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Digital Pathology - Implementing it in a Leading Cancer Centre

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William Baird
William Baird

The document discusses implementing digital pathology at The Christie Hospital in Manchester. It describes a digital pathology pilot study conducted across Greater Manchester as part of the Cancer Vanguard Initiative. The study found that digital pathology could help reduce diagnosis time by allowing fast sharing of samples among specialists. However, the pilot also encountered some technical challenges, such as the IT system becoming overloaded. The document argues that digital pathology, combined with workflow and infrastructure improvements, has the potential to make pathology services more efficient and enhance patient care.

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The Christie NHS Foundation Trust Digital Pathology Implementing it in a leading Cancer Centre ¡­ Dr. Pedro Oliveira Dept. of Pathology / The Christie Hospital Poland, and with great relief to the team (not that it was ever in doubt) the conference was awarded to Manchester by the global steering committee. PTCOG 55 will be held in Manchester in June 2019, showcasing the Christie service on the national stage and bringing an estimated ?1.4m into the local economy. Thanks to everyone who made this proposal such a success. Readers interested to read the bid book itself can get in touch with Jim Weightman (link opposite). Proton Beam Therapy The Christie NHS Foundation Trust Wilmslow Road, Manchester, M20 4BX Phone: 0161 918 2190 E-mail: James.Weightman@christie.nhs.uk
The Christie NHS Foundation Trust Disclosures ¡­
The Christie NHS Foundation Trust Summary ¡­ 5¡¯ The Myths 5¡¯ The Reality 5¡¯ The Future
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust Myth #1 Digital Radiology = Digital Pathology!
The Christie NHS Foundation Trust Why Radiology became ¡°digital¡±?
The Christie NHS Foundation Trust Because there is no other option anymore ¡­
The Christie NHS Foundation Trust ¡­ and the multiple CT, MRI and PET images couldn¡¯t be evaluated ¡°dynamicaly" without digital reconstruction!
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust We still have the ¡­ Microscope
The Christie NHS Foundation Trust 1667 - Robert Hooke
The Christie NHS Foundation Trust I am quiet confident that a 2017 Histopathologist can do a diagnosis of Basal Cell Carcinoma with the 1667 microscope ¡­
The Christie NHS Foundation Trust Microscope as a Tool ¡­ Simple Reliable technology Resistant
The Christie NHS Foundation Trust Why no conventional radiology film?
The Christie NHS Foundation Trust Why no Photographic film cameras?
The Christie NHS Foundation Trust Why no Black & White TVs?
The Christie NHS Foundation Trust They stop producing them!
The Christie NHS Foundation Trust The ¡°Microscope blocking¡± will only be overtaken by ending production (unless a ¡°miracle¡± occurs!)
The Christie NHS Foundation Trust ¡­ and after all we still need the Glass ºÝºÝߣs!
The Christie NHS Foundation Trust #1 Digital Radiology = Digital Pathology!
The Christie NHS Foundation Trust Myth #2 Image Analysis = Digital Pathology!
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust We have been using ¡°graticules¡± ¡­ We can use ¡°static images¡± for assessing ER, PR, Ki-67, ¡­ We can use ¡°stereological methods¡± on images taken ¡­
The Christie NHS Foundation Trust Image Analysis by Digital Pathology is ¡°easier¡± and ¡°faster¡± but not forcefully ¡°better¡±!
The Christie NHS Foundation Trust Do you believe that your Trust bought a CT scan because of ¡°Hounsfield unit¡± capabilities?
The Christie NHS Foundation Trust How much of your current time as a Histopathologist do you dedicate to ¡°image analysis¡±?
The Christie NHS Foundation Trust Myth #2 Image Analysis = Digital Pathology!
The Christie NHS Foundation Trust Myth #3 Cost effective = Digital Pathology!
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust Histopathology is ¡°problematic¡±¡­
The Christie NHS Foundation Trust ¡­ it is a typical example of the ¡°Baumol effect¡±!
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust We still need the Glass ºÝºÝߣs!
The Christie NHS Foundation Trust We still need to ¡°see¡± the ºÝºÝߣs!
The Christie NHS Foundation Trust We need to buy ¡°Scanners¡±!
The Christie NHS Foundation Trust We need new IT infrastructure!
The Christie NHS Foundation Trust And more important, needs a overall ¡­ Reformulation of the ¡°Workflows¡±
The Christie NHS Foundation Trust ?????????????¡­
The Christie NHS Foundation Trust Myth #3 Cost effective = Digital Pathology!
The Christie NHS Foundation Trust Why am I playing like the Devil¡¯s advocate?
The Christie NHS Foundation Trust We need a ¡°different approach¡±¡­ Digital pathology
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust The Future challenges in Histopathology
The Christie NHS Foundation Trust #1 Needed ¡­ Workforce Skilled resources
The Christie NHS Foundation Trust Increasing workload!
