EH 6_2015

www.sysmex.de/digitalepathologie Digital pathology – independent of space and time Charité Berlin International Scanner Contest 2012 Winner in 5 of 9 categories ■ Image quality at 40x ■ High throughput at 20x ■ High throughput at 40x ■ Image Analysis ■ Green IT SYSME_15774_Advert 3DHistech European Hospital EN_RZ.indd 1 09.12.15 11:50 www.healthcare-in-europe.com 13DIGITAL PATHOLOGY workflow and specialists’ efficiency archiving at publication quality all support the pathology workflow. Several digital slides can be opened side-by-side on the monitor for com- parative analysis of serial slides of a sample stained for different biomarkers. Even samples of immu- nohistochemistry and FISH (fluo- rescence in situ hybridisation) can be opened, linked and navigated alongside, which normally need consecutive steps or even separate microscopes. Pixels making up the images have calibrated dimension, colour and intensity, features that can be used for colour separation-based auto- mated quantification and measure- ments of image-objects. Furthermore, pattern recognition of morphological and functional units within the tissue, such as glands, or hyperplastic or abnormal- ly arranged epithelial nests, can be automatically made based on shape, size and texture identification. Serial digital slides can also be assembled into a 3-D structure for reconstructing tissue architecture, e.g. to study tumour invasion or re-orient colorectal biopsies. Digital data, including whole digital slides with annotations and measure- ments, can be integrated into digital databases and shared though intra- or internet with unlimited partners, even simultaneously. The freedom to access digital slide archives for re-review, and the logistics of slide storage and sorting are simple tasks managed through a computer. All these, of course, need advanced IT, including high speed comput- ers, massive storage capacity, safe data handling using backup stor- age, and wide-range internet access and dedicated software tools with a user-friendly graphic interface. Molecular pathology visualisation Immunofluorescence and FISH applications and small signals detec- tion: - Fluorescence microscopy detects fluorophores used to label molecules in cells and tissues with the techniques of molecular mor- phology. Fluorophores are activated at UV or visible wavelength to emit light of lower frequency, usually in blue, green or red, which can be collected through emission filters in a dark background. Samples targeted with fluorescing labels, particularly genomic FISH, must be studied within a short time- frame to avoid false negative results due to rapid signal fading (fading artefacts). In addition, small signals of a few hundred nm size, such as those of gene and chromosome probes in FISH, or those of its chromogenic version (CISH), are randomly placed throughout the whole 3-8 μm thick- ness of tissue sections, or cells, and thus some remain hidden from con- ventional single focus photography. These signals can only be revealed with confidence by scanning sev- eral focal planes through the sam- ple (z-stacking, or extended focus) for proper quantification of gene/ chromosome gain, such as that of HER2 on chromosome17 (CEP17) in breast cancer (Fig. 4); or for the fine spatial localisation of signals proving gene-translocations, such as that of t (9;22) resulting in the BCR-ABL gene fusion in a case of chronic myeloid leukaemia. Gene abnormalities may determine a spe- cific diagnosis and the concomitant treatment options in an increasing number of malignant tumours. Digital pathology within routine sign out processes Once the digital slide scanners dig- itise the hematoxilin eosin, surgi- cal pathology specimen, and then immunohistochemical second round and FISH third round slides are also available in the slide holder/server solution, a pathologist can evaluate them from the laboratory’s digital workplace. In addition to slide viewing, the software supports quantifica- tion of identified alterations. The digital report can be signed out with detailed image and quantita- tive data. Fig. 3 A) Digital slide viewer interfaces utilise the whole computer monitor where preview images and navigation history (left side) of high power analysis can also be traced. See details within the article. Fig.5 Digital pathology integrated in the routine workflow processes. Imaging of the grossing, different slide stainings are combined into one digital case, which is then later evaluated on a digital pathology workplace. The quantitative analysis is an integrated part of the digital pathology report. SYSME_15774_Advert 3DHistech European Hospital EN_RZ.indd 109.12.1511:50

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