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Whole Slide Scans and Web-Based Conferencing Tools Used in Combination Provide Accurate Assessment of Cases for Real-Time Global Clinical Consultation. Subodh M. Lele 1 , Anita Bhaduri 2 , Chitra Madiwale 2 , Kirti Chadha Kazi 3 , Anuradha Murthy 3 , Sandhya Sampath 4 , Tao Liang 4 . - PowerPoint PPT Presentation
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Whole Slide Scans and Web-Based Conferencing Tools Used in
Combination Provide Accurate Assessment of Cases for Real-Time
Global Clinical Consultation
Subodh M. Lele1, Anita Bhaduri2, Chitra Madiwale2, Kirti Chadha Kazi3, Anuradha Murthy3, Sandhya Sampath4,
Tao Liang4. 1University of Nebraska Medical Center, Omaha, NE;
2Hinduja Hospital, Mumbai, India; 3Metropolis Healthcare, Mumbai; 4BioImagene Inc.
Background
Whole slide imaging (WSI) for clinical consultation: an emerging field– Convenient: fast, anywhere, anytime– Increasingly accurate reproduction of the effect of a light microscope
Sign Out
Background
Web based conferencing (WBC) methods– Long distance communication– Cheaper, faster– Video capabilities
Background
WSI WBC+
- Live conferencing- All parties can see slide(s)- Control of slide(s) can be exchanged
Background
WSI variables– Scan:• Magnification• Color calibration
– Monitor: •Size•Resolution•Color calibration
– Navigational ease
Background
WBC variables– Monitor: •Size•Resolution•Color calibration
– Navigational ease
Background
Consultation/conferencing variables- Histology processing and staining quality- Clinical details- Subspecialty review
Background
• Cannot control all variables• WSI + WBC = ? Accurate
assessment for clinical decision making
Design
Metropolis Healthcare Mumbai, India
20X
BioImagene iScan Coreo™ system
Hinduja HospitalMumbai, India
• Cases were viewed using PathXchange without access to glass slides• Subspecialty expertise sought as required
Design
Real-time conferencing performed on set date using:• WebEx• PathXchange
Design
WebEx:• Share desktop between participants
- use mouse as pointer• Audio via telephone line
PathXchange:• View cases simultaneously• Enter diagnoses/comments using the free text box
Design
Design
Cases:• Those used for the monthly Senior Pathologists’ Meeting (18 hospital based groups in Mumbai)
- Hinduja Hospital - Metropolis Healthcare
Cases:• Difficult cases intended to challenge diagnostic skills• No organ system/subspecialty restrictions• N=12
Design
Design
Cases:• Each case had a brief clinical history and description of pertinent gross findings• Gross photographs were not available for review
Cases:• Slide scans:- H&E stain- Special stains/results of stains were not available for review
- 1/2 slides per case• One case had results of limited immunohistochemical work up
Results
Cases:• Additional work-up if done revealed at conference (without review of immunostains at conference)
Results
Cases: Real-time discussion using WebEx and PathXchange• 8/12 (67%) cases:
- complete agreement among participants on
diagnosis (inter hospital and between US and Indian pathologists)
Results
Cases: Real-time discussion using WebEx and PathXchange• 4/12 (33%) cases:
- consensus on differential diagnoses among participants (inter hospital
and between US and Indian pathologists)
Results
Results Complete consensus on diagnosis:• Bland spindle cell neoplasm, favor schwannoma subjacent to adrenal gland• Peutz-Jeghers polyp with misplaced glands• Inflammatory bowel disease, favor Crohn’s disease• Strongyloidiasis – GI biopsy• Meconium periorchitis• Angiosarcoma – skin• Malignant spindle cell neoplasm, chest wall (further work-up needed)• Metastatic melanoma/carcinoma, ovary
Consensus on differential diagnoses: • Hepatocellular carcinoma/atypical hepatocellular nodule• Lymph node : Kikuchi’s vs Hodgkin’s vs reactive IHC work up required • Leydig cell tumor negative for inhibin versus oncocytic neoplasm • Amyloidosis – GI biopsy
Results
Conclusions
• WSI and WBC methods provide accurate assessment of challenging cases• WBC allows for sharing of cases for real-time rapid review and obtaining group consensus
Conclusions
Reasons for lack of a specific diagnosis/error:- Limited H&E slides for review- Lack of information on immunostains- Immunostains not available for review- Additional clinical details- Subspecialty review
Conclusions
Reasons for lack of a specific diagnosis/error:- Navigational ease and speed
WSI +WBC: Who can benefit?
- Solo practice- Small group practice- Limited access to scientific material- Large academic centers
- Second signature for malignancies - To get a differential and help in working up a case- To boost confidence (new pathologist)- Interpreting a special stain- For consensus - for QA
Types of consults
PathXchange
Read scanned slides (exchange slide driving control)
Talk/Conference
•Video (gross, other)•Image Order Stains
•Transcribe (Voice recognition)•Sign out
Future: One System
Acknowledgement
• Anita Bhaduri, M.D.• BioImagene (Mohan Uttarwar, Tao Liang, Sandhya Sampath)• Steve Hinrichs, M.D.
