Digital Pathology Blog

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Posted by Corista Marketing 08/09/2016

Digital Study Sets Come of Age

During a recent family dinner our 17-year old was discussing her post-high school plans, which led to a walk down memory lane for her parents. While sharing our own ”ancient” college experiences, she was intrigued (rather than horrified) to learn that I had spent the lion’s share of my last year as an undergrad in the morgue gathering specimens at autopsy. Seems old moms can be cool after all!

During my senior year, we were running a study (using specimens from posts) to search for a protocol that might lead to a pre-symptomatic diagnosis of pancreatic carcinoma – particularly for tumors located away from the duct, in the body or tail. Even then, finding a way to diagnose pancreatic CA “early” was the Holy Grail – and strongly correlated with a vastly better survival rate.

My senior thesis required the collection of dozens and dozens of pancreatic FNAs, which meant hundreds of smears were created and stained. In those long-ago days, this translated into box loads of unwieldy, fragile glass slides needing a permanent place where they could be organized and filed for future retrieval – slides that must be kept carefully segregated from those generated in our clinical lab. In addition, demographic data needed to be “attached” to correlate with microscopic findings. In short, a “study set” was created for each autopsy. In the dark ages of pathology, study sets consisted of a clear plastic “holder” containing a large sleeve to hold patient data on a 3” by 5” card, and four slender sleeves to hold glass slides.

Over time, there was inevitable attrition among our study sets. The plastic holders would crack as they aged. Irreplaceable slides would become broken. If not stained or coverslipped properly, slides would dry out or fade over time. Other slides might be borrowed for publication, presentation, teaching, or further study, and never returned to their sleeve. Often we would pull a much-needed study set, only to find a plastic sleeve containing a sole index card with no slides.

Fast-forward to today, and the valuable “study set” is now a dynamic, searchable, easily accessed, portable, sharable, and reproducible resource – no longer limited by the boundaries of geography or sample size or type of preparation. The advent of digital slides has transformed this cornerstone of pathology, making the creation of unlimited virtual study sets both simple and affordable. When incorporating searchable, text-based functionality across case metadata (tissue description, grossing data, demographics, patient history, and reports), pathologists gain a powerful tool for creating, annotating, sharing, storing, and coordinating cases for publication, training, and clinical utility. A few areas where digital study sets are of particular use include:

Correlation
Digital study sets seem tailor-made to document correlation in a wide array of comparative situations; histo-cyto, colposcopic-histo, and gross-micro. With the press of a button, images are quickly available for comparison – whether for QA, research, publication, teaching, or to build a more complete, robust diagnostic picture.

Changes over time
Watching a patient over time is critical when evaluating certain conditions. A good example is when patients undergo solid organ transplant. Over time, repeat serial biopsies are taken to assess for graft rejection and the health of the graft, to see if the primary disease has recurred. Digital slides make it possible to review all the former prior biopsies quickly and efficiently, and in context of the most recent biopsy.

Prognostic picture
Building prognostic study sets goes beyond the basic H&E or Pap stain. The ability to easily include immuno and molecular stains, photos of gross specimens, and even radiologic images, provide a more comprehensive picture upon which a tailored therapeutic protocol can be built. For a breast cancer patient, this might include several H&Es of the tumor (if the grading is heterogeneous throughout), along with immuno stains for ER, PR, and HER2 – and even a cytokeratin cocktail stain for micromets in an axillary node – all visible on a single screen.

Temporary preparations
Immuno and molecular fluorescent stains can vanish in the blink of an eye. Whether for clinical documentation, publication, or training, building digital study sets of these ephemeral slides provide the shelf life missing in their glass counterparts.

Training and test sets
When learning to diagnose rare lesions – or common ones for which there are challenging differential diagnosis – the only way to gain proficiency is extensive repetition. The ability to duplicate and share digital study sets removes any barrier to access, easily encouraging repeated exposure.

Recently, I uncovered a dusty archive box with the intent of going through the contents in preparation for disposal. It had been buried in the back of my office storage closet for decades, so I was fairly certain nothing precious was inside, but what a sight awaited me. It was filled to the brim with 35mm slides still loaded in their carousels, and old glass-based study sets stored in plastic sleeves. Not quite buggy whips, but antiques nonetheless. Using today’s digital slides, the entire box would fit into one small corner of a reproducible, pocket-size, multi terabyte drive, with room left over for plenty more!

Topics: Slide Management

Posted by Robin Weisburger 07/21/2016

Use Lean Thinking to Optimize Your QA Workflow



Pathology practices routinely use QA case reviews to detect potential errors and improve the quality of their service. The process of performing case reviews, however, varies not only between practices, but also between pathologists within the same practice. This variation leads to waste, resulting in a difficult to manage and labor-intensive process.

Reduce process waste by standardizing QA reviews using a digital approach. This approach increases throughput and reduces manual steps across your practice including its remote sites. Cases are tracked from their original interpretation through the entire QA review. Remediation actions are documented within the platform and may be exported to the LIS.

The digital platform automatically generates a summary report of all QA results, remediations and performance statistics. Reports are then available for both internal review to monitor trends and regulatory inspections.

The following Infographic demonstrates the improved QA workflow enabled by Corista’s digital pathology platform.

Topics: digital pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 06/21/2016

What Do Oncologists Think About Digital Pathology?

