Hospital tumor boards meet routinely for multidisciplinary
case presentations and reviews of various types of cancer cases.
Pathological findings are a significant component of tumor-board
presentations, but assembling the pathological information for a given case
is a lengthy and painstaking process, requiring hours of preparation. For
many hospitals, a digital-pathology environment that enables pathologists to
manage and interpret information originating from the digitization of a
glass slide offers a practical alternative to traditional microscopy. As the
Laboratory Diagnostics Medical Group successfully discovered, a
digital-pathology platform vastly improved the tumor board experience —
saving time, enabling greater flexibility, and improving the quality of
slide-image data.
Pathology challenges
Laboratory Diagnostics Medical Group consists of six
pathologists providing anatomic-pathology services for two sites at a
five-hospital system in San Diego, CA. A breast and general tumor board is
held each week in the main facility. Preparation for tumor board meant both
staff and pathologists needed to pull reports and slides for six to eight
cases, for an average of two hours each week. Pathologist review, along with
photographing areas of interest, averaged a little more than two additional
hours per week.
Frequent inability to access material for cases from
outside institutions or prepare photographs for last-minute, add-on cases
extended the preparation time in many instances. Time was also wasted in
photographing cases that were subsequently bumped from tumor-board
presentations, as these cases were then deleted from the files and had to be
re-photographed and presented the following week.
The actual presentations at tumor board also had several
shortcomings. Foremost was the quality of low-power images, which received
the lowest ranking by pathologists of any variable in the presentation.
Another challenge was not having the correct photograph available to
supplement the answers to questions raised by clinicians attending the tumor
board.
Digital-pathology solution
Pathologists expressed an interest in digital pathology —
a computerized, image-based environment for managing and interpreting
information enabled by a digital slide — and agreed to participate in a
pilot study to test and measure the effectiveness of a digital pathology
solution as applied to tumor boards in a community hospital.
Goals for the pilot included streamlining tumor-board
preparation, enabling real-time flexibility through the ability to show any
region of a slide, providing higher-quality images, and improving
satisfaction of all parties including pathologists, clinicians, and staff.
During the pilot, the scanning of slides was performed by
an administrative staff member. Because the assistant had no specialized
training, it was important that the scanner be easy to operate. In addition,
it was important that the digital-pathology platform include
information-management software for the easy archival and retrieval of
digital slides for both current and past tumor boards. A digital-pathology
vendor who met the desired criteria was chosen as the technology platform
for the pilot.
A 17-week pilot was conducted in the summer and fall of
2007. Eight weeks were dedicated to collecting data on existing processes,
the final nine weeks to collecting data using the digital-pathology
technology. Surveys were performed with pathologists and administrative
staff each week to measure pre- and post-technology intervention
efficiencies and improvements related to preparation and presentation. In
addition, pre- and post-pilot surveys were completed with clinicians
attending tumor boards.
Results and benefits
The digital-pathology system successfully fulfilled and
exceeded the goals of the pilot. Satisfaction in the process improved across
all parties, including non-pathologist clinicians who attended tumor boards.
Consensus was reached that the digital-pathology system was preferred over
the previous method.
The overall impact on the preparation process was very
positive and far more efficient for pathologists and staff. Pathologists
saved an average of one hour per week in preparation, thus cutting their
time by 50%. Satisfaction ratings improved significantly for the staff, as
the process was less stressful and less chaotic, and the hardware and
software were easy to use. For the pathologists, less time was required for
photography preparation.
The use of digital slides for the presentations at tumor
boards was successful. During the pilot, scores on image quality and other
key variables improved, with image quality improving the most. Because
pathologists were better able to demonstrate their findings and respond to
questions, the overall experience for attendees of the tumor boards
improved.
Presenting digital images at tumor boards was enhanced by
the use of the viewing software, which provided capabilities not possible
with photographs, including access to whole slide images, side-by-side
viewing of more than one image at a time, and the ability to annotate
sections of the images with the click of a mouse.
A digital-pathology platform successfully helped
Laboratory Diagnostics Medical Group provide its pathologists with a
solution to better manage the tumor-board experience and provide more
efficient pathology services.
Raymond Tecotzky is product director of Marketing at
Aperio, which is headquartered in Vista, CA. He can be reached at
[email protected] .
