Futureproofing neuropathology diagnosis with digital pathology imaging

Leeds Teaching Hospitals NHS Trust is a major NHS cancer centre, with a fully sub specialised diagnostic histopathology department. Leeds provides neuropathology and ophthalmic pathology services to the West Yorkshire region, encompassing a population of 2.2million. It includes multidisciplinary team meetings (MDTM) for adult, young adult and paediatric central nervous system tumours, and adult and paediatric neurology. Two neuropathologists work on site to deliver this crucial diagnostic service.

Situation

Pathology services are under increasing pressure due to an increase in workload and reduced workforce. A shortage of consultant pathologists in the UK means that pathologists need to be able to view and share cases efficiently. This can be difficult using conventional glass slides, as they have to be transported from the laboratory to the pathologist, between pathologists, and between hospital sites. Given the relatively small number of specialist neuropathologists, these staff may need to be able to work more flexibly in the future. Opportunities for this are limited by the physical glass slide medium.

Aspiration

Leeds Teaching Hospitals NHS Trust wanted to future-proof neuropathology diagnostic services by digitizing neuropathology glass slides, so they could be accessed by neuropathologists for primary diagnosis, MDTM discussion and the training of pathologists.

Pathologists would be able to view, assess, transfer and share images quickly and safely.

Solution and impact

Leeds Teaching Hospitals NHS Trust has deployed Aperio GT 450 DX scanners from Leica Biosystems to provide a fully digital neuropathology service. This service started as a pilot, the success of which has led to a 100% digital transformation of the histopathology output at the Trust, covering all specialties and cancer pathways.

In 2018, the Trust devised training and validation materials to allow their 2 neuropathologists to learn how to use the digital microscope for primary diagnosis and frozen section diagnosis. Since then, the neuropathologists have made all primary diagnosis on digital slides as standard and performed MDTs using digital slides.

Impact

The use of digital slides has had a number of benefits for the neuropathology service, including:

• greater efficiency assessing large, multi-slide cases
• streamlined delivery of diagnostic slides from the laboratory to the reporting pathologist, without loss or damage.
• more efficient preparation of cases for MDTMs
• more secure and convenient MDTMs, negating the need for physical transport of glass slides between hospital sites
• easy sharing of cases for second opinion
• enhanced training and educational opportunities for trainee pathologists
• increased flexibility of reporting time and location

Functionality

Leica Biosystems Aperio GT 450 DX digital slide scanners are benchtop laboratory hardware devices that capture and store high resolution images of glass histopathology slides using quality microscope lenses. The images can be accessed by pathologists who can then use a Sectra IDS7 PACS system with digital microscope software to make a diagnosis on a high resolution computer screen.

Capabilities

• Primary diagnosis of standard histopathology specimens by pathologists
• Assessment of frozen section surgical specimens by pathologists
• MDTM pathology presentation
• Remote reporting of standard histopathology specimens by pathologists

Scope

• To make primary diagnosis in clinical histopathology departments
• To share pathology images as part of physical or virtual MDTM discussions
• To share pathology images with pathologists intra or inter-departmentally in clinical settings
• Potential to use from home in times of service pressure and necessity

Key learning points

Training and education of healthcare professionals is key in ensuring safe transition from standard glass slide microscopy to the interpretation of digital slides.

Enhanced sharing of images and improved collaboration opportunities benefit clinical, educational and research activities in the department.

Deployment of a digital pathology system requires close collaboration between pathologists, laboratory staff, pathology management and IT/informatics staff to ensure all stakeholders are involved in the project.

Key figures/quotes

“In addition to clinical diagnosis, I use the digital pathology system for several MDTs, teaching and research. At MDTs, surgeons find it very useful and informative when we are able to zoom in from a brain slice or a large anatomical structure to demonstrate single cell pathology. Equally, whilst teaching junior histopathologists and researchers, the ability to move around the slide with ease and correlate pathological features with adjacent or background normal tissue structures enhances the understanding of pathology tremendously.”
Dr Aruna Chakrabarty, neuropathologist

“Digital pathology has improved my turnaround 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, neuropathologist

Find out more

Find out about the National Pathology Imaging Co-Operative (NPIC) of which Leeds Teaching Hospitals NHS Trust is a part. NPIC (Project no. 104687) is supported by a £50m investment from the Data to Early Diagnosis and Precision Medicine strand of the government's Industrial Strategy Challenge Fund, managed and delivered by UK Research and Innovation (UKRI).

Learn more about the initial digital neuropathology pilot

Read the Leeds guide to digital pathology (deploying digital pathology systems in the NHS)

Key contact

Dr Bethany Williams, lead for digital pathology training and education, National Pathology Imaging Co-Operative, Leeds Teaching Hospitals NHS Trust

Bethany.williams2@nhs.net