 

If the dialogue at ASCO this month was any indication, oncologists, who I tremendously respect, actually know about digital pathology.  In many instances their research and/or clinical facilities already use the technology.  Oncologists were familiar with whole slide scanning, image analysis and analytics, and the ability to have cases reviewed quickly without the need to transport glass slides – having seen it successfully used for tumor boards and education in their own institutions. 

Topics: digital pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 05/24/2016

I Have Lung Cancer

On a recent trip, to present at grand rounds at a well-known midwestern medical school, I noticed a dapper gentleman on my flight.  He was wearing a three-piece suit and carrying an impressive attaché case. He stood out among the many travelers dressed in shorts and flip-flops, and who probably wished they hadn’t when we reached our destination where the weather was not as friendly.

Topics: Pathology

Posted by Robin Weisburger 02/09/2016

Search – Find the cases & images you need, FAST

Whole slide scanning of pathology slides is becoming more affordable and convenient for building the foundation of a laboratory’s digital pathology service.  

Once you’ve obtained a whole slide scanner and your laboratory has developed an effective workflow for scanning images of pathology slides from your cases, you can store your whole slide images (WSI) on a server making them easily accessible from your laptop or tablet. As your image repository grows, however, finding the images you need becomes a challenge.

Most WSI directories are based on laboratory accession numbers.  When needing to access images to demonstrate certain features, whether for research, teaching, publication, creating digital study sets or other applications, you must first determine which cases will potentially have the images that best demonstrate what you want to show.

Topics: digital imaging

Posted by Keith Kaplan, MD, Chief Medical Officer 01/19/2016

A New Dawn is Upon Us

A Move by the FDA Signals Possible Classification for Patient Safety and Industry Collaboration

On Jan. 14, 2016, the Digital Pathology Association (DPA) issued a press release suggesting “digital pathology manufacturers currently interested in marketing whole slide imaging (WSI) devices for primary diagnosis in the United States submit de novo applications to the Food and Drug Administration (FDA).”

What exactly does this mean?

The press release goes on to say, “The FDA had previously stated it considered WSI for primary diagnosis to be a Class III medical device. However, FDA had never formally

Posted by Robin Weisburger 01/12/2016

Implementing Digital Pathology — A Peer-to-Peer Discussion

At Pathology Visions 2015 Corista hosted a reception featuring guest speaker, Dr. Arief Suriawinata, Chief of Anatomic Pathology at Dartmouth-Hitchcock Medical Center in Lebanon, NH. Dr. Suriawinata spoke on “The Dartmouth Experience: Whole Slide Imaging, Workflow and Quality Assurance”.

Dr. Suriawinata noted that while whole slide imaging is here to stay, its implementation is not without challenges in terms of integration, workflow, support, data storage and, last but not least, pathologists’ comfort. He emphasized that the key to successful implementation is a well-designed workflow providing whole slide images (WSI) of excellent quality to pathologists and residents where and when they need them.

Dartmouth-Hitchcock’s experience using WSI for its quality assurance program and how the program prepares pathologists for the utilization of telepathology generated a lively discussion on today’s key issues in digital pathology.

Topics: Slide Management

Posted by Keith Kaplan, MD, Chief Medical Officer 12/08/2015

The Rule of 70s – Does it Still Apply?

There is a decades-old theorem first derived at the Mayo Clinic that although based on little actual data has been popularized over the years stating:

  • 70% of patients in a hospital have laboratory data.
  • 70% of clinical data points (objective information) come from laboratory data.
  • 70% of clinical healthcare decisions result from laboratory tests.
  • These data account for less than 5-10% of healthcare costs.

This is a lot of bang for the buck. Imagine 70% of objective information assisting in 70% of healthcare decisions for as little as 5% of total healthcare expenditures.

Topics: Pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 11/17/2015

Is There a General Pathologist in the House

Almost 3 years ago I wrote a piece for Advance for Administrators of the Laboratory in their "Perspectives in Pathology" entitled Death of the General (Surgical) Pathologist.

This piece discussed the issues surrounding what is perceived by many as the increasing (and necessary) sub-specialization in pathology.  The model of "everybody doing everything” has evolved into “everybody doing one thing".

Historically, practicing pathologists were solid general surgical pathologists, often times with their own expertise/interest in a particular area, but they prided themselves on being "surgical pathologists" rather than "liver", "hemato-" or "dermato-" pathologists as in today’s world. A number of factors have driven and resulted in this trend.  

First and foremost, the needs of the market.  Dedicated specialists in breast or gastrointestinal diseases are commonplace in medicine including the radiologist, surgeon, oncologist and radiation therapist.  Pathology appropriately responded accordingly. Secondly, pathologists have driven some our own marketing and needs.  The resulting potential problems are paramount and based on many fallacies.

Topics: Pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 11/04/2015

The State of the Pathology Union

Dr. Keith Kaplan, Chief Medical Officer for Corista, LLC, offers his thoughts on “The State of Pathology Today” and some strategies for facing today’s challenges. 

Today, the state of pathology, along with our national leadership and organizations, seems fragmented and without direction. I attended the College of American Pathologists (CAP) and House of Delegates meetings earlier this month, and there seem to be a few issues which we cannot deal with as a group:

  • Needs of academics vs. community-based hospitals: From the need for AP/CP generalists in some settings to the need for sub-specialists in others, how do we best practice our specialty? We seem to be an increasingly heterogeneous group with loss of identity.  

Topics: Pathology