The Christie NHS Foundation Trust Please, nominate a Department where the worload has reduced¡­
The Christie NHS Foundation Trust #2 Diagnosis ¡­ Complexity Comprehensiveness
The Christie NHS Foundation Trust 1976
The Christie NHS Foundation Trust 2016 CEff 220616 1 V1 Final Pathology reporting of breast disease in surgical excision specimens incorporating the dataset for histological reporting of breast cancer June 2016 Authors: Professor IO Ellis (Chair) Dr S Al-Sam Dr N Anderson Dr P Carder Dr R Deb Dr A Girling Dr S Hales Professor A Hanby Dr M Ibrahim Dr AHS Lee Dr R Liebmann Dr E Mallon Professor SE Pinder Dr E Provenzano Dr C Quinn Dr E Rakha Dr D Rowlands Professor T Stephenson Dr C A Wells Unique document number G148 HR (This publication contains high-resolution images and is 12 MB. It is also available on www.rcpath.org as a 4 MB PDF, with lower-res images.) Document name Pathology reporting of breast disease in surgical excision specimens incorporating the dataset for histological reporting of breast cancer Version number 2 Produced by The authors are members of the Guidelines Working Group of the UK National Coordinating Committee for Breast Pathology, which leads on developing pathology guidance for the NHS Breast Screening Programme (NHSBSP) and for preparation of dataset standards in breast cancer pathology for The Royal College of Pathologists. Dr Ibrahim is a member of UK NEQAS and was co-opted to the Working Group to assist with the sections regarding quality assurance of immunocytochemical predictive testing for hormone receptors and HER2. Dr Liebmann provided guidance on RCPath policy including standards for hormone receptor evaluation. Dr Rakha is a member of the Research Sub-Committee of the UK National Coordinating Committee for Breast Pathology. Date active June 2016 Date for review May 2019 Comments This document updates the NHSBSP Guidelines for Pathology Reporting in Breast Cancer Screening and The Royal College of Pathologists¡¯ Standards and datasets for reporting cancers: Dataset for histological reporting of breast cancer. It replaces the previous Minimum dataset for breast cancer histopathology, published in 2005. In accordance with the College¡¯s pre-publications policy, it was on the College website for consultation from 21 October to 18 November 2015. Thirty-six items of feedback were received and the document was amended accordingly. Please email publishing@rcpath.org to see the responses and comments. In June 2016, Appendix M was amended to correct the coding for hamartoma. Dr Lorna Williamson Director of Publishing and Engagement CEff 220616 123 V1 Final Appendix B RCPath dataset for histopathological reporting of breast cancer surgical resections (in situ and invasive disease) This section lists the items recognised as core cancer dataset fields. These have been incorporated into a recommended synoptic reporting format in Appendix A. Surname: ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­ Forenames: ¡­¡­¡­¡­¡­¡­¡­ Date of birth: ¡­¡­¡­¡­¡­¡­ Sex: ¡­.¡­¡­. Hospital:¡­¡­¡­¡­¡­¡­.. ¡­¡­¡­¡­¡­.¡­.. Hospital/CHI no: ¡­¡­¡­¡­¡­¡­¡­.¡­¡­¡­.. NHS no: ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­ Date of surgery: ¡­¡­¡­¡­¡­¡­.¡­¡­¡­¡­ Date of report ¡­¡­¡­.. Authorisation: ¡­¡­¡­¡­¡­.. Report no: ¡­¡­¡­¡­¡­¡­¡­¡­¡­.Date of receipt:¡­¡­¡­¡­¡­¡­¡­¡­... Pathologist: ¡­¡­¡­¡­¡­.¡­¡­¡­¡­¡­¡­¡­¡­¡­... Surgeon: ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.. ¡­ Surgical specimen(s) Is there a history of neo-adjuvant therapy?* Yes ¡õ No ¡õ Not known ¡õ Side:* Right ¡õ Left ¡õ Specimen type:* WLE ¡õ Excision biopsy ¡õ Localisation specimen ¡õ Segmental excision ¡õ Mastectomy ¡õ Subcutaneous mastectomy ¡õ Re-excision ¡õ Further margins (including cavity shaves/bed biopsies) Microdochectomy/microductectomy ¡õ SLN ¡õ Axillary sampling ¡õ Axillary LN level I ¡õ Axillary LN level II ¡õ Axillary LN level III ¡õ Total duct excision/Hadfield¡¯s procedure ¡õ Other .......................................................... Specimen weight (g) .......................................... Malignant lesions Malignant in situ lesion: In situ components: DCIS grade:* High ¡õ Intermediate ¡õ Low ¡õ Cannot be assessed ¡õ DCIS/pleomorphic or DCIS like LCIS size mm: ........................................... LCIS: Present ¡õ Not identified ¡õ Paget¡¯s disease: Present ¡õ Not identified ¡õ Cannot be assessed ¡õ Microinvasive: Present ¡õ Not identified ¡õ Invasive carcinoma Size and extent Invasive tumour size (mm): * ................................... Whole tumour (invasive + DCIS) size (mm): * ............................... Disease extent:* Localised ¡õ Multiple invasive foci ¡õ Cannot be assessed ¡õ ¡­ a document of more than 100 pages! ¡­ a template of #4 pages!
