Improving Intraoperative Frozen Section Consultations Through the Use of Whole Slide Imaging

Support for intraoperative frozen section consultation is core to good patient care and cannot be compromised. Historically, IFS has required a pathologist’s physical presence in the location where frozen sections are being prepared. However, there are persistent (and deteriorating) shortages of qualified pathologists to review these time sensitive cases. The same is true for qualified lab staff. 

These shortages, combined with the increasing incidence rates of disease, present additional challenges to the resources responsible for supporting IFS workflow and completing daily clinical diagnostic cases. 

IFS workflows in the traditional in-person capacity present challenges for clinicians and healthcare organizations including, but not limited to:

• Commute time for pathologists arriving at the location where frozen sections are being prepared, whether by car, train, or even walking between buildings on a large campus.
• Idle time for pathologists waiting for slides to arrive for assessment.
• Delays to routine diagnostic work due to the time required to support intraoperative consultations

This list represents time that could be otherwise spent on routine diagnostic activities and patient care.

Technology can help address IFS challenges

Telepathology is being increasingly utilized in intraoperative frozen section consultations and has positive implications for geographically remote practices and institutions with large infrastructure. 

Static image, dynamic microscopy, and whole slide imaging (WSI) are now common telepathology modalities. WSI is a reliable and efficient tool in the setting of a fully digital IFS workflow. In fact, utilizing WSI to support remote intraoperative consultations supports improved turnaround times while reducing cost burdens and routine diagnostic delays usually associated with in-person IFS support.

In the past 10 years, the field of pathology has made progress in adopting digital technology for routine clinical diagnosis, but the IFS workflow continues to be performed in much the same way as it was years ago. Technology providers have placed a heavy emphasis upon developing WSI systems that digitize the high volumes of daily diagnostic slides; however, these systems do not effectively support IFS workflows. 

A completely different approach is needed for IFS where the WSI system is still fast, performs reliably, and delivers excellent image quality. But it also must fit into the limited space that has (sadly) become a hallmark of pathology labs. 

Further, WSI systems can be complicated to learn and operate. For staff that rotate through different disciplines in the lab, or for labs hiring new staff members, user friendliness of WSI systems must be a priority to ease adoption and expedite implementation.

Examples of improved IFS workflows

Consider the following use cases where labs can take advantage of improved IFS workflow using WSI:

• Healthcare institutions with widespread infrastructure–Using a WSI-based approach to IFS with an integrated digital module allows such institutions to address challenges such as geographic isolation, need for subspecialty expertise, and already high clinical caseloads.
• Independent pathology groups serving remote hospitals–Through WSI and telepathology for IFS, these pathology groups can expand their capabilities without the burden of pathologist travel that contributes to higher costs and slower case turnaround times for routine clinical diagnoses.
• A “hub-and-spoke” hospital system–WSI for IFS gives the ability to bring the same level of specialty pathology expertise to all “spoke” sites that was historically only available at the main “hub.”

With the pathologist talent pool in short supply, new approaches to intraoperative frozen section consultations are a welcome alternative to delays in patient care. WSI can help by bringing the benefits of digital technology to pathologists who may be away from the treatment or surgical location.