accuracy for melanoma)

  • Ergonomic and work flow problems
  • Rooted
  • Delayed collaboration
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SLIDE 3

Approaches to pilot: to each his own

  • Direct access to referral material
  • Exception reporting
  • Limited wash
  • Full wash out
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SLIDE 4

Will it all come out in the wash?

  • 100% concordance
  • Confident use of tools
  • Confident of low power

dx

  • 5/103 (4.8%) rescans
  • More time than

analogue (subjective)

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SLIDE 5

The live experience

4 5 28 46 1 2 10 1 22 19 1 22 3 19 1 2

Total

Axillary Nodes Bladder biopsy Breast biopsy Breast resection Breast Sentinel LN Cervical biopsy Cervical loop Gallbladder GI biopsy GI polyp Liver biopsy

Tissue Type Count of Episode Number

186 cases, (24 off site/digital home reporting)

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SLIDE 6

Rescans

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SLIDE 7

Special stains and IHC

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SLIDE 8

Time and analogue

31.72% 31.72% 36.02% 0.54%

Total

less longer same (blank)

Time to assess case cf glass Count of Episode Number

72.28% 27.72%

Total

no yes

Glass Required For Si... Count of Episode Number

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SLIDE 9

Pass the glass

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SLIDE 10

Diagnostic Concordat (6) 1.35% major 0.69 % minor (2%)

Glass Required For Sign Out (Y/N) If Yes state reason Diagnostic Concordance (Y/N) If No state reason no no Underscoring of mitosis in scans yes lack of confidence no Difficult for VIN 1,2 at margins yes lack of confidence no Missed small foci of invasion yes lack of confidence no hazy scan yes lack of confidence no mucosal prolapse in C yes difficult case no Partial atrophy mimicking cancer

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SLIDE 11

CONFIDENCE TREND

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SLIDE 12

Summary (289 cases)

  • Huge quality benefits- Breast, prostate,

cervix- accuracy

  • NHSBCSP and CRC- quality neutral
  • Steep learning curve- persistent use
  • Work flow, remote site reposting, virtual

academy of specialists

  • Dearly missed for above categories
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SLIDE 13

Summary Cont’d

  • Much slower for single slide, few

fragments, low complexity cases (skin, GI, endometrium)

  • Mental barrier for challenging cases
  • CAUTION- Subtle foci of malignancy in a

large volume- TURP, re resection of bladder tumours, post NAC breast/colon

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SLIDE 14

Necessary improvements

  • Analogous to the ease of text annotation
  • f slide label
  • Microns to be converted to decimals of

mm

  • Even better focus at lowest magnificatioon
  • Better white balance with ambient

illumination

  • Memory of personal settings
  • Image stitching capability
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SLIDE 15

Future directions

  • Tumour finding tool
  • Grading algorithm
  • Biomarker scoring algorithm
  • Morphometry and image analysis
  • Image superimposition for difficult tumours
  • Man from Istanbul problem (Rosai)
  • Quantitative proteomics
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SLIDE 16

Barriers to implementation

  • Financial
  • Inertia and comfort
  • Enforcement and apprehension
  • Over enthusiasm for all that’s new and

contempt for old

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SLIDE 17

Conclusion

  • How did IHC and molecular pathology get

introduced in surgical pathology?

  • Need to distinguish between core and non

core aspect

Finance Efficiency Quality

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SLIDE 18

Conclusion

  • Critical mass
  • To gain momentum
  • Join the bandwagon
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SLIDE 19

THANK YOU ACKNOWLEDGEMENTS T WING, GE OMNYX D BOTTOMS S WILLIAMS D MEAD IT, UHNT