The Christie NHS Foundation Trust ¡­we need ¡°Experts¡±!
The Christie NHS Foundation Trust ¡­an in preference, available anywhere!
The Christie NHS Foundation Trust #3 Cancer ¡­ More frequent ¡­ Faster diagnosis¡­
The Christie NHS Foundation Trust No Pathology ¡­ ¡­ no Cancer
The Christie NHS Foundation Trust Pressure for faster diagnosis ¡­
The Christie NHS Foundation Trust #4 Therapeutics ¡­ The new ¡°Pathology Powerhouse¡±!
The Christie NHS Foundation Trust The 1% ¡­ ¡­ cut-offs!
The Christie NHS Foundation Trust #5 Money ¡­ Cost constrains: Less Investment Less Capital expenditure
The Christie NHS Foundation Trust The ¡°Fake Bus¡±
The Christie NHS Foundation Trust #6 IT/LIMS ¡­ Outdated Surreal
The Christie NHS Foundation Trust Please, nominate a Department who doesn¡¯t complain on IT issues¡­
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust It is time for Digital Pathology
The Christie NHS Foundation Trust 30/11/17, 00:13Digital pathology project is under way | Greater Manchester Cancer Vanguard Innovation Digital pathology project is under way Oct 2, 2017 | news A project to test out the latest technology in cancer pathology is under way across Greater Manchester. Vanguard Innovation is exploring the use of digital pathology that can capture a digital image of human tissue samples. Also known as on-screen microscopy, the technique allows samples to be shared quickly among specialists and so has the potential to reduce the time it takes to reach a ?nal diagnosis when second opinions are required. Latest news Pioneering website helps patient decision- making ¡®You get so much from giving¡¯ Wellbeing website up and running Pilot scheme aims to boost early cancer diagnosis Online education platform passes milestone Search about usabout us newsnews user involvementuser involvement showcasesshowcases gateway-cgateway-c videosvideos newslettersnewsletters contactcontact Digital pathology project is under way Oct 2, 2017 | news A project to test out the latest technology in cancer pathology is under way across Greater Manchester. Vanguard Innovation is exploring the use of digital pathology that can capture a digital image of human tissue samples. Also known Latest news Pioneering website helps patient decision- making ¡®You get so much from giving¡¯ Wellbeing website up and running Pilot scheme aims to boost early cancer diagnosis Online Search newslettersnewsletters contactcontact
The Christie NHS Foundation Trust Do we need to validate Digital Pathology?
The Christie NHS Foundation Trust When you bought your Plasma HD TV did you ¡°validate¡± it ?
The Christie NHS Foundation Trust What have we learnt at Christie from the ¡­ Digital Pathology Cancer Vanguard Pilot Study in Greater Manchester?
The Christie NHS Foundation Trust We Can¡¯t!
The Christie NHS Foundation Trust And not because of the ¡­ Pathologists!
The Christie NHS Foundation Trust Some Pathologists are afraid of Digital Pathology¡­
The Christie NHS Foundation Trust They are afraid of not being able to cope with the Software skills needed to use in Digital Pathology!
The Christie NHS Foundation Trust ¡­ because the Microscope is such a ¡°simple device¡± to use!
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust And neither because of ¡­ Poorer ¡°Quality¡± of Digital Pathology!
The Christie NHS Foundation Trust ¡°¡­ have never had it so good¡±
The Christie NHS Foundation Trust The ¡°Technological lag¡± has been solved for Histopathology (will be solved soon for cytology)
The Christie NHS Foundation Trust What went wrong?
The Christie NHS Foundation Trust Find a place to install the¡°scanner¡­
The Christie NHS Foundation Trust IT system jammed after the first ¡°peritonectomy¡± specimen (#70 slides) uploading ¡­
The Christie NHS Foundation Trust Digital Pathology
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust ????? ????? ¡­ how to solve?
