the use of digital microscopy in cross site frozen dignosis
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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
The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
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.
The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
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 The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
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.
The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
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
The paraffin processed block
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
The paraffin processed block
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.
The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
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.
The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
A very rare condition diagnosed and A very rare condition diagnosed and transmitted worldwide within transmitted worldwide within
minutes of scanningminutes of scanning
The Royal Brompton & Harefield NHS The Royal Brompton & Harefield NHS Foundation TrustFoundation Trust
The Royal Brompton & Harefield NHS Foundation Trust
Multi-Site International Multi-Site International CollaborationCollaboration
The Royal Brompton & Harefield NHS Foundation Trust
The EndThe EndThank you for your attentionThank you for your attention
BrianBrian