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Digital pathology facilitating intraoperative freezing

Author:admin Publication Date:2016-08-06 09:23:15 Browse:1767

Intraoperative freezing, also known as frozen section examination and diagnosis, is a method of rapid production of pathological tissue sliced using a microtome in a freezer, and provided to pathologists for diagnosis after special dyeing. During surgical procedures, clinicians can request the pathologist for emergency consultation on the nature of a lesion, scope of removed tissue and other diagnosis problems related to the surgery, and will select the appropriate surgical method and scope, based on the consultation results, so as to avoid secondary surgery and injuries.

Theoretically, frozen section diagnosis is performed during surgery, which is used as the basis for developing the surgical plan. The entire process is completed within 30 minutes, from material collection, production, reading and pathological report, with fast speed and accuracy.

However, it takes at least 10 years’ experience for a pathologist to provide independent diagnosis, and such pathologists need to evaluate tens of thousands of cases. Frozen section diagnosis production quality is inferior to the conventional paraffin section due to time constraints and material collection limitations, hence there are often delays in frozen diagnosis or misdiagnosis occurs frequently. From a large number of tertiary hospitals, the coincidence rate for frozen section and paraffin section diagnosis is around 95% on average. However, for many secondary hospitals and primary hospitals, the annual volume is less than a thousand cases. Their pathologists cannot develop faster, and lack practical experience in intraoperative freezing and in diagnosing many diseases.

With the introduction of the national diagnosis and treatment policy, advocating first visits at the primary level, two-way referral and raising the level of diagnosis and treatment in primary hospitals has become the inevitable trend. Pathology, as the "Gold Standard" in diagnosis, plays a decisive role in the hospital’s diagnosis and treatment level. Traditional pathology diagnosis relies on physical slicing and microscopy. If a hospital would like access to expert diagnosis, it has to physically mail the slice, which is impossible in the case of intraoperative freezing.

It is under this background that the potential for digital pathology has emerged. It makes use of the concept of traditional pathology & Internet; it converts the physical slice into a digital image through the digital scanner, and then uses the internet to realize remote slice sharing. Experts just need to go online to make pathological diagnosis at any time and help primary hospitals carry out intraoperative freezing. Thus, primary hospitals just need to be responsible for production and scanning, and the reading and diagnosis can be undertaken by relevant experts, thereby removing the bottleneck of lack of intraoperative freezing experts.

In addition to requiring pathology experts, time constraints are also vitally important in intraoperative freezing. During the 30-minute process, pathologists spend less than 7 minutes from reading to generating the diagnosis report, which imposes tremendous pressure on them. While the application of digital pathology requires visibility from scanning to transfer to the expert, this process needs to be as short as possible, so that the experts have enough time to read and make diagnosis. Fortunately, digital slice scanners from many manufacturers have become increasingly fast, and Konfoong Biotech’s digital slice scanner needs only 40s for an average-sized tissue, which allows more time for experts to read and make diagnosis.

Based on current practices of many primary hospitals, digital pathology facilitating intraoperative freezing is highly feasible and easy to replicate, and is a good interpretation of the country's classification and treatment policy. It can be expected that as digital pathology becomes more popular in the future, Big Data mining based on the massive digital pathology image database, and realization of intelligent diagnosis is just a matter of time.


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