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust NHS Pathology need a ¡­ Glorious Revolution
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust NHS Improvement Operational Productivity Proposed Pathology Consolidation Networks Summer 2017: NHS Improvement proposed pathology networks
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust Build a new Gateshead-like pathology ¡°factory¡± in Manchester ¡­
The Christie NHS Foundation Trust Fill with ¡°State of the Art¡± LEAN pathology continuous work?ow ¡­
The Christie NHS Foundation Trust New ef?cacious LIMS and IT solutions ¡­
The Christie NHS Foundation Trust Bring the specimens to the new central factory (less than 20 miles distance) ¡­ TissueSAFE High vacuum biospecimens transfer system FORMALIN-FREE Double layered microns in thick greater mechan resistance to pe Available in five dimensions, sui specimens. Three sealing a lines marked fo Sealable docum security for pati Automatically p label contains: I specimen and fi Enlarged base f SPECIAL BAGS Full automation and closed operation prevents exposure to formalin fu Storage in vacuum bags dramatically reduces volume. Archiving even without formalin is possible. Improved archiving Lower disposal cost thanks to a decreased volume of bio-hazard mater Extreme cost saving for disposal A D C B E A D C B E
The Christie NHS Foundation Trust Delegate ¡°cut-up¡± in properly trained Biomedical Scientists ¡­
The Christie NHS Foundation Trust ¡°Rapid processor¡±¡­ ¡°Automatic embedding¡±¡­
The Christie NHS Foundation Trust Hirata received "The Japan Machinery Federation Chairman Award" in the 6th Robot Hirata Corporation is pleased to announce we and Sakura Finetek Japan Co.,Ltd.£¨http://www.sakura- ?netek.com/), a medical equipment manufacturer, receive "The Japan Machinery Federation Chairman Award" in our joint names. Hirata designs and produces fully automatic continuous slicer Tissue-Tek Smart Section for preparing pathological sample on consignment contract with Sakura Finetek Japan Co.,Ltd.. This slicer is highly-regarded as a social value product. In medical equipment industry, more and more system automation is required because of heavy burden on
The Christie NHS Foundation Trust Continuous Scanning¡­
The Christie NHS Foundation Trust Digital Pathology
The Christie NHS Foundation Trust Networking Power
The Christie NHS Foundation Trust Digital Pathology allows for easy Hub-and-Spoke conexions!
The Christie NHS Foundation Trust Digital Pathology allows for easy Point-to-Point conexions!
The Christie NHS Foundation Trust The problem of availability of histopathologists ends!
The Christie NHS Foundation Trust I do it: Faster Better Cheaper
The Christie NHS Foundation Trust With Digital Pathology you can have an EXPERT everywhere!
The Christie NHS Foundation Trust Speed-up Digital Pathology speeds- up TAT, referrals, MDTs, expert opinions¡­
The Christie NHS Foundation Trust ¡­slides missing ¡­slides lost ¡­slides misfiled ¡­etc..
The Christie NHS Foundation Trust More ¡­
The Christie NHS Foundation Trust Imagine having all sort of Monoclonal IHC antibodies available!
The Christie NHS Foundation Trust Imagine having all sort of Molecular Testing available!
The Christie NHS Foundation Trust Imagine having all sort of Digital Image Analysis!
The Christie NHS Foundation Trust Further ¡­
The Christie NHS Foundation Trust Imagine the ¡°savings¡± by buying in ¡°bundle¡± the consumables!
The Christie NHS Foundation Trust Imagine the ¡°savings¡± by sharing office and laboratory staff!
The Christie NHS Foundation Trust You can reduce the ¡°Baumol effect¡±!
The Christie NHS Foundation Trust ¡°Forceful marriage¡± Merger of Path Departments!
The Christie NHS Foundation Trust Mergers can go wrong!
The Christie NHS Foundation Trust Contrary to what you may think, Digital Pathology allows individuality!
The Christie NHS Foundation Trust You can share but retain your identity
The Christie NHS Foundation Trust and last but not the least ¡­
The Christie NHS Foundation Trust Go for an ultimate ¡°CREATIVE DESTRUCTION¡± Joseph Alois Schumpeter (1883-1950)
The Christie NHS Foundation Trust Terminate ¡­ Pathology Department
The Christie NHS Foundation Trust Terminate ¡­ Radiology Department
The Christie NHS Foundation Trust Marry us ¡­
The Christie NHS Foundation Trust Department of Diagnostic Imaging
The Christie NHS Foundation Trust
The Christie NHS Foundation Trust Thanks

More Related Content

Digital Pathology - Implementing it in a Leading Cancer Centre

  • 1. The Christie NHS Foundation Trust Digital Pathology Implementing it in a leading Cancer Centre ¡­ Dr. Pedro Oliveira Dept. of Pathology / The Christie Hospital Poland, and with great relief to the team (not that it was ever in doubt) the conference was awarded to Manchester by the global steering committee. PTCOG 55 will be held in Manchester in June 2019, showcasing the Christie service on the national stage and bringing an estimated ?1.4m into the local economy. Thanks to everyone who made this proposal such a success. Readers interested to read the bid book itself can get in touch with Jim Weightman (link opposite). Proton Beam Therapy The Christie NHS Foundation Trust Wilmslow Road, Manchester, M20 4BX Phone: 0161 918 2190 E-mail: James.Weightman@christie.nhs.uk
  • 2. The Christie NHS Foundation Trust Disclosures ¡­
  • 3. The Christie NHS Foundation Trust Summary ¡­ 5¡¯ The Myths 5¡¯ The Reality 5¡¯ The Future
  • 4. The Christie NHS Foundation Trust
  • 5. The Christie NHS Foundation Trust Myth #1 Digital Radiology = Digital Pathology!
