The Leeds Guide to Digital Pathology Volume 2 Building a National Digital Pathology Network National Pathology Imaging Co-operative

INTRODUCTION P3 CHAPTER 1 – MAINTAINING QUALITY IN THE LABORATORY P5 CHAPTER 2 – DIAGNOSTIC DIGITAL PATHOLOGY: CLINICAL USE P13 CHAPTER 3 – HOME REPORTING P21 CHAPTER 4 – MULTISITE DIGITAL PATHOLOGY DEPLOYMENT AND NATIONAL NETWORKS P29 CHAPTER 5 – ARTIFICIAL INTELLIGENCE P37 CHAPTER 6 – PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT P43 FINAL THOUGHTS P47 FURTHER RESO

INTRODUCTION It’s hard to believe how the world has transformed in the three years since the team first published “The Leeds Guide to Digital Pathology” in 2018. The COVID-19 pandemic forced everyone, including the pathology community to rise to new challenges. The flexibility and resilience offered by digital pathology have never seemed more important if we want to future-proof our diagnostic services and ensure we can continue to deliver a high-quality histopathology service in a timely manner. At Leeds, we were fortunate to have completed our initial scanner deployment of Aperio AT2 scanners,...

The foundation of quality digital diagnosis lies in the laboratory, where biomedical staff work exceptionally hard, often under challenging time constraints.

CHAPTER 1 – MAINTAINING QUALITY IN THE LABORATORY ISO accreditation for digital pathology diagnostic services The foundation of quality digital diagnosis lies in the laboratory, where biomedical staff work exceptionally hard, often under challenging time constraints. In this section, we will explore some of the key areas pertinent to quality and safety of laboratory digital pathology services, and find out how digitisation has impacted the laboratory and its staff over the last five years. Digital pathology deployment in the clinical laboratory represents a massive change management project....

Key tips 1. e prepared! Careful planning in the earliest stages of your deployment B can help lay the groundwork for successful inspection and accreditation. Identify key personnel who will be instrumental in delivering core aspects of the accreditation procedure, and compiling necessary evidence. 2. evelop and adhere to a full change control procedure. This should D include evidence surrounding the digital deployment proposal, health and safety assessments, validation and verification of equipment, external and internal quality assurance processes, IT user acceptance testing, standard operating...

Quality assurance Daily (Recommended) • Restart the scanner and console (PC) if present • Clean the touchscreen • Clean the scanner cover and light source • Clean the slide trays and carousel/loader • Sections should be free of folds, creases and bubbles. • issue should be placed centrally, within the scannable margins of T the glass slide. • Clean the objective and Koehler • Clear the slide stage tray • Clean the fan filter When Required • Light Source bulb replacement • Schedule annual maintenance visit by vendor The key steps to quality assurance of scanned slides are relatively simple, and...

Quality control in the laboratory Laboratory quality control is an important step in the histopathology process as it checks that digital slides being signed out of the laboratory are of adequate diagnostic quality. At digital QC the lab are checking for: • overall image quality • gross or focal loss of focus and the reason for this • are there areas of the image out of focus, and the reason Using digital images for the full laboratory quality control pathways Some laboratories check their glass slides for section and staining quality using standard light microscopy before they are sent to pathologists....

Interlaboratory comparisons As more and more laboratories move towards digital pathology, interlaboratory schemes will become easier to establish. Interlaboratory schemes enable laboratories to compare how their scanners are performing against other laboratories in the network/area. This ensures an element of standardisation across digital pathology in terms of image production and image quality. Laboratory staffing and training Ensuring staff are adequately trained and supported to use digital pathology systems safely and confidently is paramount. A two-pronged approach incorporating vendor...

PERSONAL PERSPECTIVE Sarah Caton

We’ve seen a lot of change in the laboratory since 2015, evolving from a single scanner installation to running a full clinical service, scanning 100% of our glass slides. We’ve implemented next generation scanners – four Aperio GT 450 DX scanners, which have changed the way we work. We have observed an 85% improvement in scanning efficiency compared with our previous scanners, and we have been able to incorporate digital pathology into other workflows including our autosectioner. One thing I would emphasize, is how important it is to try and keep everyone in the laboratory engaged and involved...

“Digital pathology has improved my turn around time for diagnosis by at least 30 seconds for each slide. It’s very easy and quick to navigate between areas in the same slide and between slides in a case, saving me time and effort navigating through large and complex cases. Dr Azzam Ismail Consultant Neuropathologist Leeds Teaching Hospitals NHS Tr

CHAPTER 2 – DIAGNOSTIC DIGITAL PATHOLOGY: CLINICAL USE St James University Hospital, Leeds, UK, is a major NHS cancer centre serving a population of 3 million patients, with a fully subspecialised diagnostic histopathology department. We’ve been integrating digital pathology into our standard clinical workflows over the past 5 years. 100% of histology slides are scanned in the laboratory, and accessible by our consultant and trainee pathologists on medical grade diagnostic workstations. Our first subspecialties to convert to digital microscopy for primary diagnosis were breast and neuropathology,...