EH 2_2016

www.nanozoomer.com For fast and high quality whole slide scanning, virtual slide management and image sharing across a network NanoZoomer S210 and NDP.serve3 NanoZoomer S210 • Brightfield slide scanner • 210 slide scanning capability • High performance • Cost-effective • Batch scanning and continuous loading NDP.serve3 • Share and manage whole slide images across the internet or intranet • Intuitive and simple to use graphical user interface • Secure database with enhanced search functionality • 3 versions available to match application needs and budgets Digital pathology is evolving... NanoZoomer_2010_265x188_AW_Layout 1 09/12/2015 15:50 Page 1 DIGITAL PATH0LOGY tumours and their specific biomark- ers. Although previously we could gain good and realistic estimates with the bare eye, we can now gen- erate far more exact evaluations of hundreds of thousands of tumour cells in one section, for instance for each individual tumour cell. Until recently this was completely impos- sible. The integration of individual parts of DP into clinical routine is already happening in interdiscipli- nary tumour boards and confer- ences, in telepathology and through the transmission of digital slides in the context of studies or con- sultations. It has facilitated a much faster, worldwide exchange between experts and colleagues without the need to physically send sections. As there has been an abundance of new technologies and innova- tions over the last few years and a continuously expanding market for imaging equipment (scanners and the camera technology used in them) for image processing (recon- struction and visualisation software) as well as for digital image analysis (DIA) the need for standards for diagnosis and research has become equally imperative. If, one day, DP was to become established in daily routine it will have to withstand comparison with the microscope in daily practice, in terms of practicability, sturdiness and, most importantly, speed. The microscope is unlikely to disappear. Some areas, such as quick section diagnosis where a diagnosis has to be achieved within 15 minutes during on-going surgery, there can be no digitisation. However, we (including Professor Peter Hufnagel at the Charité Berlin and Professor Gian Kayser at Freiburg University Medical Centre) believe that, more and more pathologists will mainly work digitally, and also beyond uni- versity settings, in the distant future, because the requirements from this field will continue to grow and the investment costs for scanners and data storage are likely to fall due to increased competition. In our view the full potential of DP, which is as versatile as it is promising, has not yet been exhausted, by far. However, high quality standards in image generation, processing and analysis must be established independent of manufacturers. They should be the basis for the continuously growing and ambitious community of pathol- ogists in diagnostics, research and teaching. DP can help achieve a new measure of quality, particularly in the growing field of cancer diagnos- tics (companion diagnostics) with immunohistochemical biomarkers such as Her2 or PD1/PD-L1, which are decisive for treatment. The tool will become a robust, reproducible, secure, comprehen- sively quantitative and observer- independent aid for diagnosis. With the help of DIA, important biomark- ers, such as prognosis parameters, can be completely, quantitatively, digitally evaluated (e.g. Her2-FISH in Z-stack) even three-dimensional- ly. DIA is therefore superior to the previous methods, as it makes mil- lions of tumour cells analysable, if necessary even in several layers (for FISH signals). Furthermore, observer-independ- ent, digital evaluations will lead to a location-independent, comprehen- sive increase in diagnostic quality for certain problems, be it in a large centre or a peripheral practice. Along with many well-known pathologists we believe that DP will have become an established part of a hybrid workflow consisting of DP and conventional microscopy in clinical routine within the next 10 years. The advantages speak for themselves and there is no end in sight for the rapid develop- ments and resulting opportunities for application. I believe many pathologists are following the rapid developments in digital pathology with excite- ment and interest, as well as with scepticism. Most of them are not yet happy to swap their microscopes for computers. However, within the next ten years I believe that a hybrid diagnostics workflow, consisting of conventional microscopy and digital image analysis, will be established. A comprehensive change to purely digital diagnostics is still a long time coming. digital diagnostics system presents. Reaching 800 terabytes the archival system was pushing the internal capacity. ‘We had a chance to be part of a bulk central storage initia- tive at this big academic we are part of, so we joined as a customer,’ the professor explained. ‘The archives were transferred to the new system, which he said is safer, more secure and more affordable than main- taining a dedicated storage facility. Also, it is faster: flashing requested images on the screen in seconds, rather than in minutes. Challenges and compromises If the transition to working digi- tally has been fairly smooth, there remain both challenges and com- promises. ‘There are things that are simply not possible for digital processes yet,’ van Diest pointed out. ‘Here we simply go back to the slides. It is always possible to return to the slides. This does not mean the images are not good. It may be a difficult case. We certainly don’t force someone to do a diagnosis in a digital way only to make a wrong diagnosis.’ There also remains the controver- sy of depth-of-view on digital slides versus the microscope view, which he said is ‘a compromise we have to live with today’. ‘We’d prefer to have three to five focus layers within every image. Yet that increases scan time by a fac- tor of three to five, and increases storage requirements by a factor of three to five. This is something we simply cannot afford, both in terms of time and financially in terms of storage.’ Now that the diagnostic system is operational, the next stage is optimisation, working through what he called a long wish list that will keep the vendor companies busy for the next three to five years. The group, he said, is also keen to begin implementation of image analysis algorithms. ‘The one we will start with, one we have developed ourselves, are algorithms for the recognition of mitosis, something very important in cancer diagnostics that is now done in a subjective way. By using algorithms it can be done more quickly and more reliably,’ van Diest pointed out. Pleased by the high level of inter- est in visits, van Diest added: ‘We are pioneers here. We had to invent the wheel, which means that other people who plan to do this will probably be able to do it slightly faster, perhaps better, and likely in a cheaper way than us.’ Carol I Geppert MD from the Institute for Pathology at Erlangen University Hospital Continued from page 11 The digital age in ... 13 www.healthcare-in-europe.com NanoZoomer_2010_265x188_AW_Layout 109/12/201515:50 Page 1

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