Digital Pathology System

Vol. 19 • Issue 2 • Page 69
Case Study

The pathology lab at Kalmar County Hospital in Kalmar, Sweden, is a non-university general pathology lab producing 17,000 histopathology reports and 22,000 cytology reports per year. We are the only pathology laboratory in the county, and when a colleague developed problems with his cervical spine due to being continually bent over a microscope, we began to rethink the way we worked. Given Sweden’s significant lack of pathologists, one colleague on an extended sick leave could have serious consequences for the lab and patients. So we looked into technologies that would allow us to improve ergonomics for our pathologists and facilitate networking with other pathology labs.

As we began the evaluation process, it was imperative that the digital pathology system we selected be fully integrated into our SymPathy laboratory information system (LIS) so pathologists could work seamlessly from within the LIS. Good image quality and reliable scanning were essential, as was the safe mechanical transportation of glass slides so we could run the slide scanner continually with as little human interaction as possible. After analyzing and testing three vendor scanning systems, we selected the Aperio digital pathology system.

Digital Advantages

Kalmar now digitizes entire glass slides in just minutes for immediate viewing by our pathologists from a computer monitor. We scan all histopathology slides (60,000 slides per year), and more than 75% of our histopathology diagnostics is done using digital pathology.

We have two Scanscope®XT scanners in the Kalmar lab and one small Aperio Scanscope CS scanner in V„stervik-a remote hospital to which we provide frozen sections service. We have seven diagnostic workstations (one for each pathologist) and one diagnostic workstation in our conference room for tumor boards/clinicopathological rounds.

Through the use of Aperio’s ImageScope®viewing software, pathologists have the entire slide image at their fingertips. In addition, networking capabilities through digital slide conferencing and slide sharing has been tremendous. Digital pathology expedites obtaining consultations on difficult cases in a timely manner. For example, recently we had been unsuccessful in solving a complex pathology case in Sweden, but through use of digital pathology, I was able to send the digital images to a specialty pathologist in the U.S. and receive resolution to the case in under six hours.

We are impressed with the system’s smooth operation and crisp images. One of the most important features is the safe processing of our glass slides, making it possible for us to scan all day with limited use of lab personnel. Also, compared to the use of a microscope where the position of the head is quite fixed, using the monitor for slide review and diagnostics has definitely improved ergonomics.

We trust our selection of Aperio because they are continually advancing the utility of digital pathology with pivotal technology such as FDA-cleared image analysis applications for diagnosing digital slides and the industry’s first cleared digital IHC solution.

Future Objectives

Since the success of the Kalmar project, there has been tremendous interest in Sweden for digital pathology. Two large regions are planning to introduce the concept on a large scale. One of the biggest benefits of digital pathology is it provides access to information by pathologists who can interpret digital slide images and file reports from anywhere via Internet capability. In Sweden we have a national network (called Sjunet) interconnecting most hospitals that provides pathologists with the possibility of collaborating throughout the country using a digital pathology platform. This could save time compared to sending glass slides to pathologists all over Sweden for consultation.

Additionally, if a lab temporarily lacks pathologists, other labs can help via remote networking and consultation. I hope to be able to work remotely from home a portion of the week; this is also of interest to younger pathologists with small children at home.

We have already seen that recruiting future pathologists has improved through use of digital pathology, counteracting the lack of pathologists in Sweden. In fact, growing interest in digital pathology by younger doctors has made some pathology labs in Sweden evaluate adopting it for recruitment purposes.

The adoption of digital pathology at Kalmar has by far exceeded the original goal of fixing an ergonomic problem, and Kalmar is now pursuing digitization of all cytology slides as well as adding Aperio’s FDA-cleared digital immunohistochemstry (IHC) solution, including image analysis tools for the quantification of IHC stains. The digital future of pathology is here, and we are excited as hospitals from around the world visit Kalmar to see our system so they can learn how to better enhance the delivery of pathology services.

Dr. Thorstenson is medical director for the Department of Pathððology and Cytology at Kalmar County Hospital, Kalmar, Sweden.