From microscope to screen: ZNA's anatomopathology lab goes digital

Louvain-la-Neuve (Belgium), 12/04/23: Ask ten people what makes an anatomopathologist, and you will get ten different answers, possibly including some wrong ones. Yet, anatomopathology is an essential department of hospitals. Its purpose is to diagnose diseases and to study their causes as well as the underlying mechanisms. With the Telemis TM-Microscopy solution, this process is now even faster and smoother than ever before.

What exactly does an anatomopathology laboratory do? We asked Dr Sabine Declercq, Pathologist and Medical Coordinator of the laboratory at hospitals ZNA and GZA.

“We study the tissue and fluid samples taken from patients by other disciplines to determine the disease process,” she explains. “The tissues are fixed in order to be better preserved, and sliced (to a maximum size of 2 cm, and 3 mm thick). They are then placed in small cassettes. Next, the water is removed from them, and paraffin is added. After it hardens, we can cut 0.004-millimetre thick slices. “

The slices (or slides) thus obtained are then examined by pathologists to establish a diagnosis. Until recently, a microscope was used for this purpose. Now, with the TM-Microscopy solution, pathologists can view digital slices on their computer.

Much faster... 

Digitisation of images obviously requires an additional technical step. However, all the advantages of digitised images more than make up for this delay.

“Bear in mind that we are a big lab spread over several sites, with a central lab and four other sites in different hospitals, employing a total of 18 pathologists,” says Dr Declercq. “Up until last year, we had to physically distribute all the slides to the various sites so they could be examined under a microscope. One set of slides was for Pathologist X at ZNA Jan Palfijn, another was for Pathologist Y at GZA Hospitals Sint-Vincentius campus, and so on. “

It's all rather complicated and time-consuming, especially considering that you have to call a taxi for each delivery and track what has been sent, where to, and when. Thanks to Telemis, that whole distribution system can be eliminated. Once the slides have been digitised, the images are available within a minute for ‘anyone’ to view on their computer screen, in complete safety.

“If we want to ask a specialist from a different town, or even another country, for a second opinion on a difficult case, this solution saves even more time,” adds Dr Declercq. “Sending tissue abroad, to the USA for example, is a real logistical nightmare. You not only need to organise transportation; you must also obtain all sorts of permits because it is human tissue. There is also the risk of breakage when sending glass slides. By working with digital slides, we avoid all those hassles. Of course, not everyone is yet receptive to this change, but this is a phenomenon that is often observed with new technologies. For that reason, sometimes we are still obliged to send physical slides. “

...and far more efficient

Saving time is one thing. But the software also makes the pathologist's work much easier. “For example, sometimes we hold multidisciplinary discussions about certain patients, especially in oncology. Now, if the oncologist, the surgeon, or the radiologist have any questions, we can immediately load the images and examine them together during the meeting. “

It is also much easier to coach and train students on a big computer screen than with a microscope. Making measurements is also facilitated. “We now have a tool in the Telemis solution that enables us to carry out very precise digital measurements between two points, accurate to within a hundredth of a millimetre. Before, we would have had to use a special eyepiece on the microscope and then perform a conversion. “

And we haven't even mentioned artificial intelligence, which is perhaps the biggest advance of all. It is not included in TM-Microscopy, but the software is compatible with many AI tools. “Artificial intelligence offers unprecedented possibilities, such as exact counting of the healthy and diseased cells, for example. That’s a technology we currently use. “

Obstacle course

According to interviews within the hospital, some pathologists were initially reluctant to change their methods and habits. That's not surprising since pathologists have been using microscopes since 1850. That's why it was necessary to gradually introduce the developments leading to digital research. But when it became clear that everything was going faster, that results were more accurate, and anybody could work from home, the resistance melted away and the implementation of change accelerated. Since then, our conversation with Dr Declercq indicates that nobody really wants to turn the clock back.

Custom software

“One of the reasons we chose Telemis is that this is a young department in a long-established company, that is willing to collaborate openly and help to develop the software. It also has a very open interface, is web-based, and insists on images being freely accessible to ‘external’ users, in a secure form. This is in striking contrast to old platforms that required a lot of technical gymnastics before you could view images at home.

Because we are a complete clinical lab that wants to use the software as a clinical diagnostic tool, not a research tool, we are one of the first to adopt TM-Microscopy. It's true that, initially, there were a few teething problems at its inception, since its main focus was on research. But it also means that we were able to fine-tune it to suit our needs by working with Telemis. Of course, we haven't obtained absolutely everything that was on our wish list, but we have managed to modify the software as we wanted to, and we have contributed to developing the final platform for our users.”

The discussion with Dr Declercq shows that one of the major strengths of the TM-Microscopy is its adaptability. The integration of the Telemis solution with the LIS (Laboratory Information System by NeoPath) at ZNA is an excellent example of this. Telemis adapts itself to all LIS systems and to customer needs, not the other way around. This article is based on an interview conducted  by journalist Bart Bettens