During the COVID-19 pandemic, Memorial Sloan Kettering doctors and nurses have been able to continue to provide high-quality care for people with cancer. They’ve done this through traditional appointments and by offering telemedicine services while working from home.
MSK has taken many other steps to keep staff safe while continuing to care for patients. Some of the most noteworthy changes have come from the Department of Pathology. Pathology has traditionally required everyone to be in the lab, with doctors and pathology technicians working together in close quarters. This situation would have made it difficult to create the physical distance that’s key to preventing the spread of COVID-19. So when the pandemic hit New York City in March, leadership within MSK’s Department of Pathology adopted new procedures to keep its workers safe without having to compromise patient care.
“One of our immediate safety measures was to stagger shifts for our employees so they were able to physically distance,” says Meera Hameed, Chief of the Surgical Pathology Service. “It required a lot of coordination, but in the end, the lab functioned extremely well during this whole period.”
In addition, the team modified digital technology previously used only for research purposes so it could be applied to remote patient care. This has enabled many of the pathologists to do their work from home.
“We decided to make the best of a bad situation,” says Pathology Department Chair David Klimstra. “Everyone came together and worked so hard to make this happen. It was remarkably fast.”
Providing Cancer Diagnoses in a Challenging Time
Pathologists specialize in examining tissues and cells to diagnose cancer and other diseases. Getting an accurate, specific diagnosis is vital because it ensures that each patient gets the correct treatment. MSK’s pathologists are world-renowned for their expertise in identifying challenging and rare cancers as well as subtypes of common cancers.
Making a diagnosis is a multistep process. “Several different pathologists’ assistants handle each tissue sample and cut very thin slices of it to prepare the slides,” Dr. Hameed explains. Once the glass slides are prepared, they are handed off to the pathologists to study using a microscope and make a diagnosis. “This procedure hasn’t changed much in 200 years,” she says.
Updating a 200-Year-Old System
In 2017, MSK established the Warren Alpert Center for Digital and Computational Pathology. One of the center’s missions is to establish a digital workflow in pathology. Over the past few years, MSK’s pathology team has developed a system for digitally scanning slides of patients’ tissue and archiving them after the final diagnosis. Scanning gives pathologists the ability to view the digitally converted glass slides on a computer screen.
Early in the COVID-19 pandemic, the government agencies that regulate diagnostic labs granted temporary permission for pathologists to participate in telemedicine. (This was in response to pressure from national organizations and individual institutions. At MSK, this effort was led by Sahussapont Joseph Sirintrapun, Director of Pathology Informatics.) The permission allowed pathologists to make diagnoses from home using digital scans — but only if the digital scanning systems had been validated and accredited. MSK’s system, which was custom-developed internally, had never before been used for prospective patient diagnoses and was not approved for that purpose.
In New York, the State Department of Health requires an extra level of review for medical technologies and lab tests, in place of federal agencies like the US Food and Drug Administration. MSK’s pathology team worked together to clinically validate their system and used the data to apply for approval from the state.
A Motivation to Protect Colleagues
The team needed to show that digital diagnoses were the same as those made with a microscope. The validation endeavor was spearheaded by Matthew Hanna, Director of Digital Pathology Informatics.
“We were motivated by a real concern for our doctors,” Dr. Hanna says. “Finding a way for them to work at home has eliminated a huge burden during the pandemic.”
Twelve pathologists participated in the validation process. For nearly a month, they used their computers at home to review more than 1,100 digital slides from more than 100 patients. The slides had been prepared and scanned in the lab. During the validation, they later went into the lab to re-review and confirm that their diagnoses matched before final reporting.
The data were submitted to the State Department of Health at the end of April, and provisional approval came in less than two weeks. “This is the first ‘home-grown’ digital pathology system to obtain approval from any regulatory body,” Dr. Klimstra says. The team published a paper about their validation process on June 22 in Modern Pathology.
The Warren Alpert Center is aimed at assuming a leadership role in technology development, computational innovation, and operational integration of digital pathology into clinical practice.
After the provisional approval, MSK pathologists started diagnosing patients from home and using their own digital workflow in the hospital. Many of MSK’s pathologists have now been working partially remote for several months. Some technicians in the lab are continuing to stagger their shifts, although more people are allowed in the lab at once now than they were at the height of the pandemic.
The team is still waiting for final New York State approval, but Dr. Klimstra says he expects that it will happen soon.
Opportunities for Long-Lasting Changes
Assuming the approval becomes permanent, MSK pathologists will be able to continue using their own digital pathology platform to diagnose cases and work away from the hospital when necessary. Dr. Hanna describes one case that happened shortly after the system was validated that could become commonplace in the future: On Memorial Day weekend, a patient needed an emergency diagnosis at One of MSK’s pathologists was able to review the patient’s tissues from home in New Jersey using the digital system. This enabled the patient’s other doctors to determine the best patient management immediately.
“It was surreal to see how effective the system worked in this case,” Dr. Hanna concludes. “This will completely change the way we diagnose patients in the future.”
