Events during September 2023

Lower G.I tract

Nations, institutions, and now the NHS have made net-zero commitments, but how will this affect scientific operations, and what would net-zero science look like? Laboratories are recognising their energy intensive nature, and assessing their immense consumption of consumables. More green lab efforts are growing around the world, though more standards are needed.

This talk will include:

An introduction to sustainable and green labs
A look at what net-zero laboratories might resemble in the future
An introduction to Sustainability standards, and what programmes are developing regarding the sustainability of clinical, research, and all kinds of labs
Questions!

There are 1.4 million UK ED attendances for head injury every year. Up to 2/3 of these are in adult patients. The severity of head injury associated traumatic brain injury (TBI) is assessed clinically using the Glasgow Coma Score (GCS). The majority of fatal outcomes occur in moderate TBI (GCS 9-12) or severe TBI (GCS=8), which account for only 5% of attenders.

The presence of severe TBI is usually clinically clear cut and prompt evaluation using computed tomography (CT) imaging of the brain is performed, followed by hospital admission with further detailed evaluation. This is also often the case where moderate TBI is suspected. There is clearly a need to identify patients that account for the remaining 95% of attenders, with minor or mild head injuries, who will go on to have serious intracranial lesions.

In patients with GCS 13-15, however, only 1/10 demonstrate evidence of pathology on CT scan.

The measurement of serum biomarkers of brain injury has been proposed as a method to accurately differentiate those patients with GCS 13-15 who are likely to have underlying pathology from those with GCS 13-15 with no underlying pathology.

Among the most studied biomarkers are Ubiquitin C-terminal hydroxylase-L1 (UCH-L1) and Glial Fibrillary Acidic Protein (GFAP). UCH-L1 GFAP have been shown to correlate with TBI severity and clinical outcomes. Current evidence indicates that both serum GFAP and UCH-L1 are detectable in serum in less than 1 hour following a mTBI. GFAP and UCH-L1 levels are significantly elevated in patients with TBI with intracranial lesions on computed tomography (CT) and, in patients with mTBI, can distinguish between those with a normal and an abnormal CT scan of the brain.

Patients with mild TBI are at low risk of clinically significant brain injury in the absence of raised serum GFAP and UCH-L1 and other associated risk factors. They do not require a CT head scan and may be safely discharged providing there is a safe support system of care. It is anticipated that this could reduce head CT in these patients by 40%.

Methodology and preliminary results form an ongoing clinical and economic evaluation of the FDA approved serum GFAP and UCH-L1 on the Abbott Alinity platform in patients with mTBI will be presented.

Your career in Clinical Biochemistry: IBMS qualifications and the role of the Advisory Panel

Non-melanoma skin cancers (NMSC) are on the rise, with around 156,000 cases diagnosed annually in the United Kingdom. Basal cell carcinoma (BCC) is the most predominant form that is encountered, and cutaneous squamous cell carcinoma (cSCC) accounts for 20% of all non-melanoma skin cancers. Although the vast majority of non-melanoma skin cancers have a good prognosis and can be cured by surgical intervention, they can cause the destruction of local tissue architecture due to tumour growth. Moreover, a small subset of tumours have poorer outcomes with metastases and mortality.

The underlying biological mechanisms governing a higher risk of recurrence, metastasis, and death remain poorly understood due to a lack of accurate risk stratification. Risk prediction is important in the management of NMSC, as it informs which patients require imaging, how frequently imaging should be performed and how frequently patients should be reviewed. It also informs which patients will benefit from wider surgical resection, adjuvant radiotherapy or sentinel lymph node biopsy. In the future, there is a role for the use of adjuvant immunotherapy for patients with particularly high-risk tumours. This presentation aims to highlight the use of single-cell and spatial transcriptomics analysis approaches in comprehensively mapping the localisation of the different cellular subpopulations in non-melanoma skin cancers. The ultimate aim is to develop better diagnostic tools and markers to predict patient risk status, which will lead to better clinical outcomes.

Digital imaging for remote viewing to enable reporting is becoming increasingly prevalent in the NHS cellular pathology services. Sea change levels of improvement in the technology that enables digital image acquisition, viewing, transfer and storage has allowed its widespread deployment and adoption and concomitant to this has been the development of software applications to enable the analysis of those digital images for a huge variety of reasons.

In my talk I will discuss the application of digital image analysis to the scans of the slides that we assess as part of our routine external quality assessment (EQA) workload. Both as aids to improve the information and the accuracy of that information e.g., in the assessment of the proliferation marker Ki-67 in breast cancer to improve its use as a prognostic marker, and as a tool to verify and quality control our own processes and EQA materials e.g., the measurement of reproducibility and homogeneity in tissue and cell line samples used in the assessment of PD-L1 immunohistochemistry staining in non-small cell lung cancer.

Delegates attending this session will learn about and gain knowledge on the introduction and application of the new EQA scheme to cover digital pathology in Cellular Pathology.

This presentation will support the introduction of the Digital Pathology EQA explaining the assessment criteria and how the technical issues may be overcome in a routine laboratory.

Histopathology has numerous stages in the production of a digital image and its subsequent use. Each of the stages can introduce variations that are compounded resulting in a net variation in image quality for nominally the same tissue. Humans are tolerant of variation so this variation in quality has minimal impact on outcomes, which are additionally validated by EQA services.

But AI is in some cases being negatively impacted by variation and highlights the need for quality metrics and subsequently standards for each stage, where possible. But currently there are few independent QC tools for digital histopathology. This presentation will present the results of our work in NPIC were we have developed QC tools for staining, digitisation and display in digital histopathology.

Overcoming challenges to passing cervical cytology exams