Telepathology is the process of digitizing histological images for transmission electronically to remote centres, often for the purposes of diagnosis. The Aperio system from Leica Biosystems described in this report uses Whole Slide Imaging (WSI) to produce a complete digital representation of the tissue. The loss of the neuropathology post from the pathology department at Aberdeen Royal Infirmary resulted in the suspension of the intra-operative reporting of neurosurgical biopsies. The Aperio CS2 system was installed in early 2014, with the primary aim of re-establishing this important service. In conjunction with this, the neuropathology department at the Western General Hospital in Edinburgh agreed to include the remote reporting of urgent neurosurgical biopsies as part of their overall referral service. This article describes our experience of the Aperio system in its first year of use, during which time approximately 70 urgent neurosurgical cases have been reported.
During the intra-operative procedure, telephone contact between the department and the remote neuropathologist is not continuous, but is made at appropriate stages, for example, when the specimen has newly arrived or when the first slide has been scanned and is available to access remotely. Specimen sampling and laboratory procedures are carried out following the guidelines and advice of the neuropathology team in Edinburgh. During its first year of use, the Aperio system has been found to be easy to use, providing excellent image quality, and requiring minimal calibration. For urgent intra-operative cases, we have found that it is possible to have at least one scanned slide ready to view within 15 minutes of receipt of the specimen. There was only one failure of the intra-operative procedure in the first year of use, but this was due to a network problem at the remote site rather than a hardware or software problem.
In the majority of cases, the automatic scanning mode is ideal, especially when scanning frozen sections, which provide a relatively flat surface and a clear outline on the glass. It is possible to load up to five slides at a time for automatic scanning, allowing the operator to attend to other duties. Allowing for the extra time required for the scanning process, the reporting turnaround time should be only marginally greater than that of a conventional in-house, intra-operative case using a microscope. Remote reporting obviates the inconvenience, expense and time required for a neuropathologist to travel to other centres. With good communications and a little pre-planning, the referring laboratory can ensure that the whole procedure has minimal impact on the reporting neuropathologist’s normal daily working commitments. From our laboratory’s perspective, the introduction of scanning for remote reporting has been a necessary new technology, which has restored an important service for the benefit of patient healthcare.
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