A Feasibility Study of Multisite Networked Digital Pathology Reporting in England

Abstract

Background: The objective of the project was to evaluate the feasibility of introducing a single-networked digital histopathology reporting platform in the Southwest Peninsula region of England by allowing pathologists to experience the technology and recording their perceptions. This information was then used in planning future service development. The project was funded by the National Health Service (NHS) Peninsula Cancer Alliance and took place in 2020 during the COVID-19 pandemic.

Materials and methods: Digital slides of 500 cases from Taunton were reported remotely in Truro, Plymouth, Exeter, Bristol, or Bath by using a single remote reporting platform located on the secure Health and Social Care Network (HSCN) that links NHS sites. These were mainly small gastrointestinal, skin, and gynecological specimens. The digital diagnoses were compared with the diagnoses issued on reporting the glass slides. At the end of the project, the pathologists completed a Google Forms questionnaire of their perceptions of digital pathology. The results were presented at a meeting with the funder and discussed.

Results: From the 500 cases there were nine cases of significant diagnostic discrepancy, seven of which involved the misrecognition of Helicobacter pylori in gastric biopsies. The questionnaire at the end of the project showed that there was a general agreement that the platform was easy to use, and the image quality was acceptable. It was agreed that extra work, such as deeper levels, was easy to request on the software platform. Most pathologists did not agree that digital reporting was quicker than glass slide reporting. Some were less confident in their digital diagnoses than glass diagnoses. They agreed that some types of specimens cannot easily be reported digitally. All users indicated that they would like to report at least half of their work digitally in the future if they could, and all strongly agreed that digital pathology would improve access to expert opinions, teaching, and multidisciplinary meetings. It was difficult to find pathologists with time to undertake remote digital reporting, in addition to their existing commitments.

Conclusions: Overall, the pathologists developed a positive perception of digital pathology and wished to continue using it.

Keywords: Cancer diagnosis; digital pathology; information technology; software.

Fig. 1

The study involved NHS sites in the Southwest Peninsula of England. Digital slides scanned in Taunton were reported remotely in Truro, Plymouth, Exeter, Bristol, and Bath by using the Free D Path networked reporting platform. (Map© OpenStreetMap contributors)

Fig. 2

A pathologist reporting a digital slide (right) using the Free D Path software platform (left). This model allowed multiple remote NHS sites to run on a single server using the HSCN secure network. The server was located in Taunton. (original image)

Figs. 3-18

Questions and responses that reporting pathologists gave regarding the study. These were collected by using Google Forms. The comments include some abbreviations. SW = Southwest, EQA = external quality assessment, MDT = multidisciplinary meeting, UHP = University Hospital Plymouth, Free D Path = the networked reporting software, RCT = Royal Cornwall Hospital, H&E = hematoxylin & eosin stain, IHC = immunohistochemistry, HPB = hepatobiliary, GI = gastrointestinal, UGI = upper GI.

Figs. 3-18

Questions and responses that reporting pathologists gave regarding the study. These were collected by using Google Forms. The comments include some abbreviations. SW = Southwest, EQA = external quality assessment, MDT = multidisciplinary meeting, UHP = University Hospital Plymouth, Free D Path = the networked reporting software, RCT = Royal Cornwall Hospital, H&E = hematoxylin & eosin stain, IHC = immunohistochemistry, HPB = hepatobiliary, GI = gastrointestinal, UGI = upper GI.

Figs. 3-18

Questions and responses that reporting pathologists gave regarding the study. These were collected by using Google Forms. The comments include some abbreviations. SW = Southwest, EQA = external quality assessment, MDT = multidisciplinary meeting, UHP = University Hospital Plymouth, Free D Path = the networked reporting software, RCT = Royal Cornwall Hospital, H&E = hematoxylin & eosin stain, IHC = immunohistochemistry, HPB = hepatobiliary, GI = gastrointestinal, UGI = upper GI.

Figs. 3-18

Questions and responses that reporting pathologists gave regarding the study. These were collected by using Google Forms. The comments include some abbreviations. SW = Southwest, EQA = external quality assessment, MDT = multidisciplinary meeting, UHP = University Hospital Plymouth, Free D Path = the networked reporting software, RCT = Royal Cornwall Hospital, H&E = hematoxylin & eosin stain, IHC = immunohistochemistry, HPB = hepatobiliary, GI = gastrointestinal, UGI = upper GI.

Figs. 3-18

Questions and responses that reporting pathologists gave regarding the study. These were collected by using Google Forms. The comments include some abbreviations. SW = Southwest, EQA = external quality assessment, MDT = multidisciplinary meeting, UHP = University Hospital Plymouth, Free D Path = the networked reporting software, RCT = Royal Cornwall Hospital, H&E = hematoxylin & eosin stain, IHC = immunohistochemistry, HPB = hepatobiliary, GI = gastrointestinal, UGI = upper GI.

Figs. 3-18

Questions and responses that reporting pathologists gave regarding the study. These were collected by using Google Forms. The comments include some abbreviations. SW = Southwest, EQA = external quality assessment, MDT = multidisciplinary meeting, UHP = University Hospital Plymouth, Free D Path = the networked reporting software, RCT = Royal Cornwall Hospital, H&E = hematoxylin & eosin stain, IHC = immunohistochemistry, HPB = hepatobiliary, GI = gastrointestinal, UGI = upper GI.