Transcript Whole Slide Scans and Web-Based Conferencing Tools Used in

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
Hinduja Hospital
Healthcare
Mumbai, India
Mumbai, India
20X
BioImagene iScan Coreo™ system
Design
• 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
PathXchange:
• View cases simultaneously
• Enter diagnoses/comments using the
free text box
WebEx:
• Share desktop between participants
- use mouse as pointer
• Audio via telephone line
Design
Cases:
• Those used for the monthly Senior
Pathologists’ Meeting (18 hospital
based groups in Mumbai)
- Hinduja Hospital
- Metropolis Healthcare
Design
Cases:
• Difficult cases intended to
challenge diagnostic skills
• No organ system/subspecialty
restrictions
• N=12
Design
Cases:
• Each case had a brief clinical
history and description of
pertinent gross findings
• Gross photographs were not
available for review
Results
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
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
Results
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
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
Types of consults
- 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
Future: One System
Read scanned slides (exchange slide driving control)
•Transcribe
(Voice
recognition)
•Sign out
PathXchange
Order Stains
Talk/
Conference
•Video (gross, other)
•Image
Acknowledgement
• Anita Bhaduri, M.D.
• BioImagene
(Mohan Uttarwar, Tao Liang,
Sandhya Sampath)
• Steve Hinrichs, M.D.