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Mark Lundy was convicted of killing his wife and daughter in 2002 and again in 2015 after a retrial ordered by the Privy Council. His conviction continues to divide public opinion in New Zealand. A key piece of evidence was the presence of small smears on a shirt which prosecution experts identified as central nervous system tissue relying on immunohistochemistry.

The successful challenge to his original conviction was part motivated by arguments challenging the reliability of the latter in forensic practice. This has again come under scrutiny following a 2016 report by the US President’s Council of Advisors on Science and Technology. The PCAST concluded that there were two important deficiencies in ensuring scientific validity of so-called ‘feature-comparison methods’. These are procedures by which an examiner seeks to determine whether an evidentiary sample is or is not associated with a source sample based on similar features. Proponents of Lundy’s innocence argue that the application of immunohistochemistry must be regarded as a subjective feature-comparison method.

There was a need for (1) clarity about the scientific standards for the validity and reliability of forensic methods and (2) the need to evaluate specific forensic methods to determine whether they have been scientifically established to be valid and reliable. The report emphasized 2 key elements that are required to meet the scientific criteria of foundation validity; (1) a reproducible and consistent procedure and (2) empirical measurements from multiple independent studies of a method’s false positive rate and sensitivity.

It is this author’s position that the manner in which the immunohistochemistry was applied in the Lundy case to identify central nervous system tissue was sufficiently robust in terms of rigor and reproducibility and that to insist otherwise would be tantamount to believing in biological alchemy.

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.

Diagnostic services are a fundamental aspect of modern healthcare delivery. Clinical pathways can only function properly with sufficient capacity to turnaround diagnostic tests, procedures, and reports in a timely manner. Large backlogs of diagnostic procedures hold NHS Wales back from making improvements in referral to treatment times, impair screening pathway effectiveness, result in poor patient experience, and have the potential to result in harms and poorer outcomes. COVID-19 has not gone away, and alongside the effects of global changes in behaviours and other factors, it will continue to present new and emerging challenges that must be addressed to drive improvement and deliver safe, sustainable services for the people of Wales.

The NHS Wales Diagnostics Recovery and Transformation strategy is aimed at leading and co-ordinating supportive actions to aid recovery of diagnostic services post-pandemic and ensure that our interventions implemented in the immediate term align with foreseeable future demand, and shift towards optimised delivery models as the foundation on long-term sustainable transformation. Importantly, the strategy will seek to improve outcomes for patients and reduce pressure on secondary care enabling earlier, faster detection of disease. It sets out the immediate priorities and objectives for diagnostics in NHS Wales, and how it intends to deliver against the extraordinarily challenging needs of now, but with one eye on future need and the challenges that are yet to come.

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.

Electron microscopy is essential for the diagnosis of a range of medical renal disorders, and its use is detecting immune deposits and basement membranes changes in native kideny biopsies will be familiar to many biomedical scientists and pathologists. EM is also used in the assessment of renal transplant biopsies.

In cases of recurrent disease the features are similar to those seen in native kidneys, but there are also specific features only seen in the transplant setting. This talk will focus on the utility of EM in renal transplant biopsies, demonstrating examples from relevant cases.

Delegates attending this presentation will have:

An understanding of the liquid biopsy, including:

why is circulating tumour DNA (ctDNA) sampling useful
technical considerations
clinical applications of liquid biopsies

The tyranny of learning outcomes

Training for Biomedical Scientists is a fast-growing field and has become a crucial factor in the efficiency of histopathology departments. It has many benefits from improving turnaround times, career progression and utilising Pathologist’s time more effectively. As more Biomedical Scientists are performing dissection the responsibility to teach, and train is down to the already practicing BMS dissectors rather than the Pathologists. It is imperative that training is performed correctly and suitably for the individuals, the patients, and the department as a whole. Many aspects need to be considered to deliver effective training and being fully prepared and organised for training can make the process a successful one.

This presentation will focus primarily on one discipline, cellular pathology, complimentary transformational projects of work will be explored including digital pathology and advancement of the biomedical scientist workforce.

Transforming diagnostic services - from policy to implementation