  • 6. The Christie NHS Foundation Trust Why Radiology became ¡°digital¡±?
  • 7. The Christie NHS Foundation Trust Because there is no other option anymore ¡­
  • 8. The Christie NHS Foundation Trust ¡­ and the multiple CT, MRI and PET images couldn¡¯t be evaluated ¡°dynamicaly" without digital reconstruction!
  • 9. The Christie NHS Foundation Trust
  • 10. The Christie NHS Foundation Trust We still have the ¡­ Microscope
  • 11. The Christie NHS Foundation Trust 1667 - Robert Hooke
  • 12. The Christie NHS Foundation Trust I am quiet confident that a 2017 Histopathologist can do a diagnosis of Basal Cell Carcinoma with the 1667 microscope ¡­
  • 13. The Christie NHS Foundation Trust Microscope as a Tool ¡­ Simple Reliable technology Resistant
  • 14. The Christie NHS Foundation Trust Why no conventional radiology film?
  • 15. The Christie NHS Foundation Trust Why no Photographic film cameras?
  • 16. The Christie NHS Foundation Trust Why no Black & White TVs?
  • 17. The Christie NHS Foundation Trust They stop producing them!
  • 18. The Christie NHS Foundation Trust The ¡°Microscope blocking¡± will only be overtaken by ending production (unless a ¡°miracle¡± occurs!)
  • 19. The Christie NHS Foundation Trust ¡­ and after all we still need the Glass ºÝºÝߣs!
  • 20. The Christie NHS Foundation Trust #1 Digital Radiology = Digital Pathology!
  • 21. The Christie NHS Foundation Trust Myth #2 Image Analysis = Digital Pathology!
  • 22. The Christie NHS Foundation Trust
  • 23. The Christie NHS Foundation Trust We have been using ¡°graticules¡± ¡­ We can use ¡°static images¡± for assessing ER, PR, Ki-67, ¡­ We can use ¡°stereological methods¡± on images taken ¡­
  • 24. The Christie NHS Foundation Trust Image Analysis by Digital Pathology is ¡°easier¡± and ¡°faster¡± but not forcefully ¡°better¡±!
  • 25. The Christie NHS Foundation Trust Do you believe that your Trust bought a CT scan because of ¡°Hounsfield unit¡± capabilities?
  • 26. The Christie NHS Foundation Trust How much of your current time as a Histopathologist do you dedicate to ¡°image analysis¡±?
  • 27. The Christie NHS Foundation Trust Myth #2 Image Analysis = Digital Pathology!
  • 28. The Christie NHS Foundation Trust Myth #3 Cost effective = Digital Pathology!
  • 29. The Christie NHS Foundation Trust
  • 30. The Christie NHS Foundation Trust Histopathology is ¡°problematic¡±¡­
  • 31. The Christie NHS Foundation Trust ¡­ it is a typical example of the ¡°Baumol effect¡±!
  • 32. The Christie NHS Foundation Trust
  • 33. The Christie NHS Foundation Trust We still need the Glass ºÝºÝߣs!
  • 34. The Christie NHS Foundation Trust We still need to ¡°see¡± the ºÝºÝߣs!
  • 35. The Christie NHS Foundation Trust We need to buy ¡°Scanners¡±!
  • 36. The Christie NHS Foundation Trust We need new IT infrastructure!
  • 37. The Christie NHS Foundation Trust And more important, needs a overall ¡­ Reformulation of the ¡°Workflows¡±
  • 38. The Christie NHS Foundation Trust ?????????????¡­
  • 39. The Christie NHS Foundation Trust Myth #3 Cost effective = Digital Pathology!
  • 40. The Christie NHS Foundation Trust Why am I playing like the Devil¡¯s advocate?
  • 41. The Christie NHS Foundation Trust We need a ¡°different approach¡±¡­ Digital pathology
  • 42. The Christie NHS Foundation Trust
  • 43. The Christie NHS Foundation Trust The Future challenges in Histopathology
  • 44. The Christie NHS Foundation Trust #1 Needed ¡­ Workforce Skilled resources
  • 45. The Christie NHS Foundation Trust Increasing workload!
