Couple of reasons to attend Pathology Visions 2012

IMPLEMENTING A HIGH VOLUME DIGITAL PATHOLOGY REFERENCE LABORATORY

Bio
Dr. Bloom is Chief Medical Officer of Clarient a GE Healthcare company, Medical Director of Clarient Diagnostic Services and President of Clarient Pathology Services. Dr. Bloom specializes in pathology with a special interest in breast disease and esoteric testing including immunohistochemistry, fluorescence in-situ hybridization and molecular analysis. Dr. Bloom has spent more than two decades serving in leadership and advisory roles for hospitals, medical schools and industry. He has been a prolific researcher and lecturer in the fields of pathology, cancer, telemedicine and informatics. While at Rush Dr. Bloom was a principle investigator in the design and implementation of the first commercial telepathology system as well as the information systems used for Anatomic Pathology, Surgery, Cancer Registry and Radiation Therapy. Dr. Bloom is a member of the College of American pathologists and serves as a member of the Technology Assessment Committee Personalized Healthcare Committee.

Abstract
Clarient has been a leader in digital pathology since its start in 2004. We digitize over 2000 slides each day utilizing a variety of commercial scanners for diagnostic, prognostic and predictive indications. Approximately 50-60 consults are reviewed each day by a combination of our internal pathology team, remote Clarient pathologists and our network of academic pathologists around the country. Consultation slides are scanned at 20X magnification and reviewed on-line utilizing our proprietary viewer. Since all slides are digitized, real time consultation with clients and pathologists across the country is routine. Prognostic and predictive testing is performed on over 30,000 breast cancer cases each year, and most of our clients choose to utilize image analysis algorithms to aid them in their interpretation. An expanding portfolio of non-breast prognostic and predictive markers are being added these markers become relevant to patient care. I will discuss the issues that we faced building and then scaling a digital pathology service. Our analysis of scanners, viewers, image analysis software and image storage will be presented.

Objectives
1) Define the components of a digital pathology system.

2) Describe the pros and cons of available digital pathology solutions.

3) Understand the process of implementing a digital pathology solution in a CLIA laboratory.

USE OF DIGITAL PATHOLOGY SIGNIFICANTLY IMPROVES THE QUALITY OF TISSUE MICROARRAY CONSTRUCTION

Bio
Prashant Bavi is a research pathologist at Research Centre, King Faisal Specialist Hospital, Riyadh, Saudi Arabia. He has a successful track record of over 50 publications in high impact peer reviewed journals and more than 70 presentations in international meetings. With 12 years of experience, he is well versed in oncology, biobanking, digital pathology, translational research & lab administration. Over the years, he has developed a diverse set of skills in anatomical pathology, molecular pathology, data management & biomarker validation. Other areas of his competence are scientific writing including reviewing manuscripts & serving on the editorial board. An avid proponent of digital pathology, he firmly believes in inculcating principles of productivity & time management such lateral thinking, mind mapping & “Getting Things Done” in research & diagnostic pathology. His long-term goals are harvesting the best quality samples, participate in meaningful biomarker discovery & making an impact on personalized medicine.

Abstract
Background: In the last decade, tissue microarray(TMA) has been established in translational cancer research as a high throughput tool. Similar to digital pathology, traditional purists took time to adopt TMAs as a tool in biomarker discovery and validation; teaching and as a IHC control for validation. Technology transfer, setting aside funds to purchase an arrayer, and dedicated personnel to map slides and construct TMA are still major bottle necks. Final quality of a constructed TMA depends on the yield of slides and the number of representative cores arrayed. Study of rare events in pathology pose a particular challenge for the lab personnel to accurately identify the area of interest by superimposing the slide on the paraffin block before extracting the tissue core. Therefore, we studied the effect of digital pathology in mapping the region of interest and constructing TMA’s.

Methods: We constructed two identical TMA blocs of 0.6mm diameter from 50 rare histological events that included R&S cells from Hodgkin’s lymphoma, multifocal microscopic carcinoma in thyroid and lymphovasuclar embol/perineural infiltration in colorectal carcinoma. One array block was done in the traditional way and the other array we did digital mapping of scanned images from slides, printing the life-sized images. Slides were scanned with Aperio ScanscopeCS; mapping done with Imagescope and TMA constructed using Semiautomated Arrayer, CM1 Mirlacher, Neuenburg, Germany. Using a image manipulation program IrfanView, we printed the images in the same aspect ratio as it was scanned on a semi-transparent paper.

Results: Preliminary results of 10 microscopic multifocal papillary thyroid carcinoma showed a 100% accuracy in picking up the microscopic lesions as compared to 60% with the traditional approach. Remarkably accuracy was associated with a increase in speed.

Conclusions: Modifying the process of TMA construction by embracing digital pathology is beneficial and should be adopted routinely. The tangible benefits are:(i) improved accuracy; (ii) saves time (iii) increases the speed; (iv) potentially reduces errors of misidentification and (v) frees up the lab technician to be utilized for other tasks.

Objectives
Although tissue microarray technology, as a high throughput tool, has revolutionized biomarker discovery in translational research, it has some key bottlenecks. Digital pathology has been used in IHC quantification. However, there is a potential of using scanned images for constructing tissue microarrays Embracing of these 2 technologies has immediate tangible benefits of improvement in speed, accuracy, saving of time and freeing up scarce technical staff. In addition this methodology reduced risk of misidentification and provides robust documentation of mapped images on for future usage.