Virtual Microscopy as a Surrogate for Glass Slides in Neuroblastoma Pathology Central Review, Educational Training, and Research.
Kathleen K Nicol, Jason A Jarzembowski, Vinay Prasad, Thomas J Barr, Hiroyuki Shimada. Nationwide Children's Hospital, Columbus, OH; Children's Hospital of Wisconsin, Milwaukee; Children's Hospital of Los Angeles, CA
Background: Neuroblastom(NBL) is the most common extra-cranial solid malignancy of childhood with 650 cases annually enrolled in Children's Oncology Group treatment protocols. Each tumor is centrally reviewed and diagnosed according to the International Neuroblastoma Pathology Classification, as histology is essential to patient risk and treatment protocol stratification. The INPC involves complex pattern recognition and consistent, accurate implementation accomplished only after significant training and case-based experience. Since pediatric pathologists are few in number with many institutional responsibilities,virtual microscopy practices may allow for expedited case review, e-training, image analysis, and establishment of a digital teaching set. Our initial goal was to compare the efficacy of a digital pathology system for the histopathologic classification of neuroblastic tumors compared to the standard method, whilst training young investigators.
Design: After a multidisciplinary team was assembled, slides from each NBL patient enrolled on a COG study were scanned at 40x magnification. With viewing software and an internet connection, images were reviewed at near real time. The VIPER software allows pathologists to review digital images and pathology reports, complete online review forms, and submit review results electronically to the Biopathology Center. VIPER can provide a “slide conference” environment in which multiple pathologists can simulataneously view fields of interest, annotate salient features, and discuss findings.
Results: Following one in-person training session and four digital slide conferences led by Dr. Shimada, inter-pathologist agreement was excellent, with minor discrepancies, related to the mitotic-karyorrhectic index. Through discussions among the pathologists, this discrepancy was likely due to nuclear staining characteristics.
Conclusions: Central review of neuroblastic tumors using digital pathology is accurate, more efficient, and cheaper than traditional review due to elimination of shipping and travel expenses. We are proceeding to a multi-phase project directly comparing the diagnostic accuracy of glass and virtual slides. Side-by-side comparison of glass and digital images may improve inter-observer variability of MKI. Furthermore, virtual microscopy may represent the future of pathology central review for all tumors enrolled in investigational studies.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 133, Tuesday Morning