  • 46. The Christie NHS Foundation Trust Please, nominate a Department where the worload has reduced¡­
  • 47. The Christie NHS Foundation Trust #2 Diagnosis ¡­ Complexity Comprehensiveness
  • 48. The Christie NHS Foundation Trust 1976
  • 49. The Christie NHS Foundation Trust 2016 CEff 220616 1 V1 Final Pathology reporting of breast disease in surgical excision specimens incorporating the dataset for histological reporting of breast cancer June 2016 Authors: Professor IO Ellis (Chair) Dr S Al-Sam Dr N Anderson Dr P Carder Dr R Deb Dr A Girling Dr S Hales Professor A Hanby Dr M Ibrahim Dr AHS Lee Dr R Liebmann Dr E Mallon Professor SE Pinder Dr E Provenzano Dr C Quinn Dr E Rakha Dr D Rowlands Professor T Stephenson Dr C A Wells Unique document number G148 HR (This publication contains high-resolution images and is 12 MB. It is also available on www.rcpath.org as a 4 MB PDF, with lower-res images.) Document name Pathology reporting of breast disease in surgical excision specimens incorporating the dataset for histological reporting of breast cancer Version number 2 Produced by The authors are members of the Guidelines Working Group of the UK National Coordinating Committee for Breast Pathology, which leads on developing pathology guidance for the NHS Breast Screening Programme (NHSBSP) and for preparation of dataset standards in breast cancer pathology for The Royal College of Pathologists. Dr Ibrahim is a member of UK NEQAS and was co-opted to the Working Group to assist with the sections regarding quality assurance of immunocytochemical predictive testing for hormone receptors and HER2. Dr Liebmann provided guidance on RCPath policy including standards for hormone receptor evaluation. Dr Rakha is a member of the Research Sub-Committee of the UK National Coordinating Committee for Breast Pathology. Date active June 2016 Date for review May 2019 Comments This document updates the NHSBSP Guidelines for Pathology Reporting in Breast Cancer Screening and The Royal College of Pathologists¡¯ Standards and datasets for reporting cancers: Dataset for histological reporting of breast cancer. It replaces the previous Minimum dataset for breast cancer histopathology, published in 2005. In accordance with the College¡¯s pre-publications policy, it was on the College website for consultation from 21 October to 18 November 2015. Thirty-six items of feedback were received and the document was amended accordingly. Please email publishing@rcpath.org to see the responses and comments. In June 2016, Appendix M was amended to correct the coding for hamartoma. Dr Lorna Williamson Director of Publishing and Engagement CEff 220616 123 V1 Final Appendix B RCPath dataset for histopathological reporting of breast cancer surgical resections (in situ and invasive disease) This section lists the items recognised as core cancer dataset fields. These have been incorporated into a recommended synoptic reporting format in Appendix A. Surname: ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­ Forenames: ¡­¡­¡­¡­¡­¡­¡­ Date of birth: ¡­¡­¡­¡­¡­¡­ Sex: ¡­.¡­¡­. Hospital:¡­¡­¡­¡­¡­¡­.. ¡­¡­¡­¡­¡­.¡­.. Hospital/CHI no: ¡­¡­¡­¡­¡­¡­¡­.¡­¡­¡­.. NHS no: ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­ Date of surgery: ¡­¡­¡­¡­¡­¡­.¡­¡­¡­¡­ Date of report ¡­¡­¡­.. Authorisation: ¡­¡­¡­¡­¡­.. Report no: ¡­¡­¡­¡­¡­¡­¡­¡­¡­.Date of receipt:¡­¡­¡­¡­¡­¡­¡­¡­... Pathologist: ¡­¡­¡­¡­¡­.¡­¡­¡­¡­¡­¡­¡­¡­¡­... Surgeon: ¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­¡­.. ¡­ Surgical specimen(s) Is there a history of neo-adjuvant therapy?* Yes ¡õ No ¡õ Not known ¡õ Side:* Right ¡õ Left ¡õ Specimen type:* WLE ¡õ Excision biopsy ¡õ Localisation specimen ¡õ Segmental excision ¡õ Mastectomy ¡õ Subcutaneous mastectomy ¡õ Re-excision ¡õ Further margins (including cavity shaves/bed biopsies) Microdochectomy/microductectomy ¡õ SLN ¡õ Axillary sampling ¡õ Axillary LN level I ¡õ Axillary LN level II ¡õ Axillary LN level III ¡õ Total duct excision/Hadfield¡¯s procedure ¡õ Other .......................................................... Specimen weight (g) .......................................... Malignant lesions Malignant in situ lesion: In situ components: DCIS grade:* High ¡õ Intermediate ¡õ Low ¡õ Cannot be assessed ¡õ DCIS/pleomorphic or DCIS like LCIS size mm: ........................................... LCIS: Present ¡õ Not identified ¡õ Paget¡¯s disease: Present ¡õ Not identified ¡õ Cannot be assessed ¡õ Microinvasive: Present ¡õ Not identified ¡õ Invasive carcinoma Size and extent Invasive tumour size (mm): * ................................... Whole tumour (invasive + DCIS) size (mm): * ............................... Disease extent:* Localised ¡õ Multiple invasive foci ¡õ Cannot be assessed ¡õ ¡­ a document of more than 100 pages! ¡­ a template of #4 pages!
  • 50. The Christie NHS Foundation Trust ¡­we need ¡°Experts¡±!
