gms | German Medical Science

Background: The extent of brain tumor resection is essential for postoperative recovery and survival. This requires the neurosurgeon to regularly check the border between healthy and cancerous tissue. Frozen sections support intraoperative decision-making by determining tissue status [1]. Samples are sent to the neuropathologist who performs a micro- and macroscopic assessment and delivers results via telephone to the neurosurgeon.

In recent years, innovative, high-resolution confocal microscopes for digital biopsy have entered the market. These devices enable the visualization of cellular tissue structures in vivo on a screen, eliminating the need for tissue resection. Images can be transferred to the neuropathologist for real-time analysis.

A process analysis has been conducted, comparing an exemplary process of the status quo to an ideal process of digital biopsy aiming to identify the chances and risks of digital biopsy.

Methods: An exemplary process of the current frozen section analysis has been modelled. Using the Convivo tool of the Carl Zeiss AG as a case example, an ideal process of a digital biopsy workflow has been created as well. Both processes have been created and finalized in close cooperation with neuropathologists. The ideal process assumes that all participants know how to use the device. The modeling standard Business Process Model Notation 2.0 (BPMN 2.0) has been used to visualize processes in the academic version of the Signavio Process Manager.

Results: Both processes take place in two institutions, the clinic and the department of neuropathology. The classic frozen section process requires seven people (neurosurgeon, surgery assistant, neuropathology receptionist, neuropathology secretary, lab technician, Jr neuropathologist, Sr neuropathologist), while in the ideal digital process only three people are involved (neurosurgeon, surgery assistant, neuropathologist). The number of tasks decreased around one fourth in the ideal process compared to the current one. However, the decrease only happened in the neuropathology department. Staff in the clinic face an increased workload; the number of tasks rose from 11 (status-quo) to 18 (ideal process), mostly due to the maintenance and operation of the device. In the ideal process the communication across institutions is completely digital. Since all data are created and saved digitally, many instances of media discontinuity from the current process can be eliminated.

Conclusion: The ideal process has shown that digital biopsy can have a positive effect on the workflow within the department of neuropathology and even contribute to saving human resources. An advantage from a medical point of view is the fact that the number of samples per patient is not restricted. Other studies confirm that results are available much faster, potentially shortening surgery duration [2], [3]. Joint decision-making can be strengthened, increasing chances for a more exact tumor resection. Data quality can be improved as the process is completely digital.

Clinic staff, particularly the surgery assistant, will likely face an increased workload due to the operation of the additional device. A recent qualitative study confirmed this [4]. There is a risk that the application will be rejected by the staff. Further research and evaluation of digital biopsy is necessary to advance its implementation.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.