Optimizing the management of thyroid specimens to efficiently generate whole slide images for diagnosis

Abstract

Transition from optical to digital observation requires an additional procedure in the pathology laboratory, the scanning of glass slides, leading to increased time and digital archive consumption. Thyroid surgical samples often carry the need to collect several tissue fragments that generate many slides to be scanned. This study evaluated the impact of using different inking colours for the surgical margin, section thickness, and glass slide type, in the consumption of time and archive. The series comprehended 40 nodules from 30 patients, including 34 benign nodules in follicular nodular disease, 1 NIFTP, and 5 papillary carcinomas. In 12 nodules, the dominant pattern was microfollicular/solid and in 28 it was macrofollicular. Scanning times/mm² were longer in red-inked fragments in comparison to green (p = 0.04) and black ones (p = 0.024), and in blue-inked in comparison to green ones (p = 0.043). File sizes/mm² were larger in red-inked fragments in comparison to green (p = 0.008) and black ones (p = 0.002). The dominant pattern microfollicular/solid was associated with bigger file size/mm² in comparison with the macrofollicular one (p < 0.001). All scanner outputs increase significantly with the thickness of the section. All scanning outputs increase with the usage of adhesive glass slides in comparison to non-adhesive ones. Small interventions in thyroid sample management that can help optimizing the digital workflow include to prefer black and green inking colours for the surgical margins and 2 µm section in non-adhesive glass slides for increased efficiency.

Keywords: Digital pathology; Digital workflow; Efficiency; Specimen inking; Whole slide image.

Fig.1

Hematoxylin and eosin (H&E) whole slide images of four cases with their surgical margins inked with different colours: A red, B black, C blue, D green

Fig.2

Aspect of the 4 different type of section of the same nodule disclosing the diagnosis of benign nodule in the setting of follicular nodular disease. A Hematoxylin and eosin (H&E), 40 × , 2 µm, non-adhesive slide; B H&E, 40 × , 3 µm, non-adhesive slide; C H&E, 40 × , 4 µm, non-adhesive slide; D H&E, 40 × , 2 µm, adhesive slide

Fig. 3

Measurement of the perimeter and area of the thyroid tissue fragments using digital tools on the whole slide image. A Measurement of the perimeter of a fragment inked red (arrow) that was representative of a follicular nodular disease with predominant macrofollicular growth pattern, H&E, 0.4 × , inset 41 × ; B measurement of the area and perimeter of a fragment inked green including a small fragment aligned with the largest fragment, this fragment was representative of a solid pattern papillary carcinoma, H&E, 0.4 × , inset 41 × ; C measurement of the area and perimeter of a fragment inked blue including 3 small fragments detached, this fragment was representative of a follicular nodular disease with dominant microfollicular pattern, H&E, 0.4 ×

Fig. 4

Graphic illustration of the variation of the scanning time and file size of whole slide images per section thickness, type of slide, and according to the tissue area. Graphic A illustration of the mean values ± standard deviation of scanning time variation with the section thickness and type of glass slide. Graphic B illustration of the mean values ± standard deviation of scanning time per area of the fragment according to the section thickness and type of glass slide. Graphic C illustration of the mean values ± standard deviation of file size variation with the section thickness and type of glass slide. Graphic D illustration of the mean values ± standard deviation of file size per area of the fragment according to the section thickness and type of glass slide. A adhesive glass slide, NA non-adhesive glass slide. The comparison of the results was performed using the pair T test