The 9th Asia Pacific Congress Recap

MarieAPIAPAt the beginning of June, the International Academy of Pathologists (IAP) hosted the 9th Asia Pacific Congress at the Brisbane Convention and Exhibition Centre. The APIAP 2015 was a joint conference this year as, for the first time, the IAP partnered with the Histotechnology Group of Queensland (HGQ) who were hosting the 7th National Histotechnology Conference.

With two separate conference programs, and an estimated audience of between 1200 and 1500 registrars, scientists and pathologists from across Asia Pacific, the joint conference offered attendees an incredibly diverse and educational event.

Deborah Steele from Sysmex New Zealand and Marie Czarnecki from Sysmex Australia were onsite at the Sysmex interactive exhibit showcasing how Delphic AP is helping laboratories manage every stage of their lab workflow and reporting. A popular feature on the stand this year, for the delegates who stopped by, were the demonstrations offered that explored all aspects of the pre-and post- analytical phases, including the Delphic AP Single Piece Workflow specimen tracking system.

Deborah Steele also attended a few of the presentations on offer at the event and shares some content learnt from parts of the diverse programme.

Digital Pathology

Modern microscope with digital imaging capacityDr Eric Glassy’s presentation “A Hitchhiker’s Guide to Digital Pathology” was an insight into the exciting potential for digital pathology. We are experiencing a digital revolution where research and academic tools are changing rapidly – from Encyclopaedias to Wikipedia, and Librarians to Google. The field of Pathology is not exempt from this revolution as we see it evolve to ePathology with such tools as a carousel projection of slides and whole slide imaging of a tray of slides. Pathologists will no longer use their hands on the microscope focus, instead using their hands on a touch screen. Monitors will replace the microscope!

Dr Glassy described the six benefits of digital pathology that will change the way we work today:

  • Case studies/Tumour Board. Digital path using whole slide imaging is a better way to present a case and significantly improves the presentation experience for colleagues.
  • Image Analysis. Examples of this include, multiplexing which allows digitisation of the slide using different colours to present the level of staining, or mitotic count, heat count.
  • Telepathology or digital consults. Digital Pathology makes this a reality. Pathologists anywhere in the world can look at cases sourced from across the globe which will be of significant help considering the shortage in pathology consultants worldwide. Additionally with an increasing number of patients seeking second opinions, digital pathology will allow this service to be more accessible.
  • Primary Diagnosis. The FDA has not yet approved digital pathology for primary diagnosis, however, it is currently being used in this capacity throughout Europe and Canada.
  • Education, teaching and conferences. Digital Pathology is a perfect tool for remote learning. Ideal for use in publications, with the ability to embed a link or QR code to whole slide imaging. This allows ‘readers’ to see a photograph of the area of interest, but more importantly to access the entire slide image in context.
  • Pathology Reports. Digital Pathology makes it easier to create visually appealing pathology reports. Pathologists want their reports to look as good as possible. Imagine the potential when, as well as the standard headings and diagnosis, you can also add a QR Code to the associated images. This is a huge step forward from two decades ago when a floppy disk may have been attached to the report!

Dr Glassy concluded his presentation by sharing the emerging abilities of digital pathology. As software applications evolve that provide additional information and outline areas that the eye cannot pickup, we will begin to see more computer aided diagnosis.

Whether it is via glass slides or digital, the journey of patient tissue from the body to diagnosis is remarkable.

The Changing Histology Scientist’s role

CutupTechnology is advancing in histology labs replacing manual processes typically performed by histology scientists and driving a change to redefine the profession.

At Peter Mac in Victoria, they have initiated a new programme based on a similar model established in Canada (the Pathologist Assistant programme). The Peter Mac programme has histology scientists being trained to manage some of the roles of medical practitioners, particularly in the area of cut-up.

Kellie Vukovic shared her experience as a medical scientist and the journey to achieving her qualification, along with some fascinating cases she worked on during her training. The outcome of the programme has been very successful with less pressure on registrar medical practitioners and pathologist input at cut-up. The opportunity for histology scientists also creates a promising career pathway.

Patient Safety – evaluate each and every step of your lab

LabelledSlide2Alex Laslowski, Laboratory Manager from Monash Pathology, presented several ways in which patient safety in the histopathology lab can be improved by developing and applying the right solutions. The statistics are alarming and Alex shared some of these with the audience:

  • 98k die from medical errors each year;
  • Up to 8% of slides are contaminated;
  • 1 in 1000 patient slides is mislabelled;
  • Specific cases where a lab switched specimens and the patient was incorrectly diagnosed and treated aggressively for cancer.

Technology may be advancing, but the pre-analytical phase in histology has not changed in 100 years. So many labs are still batch processing their work, a process where the majority of errors are still occurring increasing medical errors four-fold. Identification errors generally happen before staining, with the laboratory responsible for two-thirds of these errors.

However, labelling errors can be minimised through the use of unique accession numbers, no hand labelling, and auto-printing. Lower rates of mislabelled slides can be associated with continuous individual case accessioning and the use of formal checks at accessioning – all of which have increased patient safety. In addition to the accession number and patient ID, pathology labels should also include the patient name. Computerised tracking systems with unique barcoding and on-demand label printing aid these processes significantly allowing for the elimination of laboratory errors in the pre-analytical phase.

Advances in Immunohistochemistry

ImmunohistochemistryThe final day of the conference was reserved for world-renowned pathologist Dr John Chan, who shared his knowledge across a vast array of clinical topics and pathology cases. A particular focus of this session discussed the increasing identification of new antibodies and the advantages of immunohistochemistry as a complement to molecular studies for cancer diagnosis.

Immunohistochemistry is playing an increasingly important role in providing genetic information for tumours and the technology is often cheaper and quicker than molecular assays. Dr Chan shared several fascinating clinical examples in application, including gene expression for translocation of ALJ protein and Beta catenin staining assisting in the distinction of adenocarcinoma.