  • 51. The Christie NHS Foundation Trust ¡­an in preference, available anywhere!
  • 52. The Christie NHS Foundation Trust #3 Cancer ¡­ More frequent ¡­ Faster diagnosis¡­
  • 53. The Christie NHS Foundation Trust No Pathology ¡­ ¡­ no Cancer
  • 54. The Christie NHS Foundation Trust Pressure for faster diagnosis ¡­
  • 55. The Christie NHS Foundation Trust #4 Therapeutics ¡­ The new ¡°Pathology Powerhouse¡±!
  • 56. The Christie NHS Foundation Trust The 1% ¡­ ¡­ cut-offs!
  • 57. The Christie NHS Foundation Trust #5 Money ¡­ Cost constrains: Less Investment Less Capital expenditure
  • 58. The Christie NHS Foundation Trust The ¡°Fake Bus¡±
  • 59. The Christie NHS Foundation Trust #6 IT/LIMS ¡­ Outdated Surreal
  • 60. The Christie NHS Foundation Trust Please, nominate a Department who doesn¡¯t complain on IT issues¡­
  • 61. The Christie NHS Foundation Trust
  • 62. The Christie NHS Foundation Trust
  • 63. The Christie NHS Foundation Trust It is time for Digital Pathology
  • 64. The Christie NHS Foundation Trust 30/11/17, 00:13Digital pathology project is under way | Greater Manchester Cancer Vanguard Innovation Digital pathology project is under way Oct 2, 2017 | news A project to test out the latest technology in cancer pathology is under way across Greater Manchester. Vanguard Innovation is exploring the use of digital pathology that can capture a digital image of human tissue samples. Also known as on-screen microscopy, the technique allows samples to be shared quickly among specialists and so has the potential to reduce the time it takes to reach a ?nal diagnosis when second opinions are required. Latest news Pioneering website helps patient decision- making ¡®You get so much from giving¡¯ Wellbeing website up and running Pilot scheme aims to boost early cancer diagnosis Online education platform passes milestone Search about usabout us newsnews user involvementuser involvement showcasesshowcases gateway-cgateway-c videosvideos newslettersnewsletters contactcontact Digital pathology project is under way Oct 2, 2017 | news A project to test out the latest technology in cancer pathology is under way across Greater Manchester. Vanguard Innovation is exploring the use of digital pathology that can capture a digital image of human tissue samples. Also known Latest news Pioneering website helps patient decision- making ¡®You get so much from giving¡¯ Wellbeing website up and running Pilot scheme aims to boost early cancer diagnosis Online Search newslettersnewsletters contactcontact
  • 65. The Christie NHS Foundation Trust Do we need to validate Digital Pathology?
  • 66. The Christie NHS Foundation Trust When you bought your Plasma HD TV did you ¡°validate¡± it ?
  • 67. The Christie NHS Foundation Trust What have we learnt at Christie from the ¡­ Digital Pathology Cancer Vanguard Pilot Study in Greater Manchester?
  • 68. The Christie NHS Foundation Trust We Can¡¯t!
  • 69. The Christie NHS Foundation Trust And not because of the ¡­ Pathologists!
  • 70. The Christie NHS Foundation Trust Some Pathologists are afraid of Digital Pathology¡­
  • 71. The Christie NHS Foundation Trust They are afraid of not being able to cope with the Software skills needed to use in Digital Pathology!
  • 72. The Christie NHS Foundation Trust ¡­ because the Microscope is such a ¡°simple device¡± to use!
  • 73. The Christie NHS Foundation Trust
  • 74. The Christie NHS Foundation Trust
  • 75. The Christie NHS Foundation Trust And neither because of ¡­ Poorer ¡°Quality¡± of Digital Pathology!
  • 76. The Christie NHS Foundation Trust ¡°¡­ have never had it so good¡±
  • 77. The Christie NHS Foundation Trust The ¡°Technological lag¡± has been solved for Histopathology (will be solved soon for cytology)
  • 78. The Christie NHS Foundation Trust What went wrong?
  • 79. The Christie NHS Foundation Trust Find a place to install the¡°scanner¡­
  • 80. The Christie NHS Foundation Trust IT system jammed after the first ¡°peritonectomy¡± specimen (#70 slides) uploading ¡­
  • 81. The Christie NHS Foundation Trust Digital Pathology
  • 82. The Christie NHS Foundation Trust
  • 83. The Christie NHS Foundation Trust ????? ????? ¡­ how to solve?
