Events during September 2023

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

Overcoming challenges to passing diagnostic cytology exams

Clinical Andrology: A Urology Surgeon’s Perspective

Genetics and the Fertility Clinic

Semen analyses is essential to understand male factor infertility and to allow planning for treatment options. Absence or low numbers of viable sperm become a challenge and to define whether obstruction removal surgery is needed or whether it would be possible to possible to boost sperm numbers if hormonally related problems exist.

Semen diagnostic analyses is used to define which treatment modality, timed sexual intercourse, intrauterine insemination (IUI) or in vitro fertilisation (IVF) or if intracytoplasmic sperm injection (ICSI) is needed. Despite all efforts, around 70% of women remain barren after treatment and little understanding exists especially on male factor which forms almost half the problem. Poor to very poor sperm quality relating to multiple factors such as counts, motility and morphology are increasingly associated with declining embryo quality, pregnancy outcomes and recurrent miscarriage. Asthenozoospermia/asthenospermia) is related to reduced sperm motility, whereas teratozoospermia refers to morphology condition. For the first time the field of diagnostic andrology has a chance to make substantial male factor contribution towards the knowledge of poor success rates and have available a numeral encompassed in `teratozoospermia index’ (TZI). The TZI has a maximum of four defects per abnormal spermatozoon: one each for head, midpiece and principal piece, and one for excess residual cytoplasm. The TZI is the sum of all abnormalities divided by the sum of abnormal spermatozoa, thus always giving a result between 1.00 and 4.00.

Ordinary semen analyses so far have had limited predictive value, but TZI will form a meaningful and constructive contribution to reproductive medicine, allowing for less invasive and less commercially driven and unnecessary expensive ICSI treatments. To derive the TZI numeral does not require significantly more investment other than performing a simple calculation to reach this index numeral, while conforming to WHO standards. There are sufficient parallels between poor sperm quality and DNA damage and recurrent miscarriage for instance, and morphology deficit evidence is beginning to emerge, adding TZI potential substantially to diagnostic andrology analyses as well as in providing clinical steers.

The Teratozoospermia Index (TZI) is a recent addition to WHO guidelines. The interpretation of the guidelines and whether laboratories should/should not undertake this test is contentious and may cause issues for many services.

This debate will involve two speakers: one for and one against TZI implementation. This will give attendees a rounded review of this area and support their decisions in undertaking this examination.

The Teratozoospermia Index (TZI) is a recent addition to WHO guidelines. The interpretation of the guidelines and whether laboratories should/should not undertake this test is contentious and may cause issues for many services. This debate will involve two speakers: one for and one against TZI implementation.

Sperm morphology assessment is part of a basic semen analysis. Accurate assessment of the percentage of normal-shaped sperm can help in diagnosing male factor infertility and in signposting to the most effective assisted conception therapy if needed.

Beyond classifying whether or not a sperm shape is normal, the introduction of the teratozoospermia index (TZI) requires us to now look at each sperm in far more detail. We are asked to assess the percentage of specific abnormalities such as head shape (is it too thin or amorphous?), midpiece (is it slightly asymmetric?) and tail (is it a little too short?). However, such assessments require additional time-consuming work for the biomedical andrologist and is it really of any clinical relevance?

Most sperm shape defects are easy to detect by the basic analysis without this extra work. Examples include globozoospermia, macrocephaly, decapitated sperm syndrome and fibrous sheath dysplasia, all of which are simply diagnosed, as often the vast majority of sperm affected.

Following on from a talk given last year on the Precision AMR Project, this presentation will look at the incorporation of WGS and genotypic methods vs phenotypic methods and how they can impact on diagnostic laboratory practices, antibiotic reporting and prescribing.

This presentation follows on from the research on the Precision AMR project and discusses how this can be translated into routine practice. Also looking at potential new workflows that may be incorporated into laboratory's to support clinicians and infection control.