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www.KUGEL-medical.de YOUR SPECIALIST FOR LABORATORY, PATHOLOGY & HISTOLOGY MADE IN GERMANY EUROPEAN HOSPITAL  Vol 24 Issue 4/15 24 DIGITAL PATHOLOGY Increasingly presenting a potential role CAD in pathology Report: Mark Nicholls Computer-aided diagnosis could soon play a greater role in digital pathology. Dr Jeroen van der Laak, an Assistant Professor in Digital Pathology at Radboud University, believes a breakthrough that would increase the speed and accuracy of diagnoses and prognoses is closer than many observers think. Van der Laak has been leading studies in the use of computer aided diagnosis (CAD) in pathology and will outline the ‘progress on the introduction of these promising techniques’ at the Digital Pathology Conference in London at the end of this year (3-4 December). In his presentation ‘CAD in Pathology: Closer than You Think’ he will argue that, while the intro- duction of digital pathology in pri- mary diagnostics is still hampered by high costs, CAD techniques will be the tipping point, leading to large scale introduction of digital scan- ning of histopathological slides. The introduction of CAD in pathology will make digitisation of tissue sections a worthwhile step, he believes. ‘As it is now, many patholo- gists doubt this transition to “digital pathology” because the required investment is large, and benefits are not fully clear,’ he said. ‘If we can really take some of the workload off a pathologist - by pre-screening sections for certain tedious tasks, for example - the business case will become much more favourable.’ Significant steps are achieved Research in his department – under- taken mainly using a Pannoramic P250 scanner from Budapest-based firm 3DHistech with all pattern rec- ognition software developed by the group – has achieved significant steps in the last couple of years in developing advanced pattern recog- nition algorithms that can work on entire ‘whole slide images’ (WSI), in contrast to much research still being conducted on small image regions. ‘We also aim to use standard H&E staining whenever possible. This means that the software we develop will work in any lab, without special adjustments, and with hardly any user interaction.’ However, although the introduc- tion of CAD in pathology is much closer than many people realise, he acknowledges that the availability of algorithms is only a new beginning and further research is needed to bring the algorithms into the pathol- ogists’ workplace. ‘If we succeed in seamless integration in to daily pathology routine,’ he said, ‘and can prove that the software really aids the diagnostic process, large scale introduction may happen.’ Such a step would see patholo- gists become more efficient in cer- tain routine tasks, and it could improve the accuracy and reproduc- ibility of diagnosis, he suggested. ‘Future applications may add valuable information from tissue sections that is currently not avail- able. Advanced pattern recognition may enable extraction of strongly prognostic, sub-visual information,’ van der Laak pointed out. ‘CAD in pathology has the promise to radi- cally change the way we examine tissue sections. ‘We are at a stage in which we have availability of pattern recogni- tion techniques more powerful than ever before. What is needed now is availability of material from large cohorts of patients with treatment and follow-up data. ‘Trained pathologists are also needed to help identify regions of interest and to study how we can best include our algorithms in the diagnostic workflow. ‘These requirements are challeng- ing because pathologists frequently suffer high workload, and well- defined cohorts are often hard to acquire.’ A next step is for his group to study the benefit of developed algorithms in a routine diagnostic setting. Yet, if implemented, CAD in pathology could have benefits for pathologists in making routine tasks easier. Advanced quantification of histopathological patterns will add valuable information to the diagnos- tic process, he said. Patients will benefit because the diagnostic process may be more accurate and personalised, and sur- geons and oncologists may also benefit from increased speed and accuracy of diagnostics and prog- nostics. Dr Jeroen van de Laak is Assistant Professor in Digital Pathology at the Department of Pathology at Radboud University Nijmegen Medical Centre, The Netherlands, where he leads a research group on CAD in pathology. Currently numbering eight, the group is set to expand in 2016. Covering diverse disci- plines – computer science, medicine, lab technology, the group is embedded in the pathology department, and included in the radiology department’s diagnostic image analysis group (DIAG) at Radboud University Medical Centre. Ben Vainer is Professor of Pathology at the University of Copenhagen and consultant pathologist at the Department of Pathology of Rigshospitalet, Copenhagen University’s main teaching hospital. His primary interest is in the digitisation of pathology for education, research and diagnoses. Source:Huron Learning from the Danish experience A national digital pathology system Denmark has used advanced com- puter software systems and created a countrywide database to optimise the assessment of patients’ speci- mens. The development and success of the system will be highlighted at the Digital Pathology Conference in London (3-4 December) where Professor Ben Vainer will lead the session ‘How Digitisation Can Improve Pathology Service – The Danish Experience’. Vainer, a consultant in the Pathology Department at Rigshospitalet, University of Copenhagen, will focus on the Danish civil registry database and other national databases connected to this, and the use of the same LIS in all pathology departments in the entire country with access to the national pathology database of all pathology reports in Denmark since at least 1998. He will also discuss the impor- tant links between LIS and patient medical records in hospitals and in private practice (e.g. general practi- tioners), and how computerisation of the entire laboratory flow, from ordering the pathology service to specimen presentation to the order- ing physician, has helped ensure patient safety and eliminate time- consuming manual steps. Vainer: ‘Pathology departments in Denmark have, through close col- laboration, been able to build a national pathology system, where each individual pathology depart- ment serves as a sort of “branch office”.’ ‘All steps of the specimens are followed through the pathology department, which gives a good global view of the departmental activities and the possibility to trace individual specimens. For the man- agers this also provides good meas- ures of operational objectives.’ The “users” – ordering physicians – are provided with a clear overview of their patients’ specimens during the assessment process, and patients have full access to reports on their own tissue, he added. Digitisation of laboratory process- es and the link to the pathology LIS, plus national pathology database, opens up the opportunity for image automation, including digital image analysis and transfer of whole slide images, in cases where a second opinion is needed without compro- mising either patient safety or the international data acts. Vainer believes other countries can learn several points from this system: ‘In large pathology labs the large number of specimens is often a hindrance to efficient handling and ensuring patient safety without time-consuming steps. Such steps can be turned digital, releasing valu- able staff resources. However, most important is that digitisation opens up for the implementation of new imaging techniques, which are nec- essary to provide each patient with the correct assessment of diagnosis and biomarker expression profile.’ The system is fully implement- ed, with automated image analysis and the option for second opinions using whole slide images currently being tested. There are also a number of patient benefits from the Danish system. Vainer: ‘The risk of speci- men mix-ups are minimised, and application of national pathology databases linked to national person- identification databases ensures that the pathologist always has access to previous tests performed on the patient. This increases the quality of the pathology assessment and hence the final diagnosis.’ Denmark’s next step is to intro- duce new digitisation procedures such as automated image analy- sis and substitution of conventional light microscopies with whole slide images, including possibilities to perform a second opinion without the delays when using shipment of glass slides by postal services. Vainer: ‘Automated image analysis will further increase the pathology assessment quality by eliminating subjective readings of biomarker expression, for example, in addition to elimination of the risk of patient case mix-up.’ A national digital pathology system across Denmark has helped to significantly improve efficiency and raise levels of patient safety, Mark Nicholls reports.

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