Digital pathology in the muscle biopsy services during the COVID-19 pandemic: A large UK center experience

Introduction: In March 2020, the WHO declared the COVID-19 outbreak as a pandemic and soon after the UK governments declared "lockdown" measures. In line with the UK General Medical Council guidance to the healthcare workers, we adopted new working practices to meet the need for flexible and remote working including virtual clinical meetings. Methods and adaptations: The "fresh" muscle biopsy sample was handled with necessary precautions as per the Public Health England safe handling guidance. The whole slide digital images were acquired using an advanced digital slide scanner. The images were analyzed on a virtual microscopy platform with high resolution PC monitor. The digital pathology reporting was introduced as per the UK Royal College of Pathologists guidelines. Initial selfvalidation, comparing digital images with the respective glass slides was undertaken. To maintain the clinical standards and patient safety, whenever in doubt, we concurred with the glass slide findings. The multi-disciplinary neuromuscular team meetings and clinical discussions were held on a virtual platform by taking appropriate steps to protect patient confidentiality. Results: The digital reporting has enabled quicker turn around. The virtual meeting platform has enabled expansion of clinical audience and participation. It has facilitated better training opportunities to the junior doctors. Despite intermittent challenges such as scan failure, poor quality audio/video, the overall end-user feedback has been very positive. Conclusion: The COVID-19 has brought about several changes. We share our novel experience over the last year, which we hope will help to improve diagnosis and treatment in the neuromuscular services.