1. The use of Digital Microscopy in
Cross-site Frozen Section Diagnosis
The Royal Brompton and Harefield Hospitals’
Experience of the Aperio Scanscope System
Dr Brian Mitchelson
The Royal Brompton & Harefield NHS
Foundation Trust

2. The Harefield Laboratory
The Royal Brompton & Harefield NHS
Foundation Trust

3. 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

4. Our Solution
 The Scanscope system was purchased in 2009
with a view to overcoming this problem.
 As a test of the systems’ efficacy we have
monitored the system by scanning the frozen
section slides immediately after diagnosis at
Harefield and informing the Royal Brompton
pathologists that a frozen section was on the
server ready for a second opinion.
The Royal Brompton & Harefield NHS
Foundation Trust

5. Protocol
 The slide is routinely scanned at x20
magnification using either the “One Touch”
scanning, or “Manual Scan”.
 The specimen details are entered on the case file
 The Royal Brompton pathologists are informed
that a frozen section is on the server ready for
reporting
 Should the pathologist require a x40 scan they
will telephone the request through to the lab and
discuss the area of the section to be scanned.
The Royal Brompton & Harefield NHS Foundation Trust

6. The Results
 The initial results are very encouraging and have shown
a 100% concordance of diagnosis within minutes of
being put on the server.
 To date we have scanned over 50 cases with an average
time for the x20 scan being 4 minutes.
 The average time from the scan completing to
reporting at the Brompton of just over 1min 30 sec
 A further benefit is the ability for several pathologists
to view sections simultaneously from multiple locations
and also in the teaching of frozen section diagnosis.
The Royal Brompton & Harefield NHS
Foundation Trust

7. Case-1 79 year old male
Frozen Section Specimen - Jugular LN
 Right lung base lesion
with supraclavicular
lymph nodes on the
right side
 FS Diagnosis –
Hodgkin's Lymphoma

8. The paraffin processed block
 Final diagnosis:
Nodular Hodgkin's
Lymphoma, nodular
lymphocyte predominant
type, with prominent T-
cell/hystiocyte rich B-cell
lymphoma like areas

9. Case-2 73 year old male
Frozen Section Specimen- Apical segment of RLL
 RLL mass, ? Malignancy,
previous bowel cancer
2007,chemotherapy RLL
 FS Diagnosis –
adenocarcinoma

10. The paraffin processed block
 Final diagnosis: RLL
apical segmentectomy:
metastatic colorectal
carcinoma

11. Case-3 60 year old female
Frozen 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

12. The paraffin processed block
 Final diagnosis: malignant
epitheliod tumour,
 ER, PR, Calretinin, and
CK5/6 negative,
 BerEP4, CEA and TTF-1
positive.
 The profile is in keeping with
metastatic adenocarcinoma
from a lung primary

13. 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

14. 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

15. A very rare condition diagnosed and
transmitted worldwide within
minutes of scanning
The Royal Brompton & Harefield NHS
Foundation Trust

16. Multi-Site International
Collaboration
The Royal Brompton & Harefield NHS Foundation Trust

17. The End
Thank you for your attention
Brian
The Royal Brompton & Harefield NHS Foundation Trust