Being fully digital: perspective of a Dutch academic pathology laboratory.

Nikolas Stathonikos,Tri Q Nguyen,Clothaire P Spoto,Paul J Van Diest,Marina A M Verdaasdonk

doi:10.1111/his.13953

Abstract

The introduction of fast and robust whole slide scanners has facilitated the implementation of ‘digital pathology’ with various uses, the final challenge being full digital diagnostics. In this article, we describe the implementation process of a fully digital workflow for primary diagnostics in 2015 at the University Medical Centre in Utrecht, The Netherlands, as one of the first laboratories going fully digital with a future‐proof complete digital archive. Furthermore, we evaluated the experience of the first 2 years of working with the system by pathologists and residents. The system was successfully implemented in 6 months, including a European tender procedure. Most pathologists and residents had high confidence in working fully digitally, the expertise areas lagging behind being paediatrics, haematopathology, and neuropathology. Reported limitations concerned recognition of microorganisms and mitoses. Neither the age of respondents nor the number of years of pathology experience was correlated with the confidence level regarding digital diagnostics. The ergonomics of digital diagnostics were better than those of traditional microscopy. In this article, we describe our experiences in implementing our fully digital primary diagnostics workflow, describing in depth the implementation steps undertaken, the interlocking components that are required for a fully functional digital pathology system (laboratory management, hospital information systems, data storage, and whole slide scanners), and the changes required in workflow and slide production.

Highlights

The introduction of fast and affordable whole slide scanners has facilitated the implementation of ‘digital pathology’: viewing digital whole slide images (WSIs) on computer screens instead of using the traditional microscope
In The Netherlands, many pathology laboratories have at least some affinity with digital pathology, either by owning a digital slide scanner, participating in slide panels hosted on digital pathology systems, or attending/providing educational lectures based on digital slides
The people who responded that the quality of scanned slides is good enough only for a minority of cases were mainly working in paediatrics, haematopathology, and neuropathology

Summary

Introduction

The introduction of fast and affordable whole slide scanners has facilitated the implementation of ‘digital pathology’: viewing digital whole slide images (WSIs) on computer screens instead of using the traditional microscope. The utility of digital pathology includes archiving,[1] research,[2] teaching,[3,4] facilitating multidisciplinary meetings,[1] remote diagnosis, e.g. for frozen sections,[5] remote consultation,[6] and primary diagnostics.[7–10]. It is not a surprise that the overall adoption of digital pathology has increased in the past. Over the past few years, digital pathology has become more widely adopted in pathology laboratories around the world. Of the 45 pathology laboratories in The Netherlands, 16 own a digital slide scanner, including the eight academic pathology laboratories, and many more have serious plans to buy hardware. The adoption of digital pathology for primary diagnostics has remained relatively low, despite widespread validation of digital pathology for primary diagnostics.[12,13]

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Results

Conclusion