Pathology & Laboratory Medicine
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Since the height of the COVID-19 pandemic in New York City, each of the HSS lab sections has responded to the need for rapid, high-quality testing related to the pandemic. Prior to emergence of SARS-CoV-2, we obtained certification from the New York State Department of Health for virology testing and were able to start using the polymerase chain reaction (PCR) test to screen HSS employees for influenza rather than sending those tests to a reference lab. When the pandemic emerged, we were able to quickly expand capacity and implement PCR testing for the SARS-CoV-2 virus, as well as for numerous other respiratory pathogens. At the same time, we implemented testing in the Clinical Chemistry and Clinical Immunology labs for antibodies to SARS-CoV-2.
We are currently in the process of implementing digital pathology at HSS. Scanners are now available that can scan whole microscope slides, yielding high-resolution whole-slide images. Thomas Bauer, MD, PhD, was the principal investigator and medical director of the two multicenter prospective studies that formed the core of Leica Biosystems’ application to the FDA that resulted in clearance of the Leica AT2 Dx scanner for use by pathologists to interpret surgical pathology cases.
We also played a minor role in helping Sectra achieve FDA clearance for their digital slide viewing software to be used for primary diagnosis. Working with employees from Epic, Leica, and Sectra, HSS is the first hospital in the United States to have integrated a Leica scanner with our laboratory information system (LIS) (Epic/Beaker) and with our Sectra PACS. This integration allows individual microscope slides to be scanned, interpreted within the LIS, and then hosted on the PACS, thereby providing any physician who has access to Epic the ability to navigate and zoom in on the images, an experience very similar to using a microscope. Besides providing morphological support of the diagnosis, these slides will have wide use in education and research.
Precise Identification of Cell and Tissue Features Important for Histopathologic Diagnosis by a Whole Slide Imaging System. Bauer TW, Behling C, Miller DV, et al. J Pathol Informatics 2020;11:3. doi: 10.4103/jpi.jpi_47_19
Digital Whole Slide Imaging Compared to Light Microscopy for Primary Diagnosis in Surgical Pathology: A Multicenter, Double-Blinded Randomized Study of 2045 Cases. Borowsky AD, Glassy EF, Wallace WD, Kallichanda NS, Behling CA, Miller DV, Oswal HN, Feddersen RM, Bakhtar OR, Mendoza AE, Magari R, Wharton KA, Qiu J, Bauer TW. Archiv Pathol Lab Med 2020; Feb 14. doi: 10.5858/arpa.2019-0569-OA.
Rheumatoid Arthritis Morning Stiffness Is Associated With Synovial Fibrin and Neutrophils. Orange DE, Blachere NE, DiCarlo EF, et al. Arthritis Rheumatol. 2020;72(4):557-564. doi:10.1002/art.41141
Subarticular Inflammatory Pseudoabscesses: A Pathologic Study with Clinical Correlation. Zhang L, Mirza SZ, DiCarlo EF. Am J Surg Pathol. 2020 May;44(5):633-640.
Machine Learning Integration of Scleroderma Histology and Gene Expression Identifies Fibroblast Polarization as a Hallmark of Clinical Severity and Improvement. Showalter K, Spiera R, Magro C, Zhang Y. et al. Annals of the Rheumatic Diseases. 2021;80:228-237. http://dx.doi.org/10.1136/annrheumdis-2020-219264
A notable future goal for the service is the gradual implementation of patient-care diagnoses derived from digital images. As the infrastructure is now in place, images of previously diagnosed cases are being posted. In the next several months, we will validate the process for each pathologist and begin to incorporate digital images for diagnostic use in an increasing proportion of cases.