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Background

Whole Slide Scans and Web-Based Conferencing Tools Used in Combination Provide Accurate Assessment of Cases for Real-Time Global Clinical Consultation. Subodh M. Lele 1 , Anita Bhaduri 2 , Chitra Madiwale 2 , Kirti Chadha Kazi 3 , Anuradha Murthy 3 , Sandhya Sampath 4 , Tao Liang 4 .

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  1. Whole Slide Scans and Web-Based Conferencing Tools Used in Combination Provide Accurate Assessment of Cases for Real-Time Global Clinical Consultation Subodh M. Lele1, Anita Bhaduri2, Chitra Madiwale2, KirtiChadha Kazi3, Anuradha Murthy3, Sandhya Sampath4, Tao Liang4. 1University of Nebraska Medical Center, Omaha, NE; 2Hinduja Hospital, Mumbai, India; 3Metropolis Healthcare, Mumbai; 4BioImagene Inc.

  2. Background Whole slide imaging (WSI) for clinical consultation: an emerging field • Convenient: fast, anywhere, anytime • Increasingly accurate reproduction of the effect of a light microscope Sign Out

  3. Background Web based conferencing (WBC) methods • Long distance communication • Cheaper, faster • Video capabilities

  4. Background WSI + WBC - Live conferencing - All parties can see slide(s) - Control of slide(s) can be exchanged

  5. Background WSI variables • Scan: • Magnification • Color calibration • Monitor: • Size • Resolution • Color calibration • Navigational ease

  6. Background WBC variables • Monitor: • Size • Resolution • Color calibration • Navigational ease

  7. Background • Consultation/conferencing • variables • Histology processing and • staining quality • Clinical details • Subspecialty review

  8. Background • Cannot control all variables • WSI + WBC = ? Accurate assessment for clinical decision making

  9. Design Metropolis Healthcare Mumbai, India Hinduja Hospital Mumbai, India 20X BioImageneiScanCoreo™ system

  10. Design

  11. Design • Cases were viewed using • PathXchange without access to • glass slides • Subspecialty expertise sought • as required

  12. Design • Real-time conferencing performed • on set date using: • WebEx • PathXchange

  13. Design • PathXchange: • View cases simultaneously • Enter diagnoses/comments using the • free text box • WebEx: • Share desktop between participants • - use mouse as pointer • Audio via telephone line

  14. Design • Cases: • Those used for the monthly Senior • Pathologists’ Meeting (18 hospital • based groups in Mumbai) • - Hinduja Hospital • - Metropolis Healthcare

  15. Design • Cases: • Difficult cases intended to • challenge diagnostic skills • No organ system/subspecialty • restrictions • N=12

  16. Design • Cases: • Each case had a brief clinical • history and description of • pertinent gross findings • Gross photographs were not • available for review

  17. Results • Cases: • Slide scans: • H&E stain • Special stains/results of stains • were not available for review • 1/2 slides per case • One case had results of limited • immunohistochemical work up

  18. Results • Cases: • Additional work-up if done • revealed at conference (without • review of immunostains at • conference)

  19. Results • Cases: Real-time discussion • using WebEx and PathXchange • 8/12 (67%) cases: • - complete agreement • among participants on • diagnosis (inter hospital • and between US and • Indian pathologists)

  20. Results • Cases: Real-time discussion • using WebEx and PathXchange • 4/12 (33%) cases: • - consensus on differential • diagnoses among • participants (inter hospital • and between US and • Indian pathologists)

  21. Results • Complete consensus on diagnosis: • Bland spindle cell neoplasm, favor schwannoma • subjacent to adrenal gland • Peutz-Jeghers polyp with misplaced glands • Inflammatory bowel disease, favor Crohn’s • disease • Strongyloidiasis – GI biopsy • Meconium periorchitis • Angiosarcoma – skin • Malignant spindle cell neoplasm, • chest wall (further work-up needed) • Metastatic melanoma/carcinoma, ovary

  22. Results • Consensus on differential diagnoses: • Hepatocellular carcinoma/atypical • hepatocellular nodule • Lymph node : Kikuchi’s vs Hodgkin’s vs reactive • IHC work up required • Leydig cell tumor negative for inhibin versus • oncocytic neoplasm • Amyloidosis – GI biopsy

  23. Conclusions • WSI and WBC methods provide • accurate assessment of • challenging cases • WBC allows for sharing of cases • for real-time rapid review and • obtaining group consensus

  24. Conclusions • Reasons for lack of a specific • diagnosis/error: • Limited H&E slides for review • Lack of information on • immunostains • Immunostains not available • for review • Additional clinical details • Subspecialty review

  25. Conclusions • Reasons for lack of a specific • diagnosis/error: • Navigational ease and speed

  26. WSI +WBC: Who can benefit? • Solo practice • Small group practice • Limited access to • scientific material • - Large academic centers

  27. Types of consults • Second signature for malignancies • To get a differential and help in working • up a case • To boost confidence (new pathologist) • Interpreting a special stain • For consensus • for QA

  28. Future: One System Read scanned slides (exchange slide driving control) PathXchange • Transcribe • (Voice • recognition) • Sign out Talk/ Conference • Video (gross, other) • Image Order Stains

  29. Acknowledgement • Anita Bhaduri, M.D. • BioImagene • (MohanUttarwar, Tao Liang, • SandhyaSampath) • Steve Hinrichs, M.D.

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