EVENT REVIEW
Branko Perunovic described how Black Country Pathology Services (BCPS) has transformed its service to be responsive to the needs of patients and able to anticipate future needs.
well as the consolidation of services and the harmonisation of blood services. Branko covered the challenges of the next few years, emphasising that getting the correct team in place and aligning individuals with new targets and the BCPS vision was particularly important. Today BCPS serves 1.76 million patients and conducts 60 million tests annually. The partnership has led to over 27,000 more community phlebotomy appointments, improved turn-around times, access and workflows Professor Sarah Coupland, George Holt Chair of Pathology at the University of Liverpool and Consultant Histopathologist at Liverpool Clinical Laboratories was the next speaker, describing the development of a multidimensional and multimodal digital bioresource for eye cancers. Liverpool is a regional centre for the NHS treatment of malignant ocular tumours, and Professor Coupland described the patient journey and the specialised services on offer which receive patient referrals from around the world. The Liverpool Ocular Oncology Biobank was first established in 2001 and has grown considerably since then to paly a major part in collaborative research with a wide array of partners. Professor Coupland discussed the recent expansion of the facility via the creation of a trusted research environment or ‘safe haven’ which will bring together everything in the biobank to date with clinical imaging including pathology slides, radiological images of liver scans and ocular images of the eye, to enable researchers to access comprehensive datasets. The aim is to expand this eventually to incorporate
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England’s other ocular oncology centres (in Sheffield and London) as rare cancers suffer from small datasets and sample cohorts for research. The new resource is Eye-CAN-AID (Eye Cancer imaging Artificial Intelligence Database) and Bioresource, which aims to deliver better care and better outcomes in rare eye cancers such as uveal melanoma, conjunctival melanoma, vitreoretinal lymphoma and retinoblastoma.
Implementing digital The second part of the morning session saw digital pathology come to the forefront, firstly with Professor David Snead, Consultant Pathologist at the University Hospitals Coventry and Warwickshire and Director of PathLAKE – one of the five Innovate UK funded centres of excellence for the development of artificial intelligence in digital pathology and radiology. His presentation looked at the drivers and barriers to the adoption of AI in cellular pathology, firstly covering the current issues around diagnosis of cancer, going on to cover how AI can assist, especially in predicting the disease’s response to treatment, and in confirming and aiding diagnosis. Discussing barriers to the implementation of AI, Professor Snead focussed on integration into current and future digital systems, as well as how Trusts and third parties could work together to realise economies of scale – something the PathLAKE Plus group is already doing. He summed up with a strategy to overcome the barriers, which included building a strong team with a executive ‘champion’, gaining the support of the clinical team, working with
vendors and playing the ‘long game’. This was followed by Clinton Boyd, Consultant Pathologist at Belfast HSC Trust in Northern Ireland whose presentation was entitled: ‘Laying foundations for the future: digital pathology implementation in Belfast.’ In 2016/17 Northern Ireland’s (NI) pathology services were in need of modernisation and proposals for the adoption of digital pathology was part of this process. The ‘confidence and supply’ deal signed between Teresa May’s Conservative government and the Democratic Unionist Party (DUP) following the 2017 UK election saw an influx of funds into NI, enabling investment in the wider health service and digital pathology. Clinton described the build up to DP implementation after receiving the green light in January 2019, through setting up the project team, procuring hardware, LIMS integration and digital storage. COVID-19 bought challenges, not least delays and staffing issues, but testing was able to begin in late 202, ready for a ‘go live’ in May 2021.
The initial period saw issues with scanners and a validation plan which saw dual reporting for some time, before moving to ‘glass-free’ checkout after two years. By this time home reporting was also available for pathologists. Reflecting on the process, Clinton discussed changing costs, including staffing requirements as well as some of the technical challenges faced. The benefits were huge though, including access to older images, quicker second opinions, teaching and home reporting. Completing the morning session was Rahul Deb, Consultant Histopathologist at University Hospitals of Derby and Burton, presenting on opportunities and challenges with AI in breast screening pathology. He looked at the role AI could play in four areas – case booking in and laboratory processes; slide scanning and case assembly; consultant reporting; and finally post-reporting QA. Automation software has the capabilities of prioritising cases and ordering workflows appropriately. The use of AI as a diagnostic adjunct was also covered, as it can be particularly useful for tedious, time-consuming, quantitative tasks which occur frequently in breast cancer. Rahul went on to consider the challenges in working with AI in this area, including fully trusting AI models, ensuring that data sets have enough diversity to avoid data bias, and implications for cost and regulation / QA.
Novel technologies The afternoon session of the first day saw presentations from two American
AUGUST 2024
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