Histology Core Laboratory

Division Of Basic Sciences - Nci

Investigators

Linked publications & trials

Abstract

HISTOLOPATHOLOGY The Histopathology (Histology) section of the Laboratory of Pathology (LP) is a core facility devoted to supporting the clinical activities of LP. The Histology Lab does not conduct primary research but supports the activities of many investigators. The laboratory processes a large variety of tissue specimens from NIH and non-NIH patients, including a wide variety of malignancies, AIDS-related diagnostic specimens, infections, and surveillance biopsies. This consists of accessioning human tissues removed at surgery or in clinics, processing the tissues, preparing and staining slides for microscopy by LP's pathologists, clinical fellows and residents. Pathology residents are trained by LP's Pathologists Assistants (PAs) in techniques of gross dissection and taught to evaluate large and small specimens in preparation for microscopic evaluation during Histology rotations. The Histology lab serves Immunohistochemistry, Surgical Pathology, Hematopathology, Postmortem Pathology and Cytopathology sections as well as the Specialized / Molecular Diagnostics Unit. To date during the first nine months of this fiscal year, Histopathology processed more than 23,010 tissue blocks, which is a 12% decrease from the previously reported year. This decrease is attributed to a partial suspension in some services and in-house surgeries at the Clinical Center at the NIH during the COVID-19 pandemic. Of these total blocks, there were 199,461 slides from microtomy and 39,500 special stains submitted to pathologists for diagnostic interpretation. After pathology diagnoses are rendered, Clinical Operations staff provide pathology reports to requesting clinicians internal and external to the NIH. During this fiscal year, the Histology service was able to maintain adequate turnaround times to provide diagnostic material despite staffing issues that resulted from the COVID-19 campus access requirements. During this period, LP's Pathologists Assistants performed and trained residents in gross analysis and selection of the most diagnostically relevant sections for tissues collected from over 16,300 inhouse biopsy and surgical tissues. So far this fiscal year, the laboratory processed over 64,409 consult slides and 7,945 blocks from over 3,140 cases that were submitted to LP's pathologists for clinical consultation or review for patients being admitted to the NIH Clinical Center or entry on protocol. There has been a steady increase in consult cases since the start of 2020, which can be attributed to the novel methylation testing provided by our Molecular Diagnostics laboratory. These specimens are submitted from all over the United States as well as internationally; there have been 600 cases submitted since January 2020. Although more than 95% of effort is devoted to clinical duties, the Histology Laboratory also performs recuts of tissue blocks and does some routine staining for research projects in NCI by arrangement. This activity is coordinated with the tissue research request function of Clinical Operations. During the fiscal year, there were approximately 19,325 individual biospecimens (unstained slides, special stains, tissue shavings, and tissue slides processed with RNAse precautions) provided to researchers from our tissue archive. The Clinical Operations section also processed approximately 1,350 medical-legal requests, which involved retrieving and processing approximately 3,800 clinical slides and/or blocks that were forwarded to other healthcare or research facilities at the request of clinicians or patients. With an increase in volumes for the Comprehensive Oncologic Molecular Pathology and Sequencing Service (COMPASS) program, specifically in our Molecular Diagnostics section, Clinical Operations has taken an active role in the coordination of the cases. Clinical Operations oversees the clinical and research case load from submission to ordering clinical Next-Generation Sequencing to hosting an integrated conference with the clinical team to producing a report that will support clinical decisions. We work very closely with the clinicians and research teams to provide support in ordering NGS testing and receiving the clinical reports. Within the last fiscal year, there have been over 2,500 cases for Molecular testing and 700 cases for Methylation Sequencing. DIGITAL PATHOLOGY The global COVID-19 pandemic was the catalyst for LP's rapid development of whole slide imaging on a large scale. Prior to FY2020, the LP performed whole slide imaging for 164 clinical cases with 986 slides scanned. During the past eight months from August 2020 through July 31, 2021, the Clinical Operations staff performed whole slide imaging for 1,944 clinical cases with 9,250 slides scanned, quality control verified and archived in LP's LIS for permanent and easy access to LP's clinicians and investigators. In the fall of 2020, LP's Clinical Operations purchased digital pathology scanners to support the increased demand for digital archiving, remote case review by pathologists, while also embarking on an initiative to include high quality digital microscopic slides for all COMPASS cases. This ongoing project has required LP to work closely with the (a) Center for Biomedical and Information Technology (CBIIT), (b) Halo, an image analysis and image repository platform provided by IndicaLabs, (c) Palantir, an data analysis platform, and (d) SoftpathDx from Soft Computer (SCC), the company responsible for the Laboratory Information Systems within the Laboratory of Pathology. This broad collaboration between the aforementioned parties will lead to a trilateral interface resulting in a modernized clinical workflow that is streamlined for clinical research. Furthermore, the Digital Pathology Service will continuously work toward digitizing all clinical in-house cases and clinical consult cases for the foreseeable future. A digital image of each patient's slide along with slide annotation and image analysis results will now be attached to the patient's report. From August 2020 to present, 9,047 digital images have been scanned by the Clinical Operations team in support of this initiative.