Acta Biomedica Scientia

VALIDATION OF REMOTE DIGITAL PATHOLOGY FOR PRIMARY DIAGNOSTIC SIGN-OUT USING WHOLE SLIDE IMAGING DURING A PUBLIC HEALTH EMERGENCY.

Dr. Veeravalli Sudheer Kumar

Remote digital pathology, Diagnostic concordance, Whole slide imaging, Public health emergency

Remote digital pathology supports the continuation of routine pathology workflows when places are on lockdown. Based on the CLIA rules, pathologists are now required to authenticate patient reports sent by a certified laboratory using electronic methods. During the 2019 pandemic from a novel coronavirus, this guideline might have made pathologists, colleagues and family members vulnerable to infection. Relaxing some of the rules allowed pathologists to work from non-certified locations on pathology samples. Remote microscopic diagnoses are now possible with digital pathology, even though a full confirmation of accuracy has not been documented yet. In order to digitize all the glass slides used for routine clinical diagnosis in many surgical pathology fields, they were scanned using a powerful digital scanner set at a magnification of ×40 (makes each pixel 0.26 micrometers). There were twelve pathologists involved in nine medical specialty areas and they all worked remotely through a safe network connection to review and report complete pathology cases online from different locations. Whole slide images were added to the laboratory information system and examined using a vendor-independent custom whole slide image viewer. Users worked with personal devices (computers and displays of different sizes and resolutions) that were connected to clinician stations inside the organization using a virtual private network. All glass slides were then looked at using a conventional microscope by the pathologists in the official department. It was studied to what degree the key points of reporting—such as primary diagnosis, margin status, lymphovascular or perineural invasion, pathological staging and ancillary test results—were in agreement among the pathologists. Standard digital file size was 1.3 GB, it took an average of 90 seconds to scan a slide and the area of each scanned tissue was 612 mm². Signout sessions presented 108 cases with a total of 254 specimens and 1196 slides. Consistency in findings was strong at 100% for the major categories and 98.8% overall (251 out of 254). The study confirmed that primary diagnostic review and reporting of full pathology cases from remote areas could be done in a public health emergency. We found that the major diagnoses on remote cases were in perfect agreement (100%) between a review of glass slides and a review of digital images. This study using a digital pathology system proved that it can be applied remotely to support the review and reporting of cases, showing it to be operational, effective and user-friendly.