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Digital Frozen Section Pathology Acp Manchester 2012

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Digital Frozen Section Pathology Acp Manchester 2012

  1. 1. Digital Frozen Section Pathology:Validation and Implementation at The Royal Brompton & Harefield Hospital s Dr Brian Mitchelson Histology Supervisor -Harefield Hospital The Royal Brompton & Harefield NHS Foundation Trust
  2. 2. Our problems!► Firstly the two hospital sites are 20 miles apart.► Harefield currently has 1 resident Associate Specialist Histopathologist.► The Royal Brompton has 3 Consultant Histopathologists, one of whom shares her time between the Brompton and Harefield sites.► This could cause potential problems for frozen section diagnosis if no Consultant was available for difficult cases at the Harefield site. The Royal Brompton & Harefield NHS Foundation Trust
  3. 3. Our Solution►The Aperio Scanscope system was purchased in 2009 with a view to overcoming this problem by utilising Digital Microscopy to view the frozen section slides remotely. The Royal Brompton & Harefield NHS Foundation Trust
  4. 4. The Harefield Laboratory The Royal Brompton & Harefield NHS Foundation Trust
  5. 5. Validation Methodology► Frozen sections were prepared and reported as usual at Harefield Hospital.► Once the slides had been reviewed by a Harefield pathologist and the result phoned to the surgeon in theatre, the slides were scanned at x20 magnification on the ScanScope machine.► The reporting pathologist on duty at the Royal Brompton Hospital (RBH) was informed a frozen section was being scanned.► Once scanning was complete, he/she logged onto the remote server and blindly reviewed and reported the scanned images. The Royal Brompton & Harefield NHS Foundation Trust
  6. 6. Methodology (cont’d)► The pathologists then entered their frozen section report onto separate databases to ensure impartiality.► The time taken to scan the slides and to remotely report the frozen section slides was also noted.► Once approx. 50 frozen sections had been reported: the concordance in diagnosis, average time for scanning and average reporting times were assessed. The Royal Brompton & Harefield NHS Foundation Trust
  7. 7. Recording the data RBH Time arrived in Time scan time to FS Case the Time reported completed reportTest Date type No. laboratory HH HH (seconds) 1 ######## LN 09P1552 12:00:00 12:15:00 12:20:00 30 2 ######## Lung 09P1576 16:15:00 16:40:00 16:45:00 90 3 ######## LN 09P1601 10:30:00 10:45:00 10:55:00 90 09P1616 4 ######## LN A 09:15:00 9:35:00 09:55:00 60 The Royal Brompton & Harefield NHS Foundation Trust
  8. 8. Our Findings► The initial results were very encouraging and show an almost 100% concordance of diagnosis within minutes of being available.► To date we have scanned several hundred cases with an average time for the x20 scan being 4 minutes.► The average time from completion of the scan to reporting at the Royal Brompton is approximately 90 seconds. The Royal Brompton & Harefield NHS Foundation Trust
  9. 9. Results. ResultsBetween November 2009 and October 2010, 49 cases were scannedand reported.These included single and multiple frozen sections, totalling 73 frozensection slides.The specimen type was as follows;Lymph node = 19, Lung = 32, Pleura = 6, chest wall = 3.The average time from end of reporting, at Harefield, to completion ofscan was 6.3 minutes.The average time to review the slides was 64 secs.There was 98% complete concordance in diagnosis made on review ofthe histological section and of the digitised image. The Royal Brompton & Harefield NHS Foundation Trust
  10. 10. Our one discrepancyOnly one case showed a minor discrepancybetween the two reports, which had no effect onpatient treatment.This case was a lung nodule removed from a patientwith known CLL. Both pathologists reported thepresence of necrosis with granulomatousinflammation and a small lymphocytic infiltrate.The possibility of lymphoma was raised by theHarefield pathologist (to whom the history of CLLwas known), but not by the Brompton pathologist(who was not aware of the history of CLL). The Royal Brompton & Harefield NHS Foundation Trust
  11. 11. Validation Process► All the data we recorded was tabulated and presented to the Trust Clinical Practice Committee.► All the procedures were carried out in accordance with the Guidelines set out by the Royal College of Pathologists in 2005.► We formally requested that in view of the data submitted that approval be granted to use this technique for reporting frozen section pathology when the need arises.► Approval of the technique was then given for surgical pathology use in frozen section reporting, when required. The Royal Brompton & Harefield NHS Foundation Trust
  12. 12. Case A - 79 year old maleFrozen Section Specimen - Jugular LN ► Right lung base lesion with supraclavicular lymph nodes on the right side ► FS Diagnosis – Hodgkins Lymphoma The Royal Brompton & Harefield NHS Foundation Trust
  13. 13. The paraffin processed block ► Final diagnosis : Nodular Hodgkins Lymphoma, nodular lymphocyte predominant type, with prominent T- cell/hystiocyte rich B-cell lymphoma like areas The Royal Brompton & Harefield NHS Foundation Trust
  14. 14. Case B - 73 year old maleFrozen Section Specimen- Apical segment of RLL ► RLL mass, ? Malignancy, previous bowel cancer2007, ► chemotherapy ► FS Diagnosis – adenocarcinoma The Royal Brompton & Harefield NHS Foundation Trust
  15. 15. The paraffin processed block ► Final diagnosis : RLL apical segmentectomy: metastatic colorectal carcinoma The Royal Brompton & Harefield NHS Foundation Trust
  16. 16. Case C - 60 year old femaleFrozen Section Specimen- Right Parietal Pleura ► Pleura coated with talc, shortness of breath, right pleural effusion, pleural thickening, previous lump excision of breast ► FS Diagnosis – malignant epithelioid tumour The Royal Brompton & Harefield NHS Foundation Trust
  17. 17. The paraffin processed block ► Final diagnosis : malignant epitheliod tumour, ► OR, PR, Calretinin, and CK5/6 negative, ► BerEP4, CEA and TTF-1 positive. ► The profile is in keeping with metastatic adenocarcinoma from a lung primary The Royal Brompton & Harefield NHS Foundation Trust
  18. 18. Conclusions► The current data suggests this is a clinically useful system; with only a minimal time delay in reporting the frozen section diagnosis.► Diagnosis was found to be no more problematic than using a conventional microscope and in many cases was made easier due to the large screen image and zoom magnification.► Other potential benefits include second opinions, referrals and teaching. The Royal Brompton & Harefield NHS Foundation Trust
  19. 19. In Summary► The image quality is excellent► The accessibility is rapid and simple► Real time image handling is a benefit► The more we use the system the more uses and benefits we are finding for this instrument: Cross-site referrals: this saves transferring slides from one hospital to the other MDT meetings: allowing real time image handling and auditing cases on either site. The Royal Brompton & Harefield NHS Foundation Trust
  20. 20. The EndThank you for your attention Brian The Royal Brompton & Harefield NHS Foundation Trust

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