The Use Of Digital Microscopy In Cross Site Frozen Dignosis

The use of Digital Microscopy in The use of Digital Microscopy in Cross-site Frozen Section DiagnosisCross-site Frozen Section Diagnosis

The Royal Brompton and Harefield Hospitals’ The Royal Brompton and Harefield Hospitals’ Experience of the Aperio Scanscope SystemExperience of the Aperio Scanscope System

Dr Brian MitchelsonDr Brian Mitchelson

The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust

The Harefield LaboratoryThe Harefield Laboratory


Our problems!Our problems!

Firstly the two hospital sites are 20 miles apart.Firstly the two hospital sites are 20 miles apart. Harefield currently has 1 resident Associate Harefield currently has 1 resident Associate

Specialist Histopathologist.Specialist Histopathologist. The Royal Brompton has 3 Consultant The Royal Brompton has 3 Consultant

Histopathologists, one of whom shares her time Histopathologists, one of whom shares her time between the Brompton and Harefield sites.between the Brompton and Harefield sites.

This could cause potential problems for frozen This could cause potential problems for frozen section diagnosis if no Consultant was available section diagnosis if no Consultant was available for difficult cases at the Harefield site.for difficult cases at the Harefield site.


Our SolutionOur Solution The Scanscope system was purchased in 2009 The Scanscope system was purchased in 2009

with a view to overcoming this problem.with a view to overcoming this problem.

As a test of the systems’ efficacy we have As a test of the systems’ efficacy we have monitored the system by scanning the frozen monitored the system by scanning the frozen section slides immediately after diagnosis at section slides immediately after diagnosis at Harefield and informing the Royal Brompton Harefield and informing the Royal Brompton pathologists that a frozen section was on the pathologists that a frozen section was on the server ready for a second opinion.server ready for a second opinion.


The Royal Brompton & Harefield NHS Foundation Trust

Protocol The slide is routinely scanned at x20

magnification using either the “One Touch” scanning, or “Manual Scan”.

The specimen details are entered on the case file The Royal Brompton pathologists are informed

that a frozen section is on the server ready for reporting

Should the pathologist require a x40 scan they will telephone the request through to the lab and discuss the area of the section to be scanned.

The ResultsThe Results

The initial results are very encouraging and have shown The initial results are very encouraging and have shown a 100% concordance of diagnosis within minutes of a 100% concordance of diagnosis within minutes of being put on the server.being put on the server.

To date we have scanned over 50 cases with an average To date we have scanned over 50 cases with an average time for the x20 scan being 4 minutes.time for the x20 scan being 4 minutes.

The average time from the scan completing to The average time from the scan completing to reporting at the Brompton of just over 1min 30 secreporting at the Brompton of just over 1min 30 sec

A further benefit is the ability for several pathologists A further benefit is the ability for several pathologists to view sections simultaneously from multiple locations to view sections simultaneously from multiple locations and also in the teaching of frozen section diagnosis.and also in the teaching of frozen section diagnosis.


Case-1 79 year old maleFrozen Section Specimen - Jugular LN

Right lung base lesion with supraclavicular lymph nodes on the right side

FS Diagnosis – Hodgkin's Lymphoma

The paraffin processed block

Final diagnosis: Nodular Hodgkin's Lymphoma, nodular lymphocyte predominant type, with prominent T-cell/hystiocyte rich B-cell lymphoma like areas

Case-2 73 year old male Frozen Section Specimen- Apical segment of RLL

RLL mass, ? Malignancy, previous bowel cancer 2007,chemotherapy RLL

FS Diagnosis – adenocarcinoma


Final diagnosis: RLL apical segmentectomy: metastatic colorectal carcinoma

Case-3 60 year old female Frozen Section Specimen- Right Parietal Pleura

Pleura coated with talc, shortness of breath, right pleural effusion, pleural thickening, previous lump excision of breast

FS Diagnosis – malignant epithelioid tumour


Final diagnosis: malignant epitheliod tumour,

ER, PR, Calretinin, and CK5/6 negative,

BerEP4, CEA and TTF-1 positive.

The profile is in keeping with metastatic adenocarcinoma from a lung primary

ConclusionsConclusions

The current data suggests this is a clinically The current data suggests this is a clinically useful system; with only a minimal time delay in useful system; with only a minimal time delay in reporting the frozen section diagnosis.reporting the frozen section diagnosis.

Diagnosis was found to be no more problematic Diagnosis was found to be no more problematic than using a conventional microscope and in than using a conventional microscope and in many cases was made easier due to the large many cases was made easier due to the large screen image and zoom magnification.screen image and zoom magnification.

Other potential benefits include second Other potential benefits include second opinions, referrals and teaching.opinions, referrals and teaching.


In SummaryIn Summary

The image quality is excellentThe image quality is excellent The accessibility is rapid and simpleThe accessibility is rapid and simple Real time image handling is a benefitReal time image handling is a benefit The more we use the system the more uses and benefits The more we use the system the more uses and benefits

we are finding for this instrument: we are finding for this instrument:

Cross-site referrals: this saves transferring slides from Cross-site referrals: this saves transferring slides from one hospital to the otherone hospital to the other

MDT meetings: allowing real time image handling and MDT meetings: allowing real time image handling and auditing cases on either site.auditing cases on either site.


A very rare condition diagnosed and A very rare condition diagnosed and transmitted worldwide within transmitted worldwide within

minutes of scanningminutes of scanning



Multi-Site International Multi-Site International CollaborationCollaboration


The EndThe EndThank you for your attentionThank you for your attention

BrianBrian

Documents

The Use Of Digital Microscopy In Cross Site Frozen Dignosis