Digital Pathology for Improved Patient Care Ole Eichhorn Chief Technology Officer, Aperio ole@aperio.com Pathology Visions October 2010

Digital Pathology… Optical Microscopy Digital Pathology glass slide Digital slide Requires microscope to view One slide at a time Limited to manual analysis Burdensome archival & retrieval Remote viewing not possible Standalone A “piece of the puzzle” View via computer monitor Multi-slide integrated viewing Analyze by software algorithms Instant archival & retrieval View anywhere, anytime Integrated with LIS Supports consolidated viewing 2

… for Improved Patient Care Education Research Clinical 3

Education applications for Digital Pathology Digital Teaching Sets Annotations Interactive Teaching Tools Remote Viewing / Conferencing 4

Research applications for Digital Pathology Drug Discovery Tissue Microarrays Biomarker Analysis Peer Review Preclinical Studies Predictive Toxicology Automated Screening Remote Viewing / Conferencing Clinical Studies Propagate Standards 5

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 6

Lab Anatomic Pathology Workflow post-diagnosis For clinical and educational use Tumor Board Tumor Board Lab AP Workflow Internal / External Consult Internal / External Consult Start here Histology Lab, In-hospital or outsourced reporting Sample* Collection Sample* Collection Sample Collection Sample* Collection Sample* Collection Gross Exam Gross Exam Gross Exam Gross Exam Slide Preparation Slide Preparation Slide Preparation Case Assembly Case Assembly Case Review Case Review Release Result Present Diagnosis to Patient Present Diagnosis to Patient Incoming pre-diagnosis prognostic Frozen Sections Inter-Operative Consults Frozen Sections Frozen Sections Inter-Operative Consults Order Additional Tests Order Additional Tests Algorithm Analysis Algorithm Analysis Retrieval of Past Cases Retrieval of Past Cases Patient Referrals Discuss Case with Clinician Discuss Case with Clinician At academic center, resident reviews case prior to anatomical pathologist Outgoing Storage and Archiving Storage and Archiving Storage and Archiving 7

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 8

Archival / Retrieval save consult cases – risk management 9

Archival / Retrieval manage active cases 10

Archival / Retrieval resident teaching sets 11

Archival / Retrieval case archives – decision support 12

Archival / Retrieval value of Digital Pathology Risk Management Easily retrieve all case information Decision Support Instantly retrieve / compare to previous cases for same patient Quality Control Simplifies selection / routing of cases for internal overreads Clinician Communications Improves turn around time for patients Education Involve residents in review of cases when not physically present pathology reading lab, major medical center 13

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 14

Intra-Operative Consults reduce travel, simplify logistics 15

Intra-Operative Consults remote interpretation 16

Intra-Operative Consults value of Digital Pathology Enables remote interpretation Reduces travel / simplifies logistics Enables realtime consultation with colleagues or specialists Save / replay sessions for resident training surgical pathology lab at major cancer center 17

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 18

Tumor Boards preparation 19

Tumor Boards remote access / participation 20

Tumor Boards value of Digital Pathology Reduce time / simplify process for preparation Enable remote access / participation Improve presentation of case information access all slides for case, display interactively 21

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 22

Consultations shipping and handling 23

Consultations routing 24

Consultations value of Digital Pathology Faster turn around time, leads to competitive advantage Improved workflow Save cost / effort of mailing cases Permanent record of consultation Physical slides never lost consult cases ready to ship at major medical center 25

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 26

IHC Quantification workflow and accuracy 27

IHC Quantification value of Digital Pathology Faster turn around time, leads to competitive advantage Improved workflow More accurate results, leads to improved patient care Attractive reports Digital IHC quantification is U.S. FDA approved 28

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 29

Digital Signout Pathologist’s cockpit 30

Clinical applications for Digital Pathology Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification Digital Signout 31

Digital Pathology for Improved Patient Care Education Research Clinical Digital Teaching Sets Annotations Interactive Teaching Tools Remote Viewing / Conferencing Drug Discovery Tissue Microarrays Biomarker Analysis Peer Review Preclinical Studies Predictive Toxicology Automated Screening Remote Viewing / Conferencing Clinical Studies Propagate Standards Archival / Retrieval Risk Management Decision Support Quality Control CAP / CLIA Compliance Clinician Communication Education Intra-Operative Consults Tumor Boards Consultations IHC Quantification 32