  • 84. The Christie NHS Foundation Trust
  • 85. The Christie NHS Foundation Trust NHS Pathology need a ¡­ Glorious Revolution
  • 86. The Christie NHS Foundation Trust
  • 87. The Christie NHS Foundation Trust NHS Improvement Operational Productivity Proposed Pathology Consolidation Networks Summer 2017: NHS Improvement proposed pathology networks
  • 88. The Christie NHS Foundation Trust
  • 89. The Christie NHS Foundation Trust Build a new Gateshead-like pathology ¡°factory¡± in Manchester ¡­
  • 90. The Christie NHS Foundation Trust Fill with ¡°State of the Art¡± LEAN pathology continuous work?ow ¡­
  • 91. The Christie NHS Foundation Trust New ef?cacious LIMS and IT solutions ¡­
  • 92. The Christie NHS Foundation Trust Bring the specimens to the new central factory (less than 20 miles distance) ¡­ TissueSAFE High vacuum biospecimens transfer system FORMALIN-FREE Double layered microns in thick greater mechan resistance to pe Available in five dimensions, sui specimens. Three sealing a lines marked fo Sealable docum security for pati Automatically p label contains: I specimen and fi Enlarged base f SPECIAL BAGS Full automation and closed operation prevents exposure to formalin fu Storage in vacuum bags dramatically reduces volume. Archiving even without formalin is possible. Improved archiving Lower disposal cost thanks to a decreased volume of bio-hazard mater Extreme cost saving for disposal A D C B E A D C B E
  • 93. The Christie NHS Foundation Trust Delegate ¡°cut-up¡± in properly trained Biomedical Scientists ¡­
  • 94. The Christie NHS Foundation Trust ¡°Rapid processor¡±¡­ ¡°Automatic embedding¡±¡­
  • 95. The Christie NHS Foundation Trust Hirata received "The Japan Machinery Federation Chairman Award" in the 6th Robot Hirata Corporation is pleased to announce we and Sakura Finetek Japan Co.,Ltd.£¨http://www.sakura- ?netek.com/), a medical equipment manufacturer, receive "The Japan Machinery Federation Chairman Award" in our joint names. Hirata designs and produces fully automatic continuous slicer Tissue-Tek Smart Section for preparing pathological sample on consignment contract with Sakura Finetek Japan Co.,Ltd.. This slicer is highly-regarded as a social value product. In medical equipment industry, more and more system automation is required because of heavy burden on
  • 96. The Christie NHS Foundation Trust Continuous Scanning¡­
  • 97. The Christie NHS Foundation Trust Digital Pathology
  • 98. The Christie NHS Foundation Trust Networking Power
  • 99. The Christie NHS Foundation Trust Digital Pathology allows for easy Hub-and-Spoke conexions!
  • 100. The Christie NHS Foundation Trust Digital Pathology allows for easy Point-to-Point conexions!
  • 101. The Christie NHS Foundation Trust The problem of availability of histopathologists ends!
  • 102. The Christie NHS Foundation Trust I do it: Faster Better Cheaper
  • 103. The Christie NHS Foundation Trust With Digital Pathology you can have an EXPERT everywhere!
  • 104. The Christie NHS Foundation Trust Speed-up Digital Pathology speeds- up TAT, referrals, MDTs, expert opinions¡­
  • 105. The Christie NHS Foundation Trust ¡­slides missing ¡­slides lost ¡­slides misfiled ¡­etc..
  • 106. The Christie NHS Foundation Trust More ¡­
  • 107. The Christie NHS Foundation Trust Imagine having all sort of Monoclonal IHC antibodies available!
  • 108. The Christie NHS Foundation Trust Imagine having all sort of Molecular Testing available!
  • 109. The Christie NHS Foundation Trust Imagine having all sort of Digital Image Analysis!
  • 110. The Christie NHS Foundation Trust Further ¡­
  • 111. The Christie NHS Foundation Trust Imagine the ¡°savings¡± by buying in ¡°bundle¡± the consumables!
  • 112. The Christie NHS Foundation Trust Imagine the ¡°savings¡± by sharing office and laboratory staff!
  • 113. The Christie NHS Foundation Trust You can reduce the ¡°Baumol effect¡±!
  • 114. The Christie NHS Foundation Trust ¡°Forceful marriage¡± Merger of Path Departments!
  • 115. The Christie NHS Foundation Trust Mergers can go wrong!
  • 116. The Christie NHS Foundation Trust Contrary to what you may think, Digital Pathology allows individuality!
  • 117. The Christie NHS Foundation Trust You can share but retain your identity
  • 118. The Christie NHS Foundation Trust and last but not the least ¡­
  • 119. The Christie NHS Foundation Trust Go for an ultimate ¡°CREATIVE DESTRUCTION¡± Joseph Alois Schumpeter (1883-1950)
  • 120. The Christie NHS Foundation Trust Terminate ¡­ Pathology Department
  • 121. The Christie NHS Foundation Trust Terminate ¡­ Radiology Department
  • 122. The Christie NHS Foundation Trust Marry us ¡­
  • 123. The Christie NHS Foundation Trust Department of Diagnostic Imaging
  • 124. The Christie NHS Foundation Trust
  • 125. The Christie NHS Foundation Trust Thanks