are we nearly there yet? pathology digital imaging for primary diagnosis
TRANSCRIPT
Digital Pathology Symposium
Digital Imaging
NE England ‘Proof of Concept’ Trial
David Bottoms, NESCN Diagnostics Project Manager
Dr Kaushik Dasgupta, Consultant Pathologist
Pathology Digital Imaging for Primary Diagnosis
“Are we nearly there yet ?”
Aims
• Scanner quality/ reliability• Case management software • Quality of the images in comparison to traditional
microscopy• Pathologist Workstations • Speed• Imaging tools – annotation/ measurements• Trust to Trust image sharing• Access from home• Algorithmic Analysis
Objectives
Outcome Views :-
• Does it improve the quality of diagnosis/ provide better outcomes ?
• Does it speed up diagnosis ?
• What are the constraints ?
• What would be the impact from an IM&T perspective ?
• Is it ‘affordable’ ?
Scope of Involvement
Digital Pathology deployments by phase
Durham North Tees South Tees
Phase 1
Phase 2
Northumbria
Newcastle Royal Infirmary
Gateshead
SunderlandMDT
Lessons from my tryst (KD)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)
The live experience
4 5
28
46
12
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)
Rescans
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
Time cf glass
Glass needed
Pass the glass
Diagnostic Discordance (6)1.35% minor 0.69 % major (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
CONFIDENCE TREND
Summary (289 cases)
• Quality benefits- Breast, cervix- accuracy• NHSBCSP and CRC- quality neutral• Steep learning curve/mental barrier• Work flow, remote site reporting, virtual academy
of specialists• Much slower for single slide, few fragments, low
complexity cases (skin, GI, endometrium)• CAUTION- Subtle foci of malignancy in a large
volume- TURP, re resection of bladder tumours, post NAC breast/colon (ROI tool?)
Results
No of Cases Tissues
N Tees 983 (5 Consultants) Breast, GI, Gynae, Head and Neck, Respiratory, Skin and Urology
CDDFT 320 (2 Consultants) Breast (2), GI(49), Gyn(22) H&N(4), Skin (56),Uro(3), Other(9)
Gateshead 90 (1 Consultant) Breast, GI, Gyn, H&N, Skin, Uro, Soft Tissue
Northumbria 32 (1 Consultant) Breast, GI, Gynae, Head and Neck, Respiratory, Skin and Urology
Newcastle 12 (1 Consultant) Soft tissue, Lymphoma
S Tees 17 (3 Consultants) Prostate cores, kidney endometrial, Lletz biopsy cervix, pleural, renal, GI
Key Issues
• Time available (for Pathologists to review cases)
• Trust to Trust IT Firewalls
• IM&T Resource/ Involvement
• IM&T Storage Strategy
• Technology currently does not accommodate megablocks, fluorescence, polarisation, gynae-cytology
• RC Path guidance – (in the making)
• ‘Challenging’ for larger cases
• Affordability – pump priming – invest to save
Key Benefits
• Faster for an estimated 80% of general work• Measurements considerably quicker and reproducible• Algorithms save considerable time – reproducible – lab based • Can provide better outcomes for patients – grading/ staging• With LIMS I/F would significantly reduce ‘wrong slide’ risks• Better workload management – urgent cases – referrals to
specialists – workload balancing – pull vs push• Excellent for ‘sharing’ expertise/ knowledge/ opinions - annotations• Saves a lot of technical time – tissue exchange/ slide retrieval/ MDT
prep/ archiving• Improved access to images via web – mortuaries/ MDT rooms/
Home• Brilliant for training & education• LEAN
Objectives
Outcome Views :-• Does it improve the quality of diagnosis/ provide better
outcomes ? – yes – better staging• Does it speed up diagnosis ? – too short/ small a study
to be sure but overall feeling was ‘yes’ • What are the constraints ? – funding/ implementation
resource/ transition• What would be the impact from an IM&T perspective ?
– all ‘doable’ if they’re on-board from the start• Is it ‘affordable’ ? – only with pump-prime funding –
however the ROI should be worthwhile
Aims/ Outcomes
• Scanner quality/ reliability – No issues/ Reliable• Case management software – Easy to Use / Improvement • Quality of the images in comparison to traditional
microscopy – As good/ Acceptable• Pathologist Workstations – Easy to Use/ Learn• Speed – Improves with experience/ quicker once learnt• Imaging tools – annotation/ measurements - brilliant• Trust to Trust image sharing – worked without delays/
diagnostic quality• Access from home – worked without delays/ diagnostic
quality• Algorithmic Analysis – excellent/ reproducible
What Next ?
• Business Case– Regional ‘Academy of Pathologists’ approach
preferred
– Recent ‘sign-up’ in principle by 7 CEOs encouraging
– However still requires pump-prime funding they don’t have
– Needs greater support from NHS Digital, National Cancer Capacity Funding to get what is seen as a new, unproven technology onto a ROI testbed.
Thanks
• To All Consultants and Lab staff who took part
• Staff from GE Omnyx for their generous support of the project
• To Trust IM&T depts. for supporting the interconnectivity infrastructure
• Any questions ??– [email protected]