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NHSE Diagnostic Transformation - progress to date and future ambition

Pathology Network Maturity - meeting the NHS Long Term Plan objective

Pathology Services in the Northern Ireland Health and Social Care (HSC) system face a range of challenges including increasing demand, recruitment and retention, aging information systems, rapidly evolving technology and changing quality requirements. The Northern Ireland Department of Health’s vision is for the delivery of modern, sustainable, world-class Pathology services through a single, regional HSC Pathology Services delivery vehicle capable of supporting safe, effective delivery of Clinical Services into the future for HSC Patients.

Stakeholder engagement and participation is viewed as critical for successful delivery of the Department’s vision. This presentation will describe how the Northern Ireland Health and Social Care (HSC) system is enabling Pathology stakeholders to design a preferred operating model for a regional Pathology Management Structure that will deliver key benefits for HSC Patients and Service Users, the Pathology Workforce, Pathology Managers and the wider HSC system. It will briefly describe complimentary programmes to implement new regional Pathology Information Management Systems, and implement a regional Workforce and Training Plan.

The role of the pathology practice educator (PE) was funded and implemented as part of the Covid response. When these roles were recruited to we were well in to the national Covid response, and the vast majority of the pathology laboratories were up and running for Covid testing and so the role of the pathology PE became so much more than Covid. Most pathology PEs no longer have this title and are all working with networks on the recruitment, retention and education of the pathology workforce from support workers to clinical roles, admin staff and biomedical scientists of all levels across all disciplines.

Since their implementation they have worked on numerous projects including a workforce gap analysis; registration portfolio training; specialist portfolio training; apprenticeships; outreach; undergraduate placements and training; continuing professional development and leadership.

There has been improved engagement with the IBMS; Universities; Further Education providers and even schools to ensure that all of the establishments involved within pathology are working together to ensure a brighter future for our pathology workforce.

In this session you will hear how these roles, as individuals and as a network have impacted the pathology workforce and how they can continue to do so as we move to mature pathology networks..

This presentation will give delegates attending an:

Overview of the pre-analytical processing pathway and potential risks associated with each stage.
Historical/current/prospective optimisation of the pre-analytical pathway.
Understanding of the near-future perspectives for standardisation-will technologies such image analysis and spatial profiling affect the practice of pathology laboratories.

The South East Genomic Laboratory Hub provides genetic and genomic testing for 19 acute NHS Trusts and 9 non-acute NHS Trusts in the South London, Kent, Surrey and Sussex region. Within the solid tumours service, we process DNA and RNA from patients with a range of cancer types and analyse them using next generation sequencing (NGS) assays.

Once the variants within a patient’s sample are identified, Clinical Scientists review them and consider what impact they would have on the function on the protein encoded by that gene. Through a process called somatic variant interpretation, the variant will be classified according to its clinical significance in relation to providing diagnostic, prognostic, or therapeutic information.

Some examples of the utility of this service include identification of:

resistance variants in EGFR within the tumours of patients with non-small cell lung cancer, providing the clinician with information to support a change to the patient’s treatment.
gene rearrangements involving TMPRSS2 can support a diagnosis of prostate cancer.
certain variants in POLE within the tumours of patients with endometrial cancer can classify their tumour into a subgroup which is associated with an excellent prognosis

Delegates will learn and understand:

What spatial profiling is about
Multi-omic techniques on tissues
How combining spatial profiling and multi-omic approaches leads to a better understanding of the pathophysiology of disease.

Specialist Portfolios – updated, flexible and achievable

Emergency presentation of adenocarcinoma in a young female.



This case study was carried out as part of the Advanced Specialist Diploma in Histological Dissection of Lower GI Pathology. The patient was a 34-year-old female who presented at A&E with sudden onset of abdominal pain and constipation. A CT scan showed multiple colonic polyps and a likely descending colon tumour. The differential diagnosis of the tumour was of an inflammatory process, in view of her young age and negative family history of colorectal cancer. Endoscopic biopsies confirmed the diagnosis of a well to moderately differentiated mucinous adenocarcinoma. A stent was placed to relieve obstructive symptoms and a genetic questionnaire was completed. The patient subsequently underwent a subtotal colectomy in view of the large number of polyps. Histology of the resection specimen showed a circumferential mucinous adenocarcinoma multiple lymph node metastases and lymphovascular invasion, TNM 8 pT3 N2b R0 V0 L1 Pn0.

Routine Mismatch Repair (MMR) immunohistochemistry detected a loss of MSH2 and MSH6, indicating possible Lynch syndrome. Further molecular testing including Microsatellite Instability (MSI) showed that Lynch syndrome was not present, and no genetic explanation could be found as to why the patient developed bowel cancer at a young age. Detection of a KRAS mutation in the tumour cells suggests that treatment with anti-EGFR therapies such as Cetuximab may not be effective in this patient. After discussion of the histology at MDT, the patient was referred to oncology for adjuvant chemotherapy which consisted of 6 months Oxaliplatin and 5-Fluorouracil. The patient completed the course in 2019 and was referred to the surgical team for follow up with CT scans, endoscopy and CEA monitoring.

In summary, this case demonstrates the essential role of appropriate sampling and molecular testing of colonic cancer resection specimens in guiding decisions about the patient’s subsequent treatment.

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.