Tuesday, May 2, 2017

Implementation of Whole Slide Imaging for Clinical Purposes: Issues to Consider From the Perspective of Early Adopters

Andrew J. EvansMD, PhDMohamed E. SalamaMDWalter H. HenricksMDLiron PantanowitzMD
From the Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology, University of Utah and ARUP Laboratories, Reference Laboratory, Salt Lake City (Dr Salama); the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Henricks); and the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Pantanowitz).
Reprints: Andrew J. Evans, MD, PhD, Department of Pathology, University Health Network, Toronto General Hospital, 11-Eaton-223, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada (email: ).
Context.— There is growing interest in the use of digital pathology, especially whole slide imaging, for diagnostic purposes. Many issues need to be considered when incorporating this technology into a clinical laboratory. The College of American Pathologists established a Digital Pathology Committee to support the development of College programs related to digital pathology. One of its many initiatives was a panel discussion entitled “Implementing Whole-Slide Imaging for Clinical Use: What to Do and What to Avoid,” given for 3 years at the College's annual meetings starting in 2014.
Objectives.— To review major issues to consider when implementing whole slide imaging for clinical purposes as covered during the panel discussion.
Design.— The views expressed and recommendations given are based primarily on the personal experience of the authors as early adopters of this technology. It is not intended to be an exhaustive review of digital pathology.
Results.— Implementation is best approached in phases. Early efforts are directed toward identifying initial clinical applications and assembling an implementation team. Scanner selection should be based on intended use and budget. Recognizing pathologist concerns over the use of digital pathology for diagnostic purposes, ensuring adequate training, and performing appropriate validation studies will enhance adoption. Once implemented, the transition period from glass slide to image-based diagnostics will be associated with challenges, especially those related to a hybrid glass slide–digital slide workflow.
Conclusions.— With appropriate preparation, planning, and stepwise implementation, whole slide imaging can be used safely and reliably for frozen sections, consultation, quality assurance, and primary diagnosis.

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