DIGITAL IMAGING
Histopathology and cytopathology reports are, to a large extent, interpretative and composed of free text. A report's content and style depends largely on the reporting pathologist. Of course, in most cases there is only one possible diagnosis, but the information contained within the written report will vary greatly between pathologists, and a pathologist's reporting style will depend on the circumstances under which s/he is writing. This particularly affects large, complex cases, where although the final diagnosis may be correct, omission of key information may influence or even hamper the treatment.
Visual presentation of pathology reports is now very much part of clinical practice, usually in the context of multidisciplinary team meetings (MDTs), which are an essential part of the management of patients with cancer. It is expected that cytology, histology and gross pathology will be shown at these meetings. Referring clinicians are becoming more familiar with the appearance of pathological findings, and increasingly interested in seeing their patients' pathology for themselves.
Diagnostic imaging is going through a digital revolution. Radiology departments throughout the UK are moving from film to digital images, enabling imaging procedures and reports to be available to clinicians in theatres, wards and outpatients' departments. The images are stored on RIS-PACS computer systems and may be called up for future reference and meetings. This film-free environment has radically altered the accessibility of imaging to clinicians and enormously increased the efficiency of radiology reporting.
Similar reporting methods will shortly be commonplace in cellular pathology reporting, and the first step is the provision of reports with pathology images embedded within them.
Applications of image reports
The benefits of image-reports are manifold, but can be summarised in a bullet point list and expanded by examples of specific cases in various specialties:
- Explanation of pathology
- Illustration of extent of disease
- Illustration of involved or clear margins
- Visual archive of pathology in progressive disease
- Archive material for teaching or research
- Education / explanation to clinicians
- Education / explanation to patients
- Visual aid to discussion of treatment with patients
- Tangible demonstration of quality of service
- Correlation of cytological and histological findings
Explanation of pathology
An illustration of pathological appearances may be useful in cases where there are several terms describing a particular lesion. This is especially helpful for those clinicians who are more familiar with histology. Dermatologists often have a working knowledge of dermatopathology, and in some cases formally report their cases. Atypical melanocytic lesions are well suited, therefore, to image reporting.
Illustration of extent of disease
Complex resections may defy clear description of the gross pathology and extent of disease. This is true for many specialties, but is especially so for head and neck pathology, where anatomy is complicated and difficult to describe in text.
Illustration of involved or clear margins
Usually this may be achieved using images of the gross specimen, but on occasion an intra-operative photograph may be especially helpful.
Visual archive of pathology in progressive disease
Many conditions show a natural history of progression, and a visual archive may be help in monitoring of sequential biopsies. Examples include dysplasia in the gastro-intestinal tract, such as large bowel in chronic inflammatory bowel disease and oesophagus in Barret's metaplasia, laryngeal dysplasia and intra-epithelial cervical neoplasia are further examples.
Visual Archive material for teaching or research
Images of pathology are an excellent adjunct for teaching or training, be it to undergraduates, post-graduates, doctors in training or clinical update meetings for a variety of medical and non-medical staff. The routine production of image reports would make such material freely available, subject to appropriate consent.
Consultation with patients
Discussion with patients may be facilitated by access to graphic representation of pathology, especially in explanation of future treatment, which may depend on the extent of the disease.
Tangible demonstration of quality of service
Private healthcare is, to some extent, a competitive environment. Although a high standard of care is often assumed, there is no doubt that presentation goes towards demonstrating a commitment to quality.
Tangible demonstration of quality of service
Image reports, presented on the appropriate media, support the patient's perception of a high-quality service, and to some extent may confer a competitive advantage to the clinician.
Correlation of cytological and histological findings
An illustration of cytological appearance and subsequent histology may be useful in cases discussed at MDT meetings, e.g. correlation of cervical smear cytology and subsequent cervical biopsy/LLETZ histology for the colposcopy MDT, and correlation of core biopsy histology with rapidly reported core biopsy imprint cytology for a breast MDT.