Azienda Zero

Azienda Zero's 12 hospitals in the Veneto region process approximately 240,000 pathology slides per month (nearly 3 million per year). The laboratories lacked a standardized digital workflow, leading to subjective interpretations, longer turnaround times, and fragmented information exchange across the regional network serving nearly 5 million people.

A comprehensive digital pathology infrastructure was deployed across 12 hospitals, including four categories of whole slide image scanners, 230 pathologist workstations, the PATHOXWEB 2.0 regional laboratory information system, a two-tier cloud storage architecture, and Aiforia CE-IVD marked AI deep-learning tools for prostate cancer (Gleason grading), breast cancer (Ki67/ER/PR scoring), and lung cancer (PD-L1 scoring). Barcode-based specimen tracking, specialist nephrology networks, and formal CAP-guideline validation were also integrated.

The deployment — detailed in a peer-reviewed proof-of-concept study (Eccher et al., 2024) — is projected to yield cost savings exceeding $250,000 per institution per year through reduced operational and asset costs. The system improves information flow across the hospital network, standardizes and enhances reproducibility of pathology reports, enables remote second opinions, and creates large WSI repositories for resident education and future AI model training.

• A regional-scale digital pathology rollout requires coordinating eight interdependent components: scanning infrastructure, workstations, LIS, storage, AI, specialist networks, quality tracking, and formal WSI validation.
• CE-IVD marked AI tools for prostate, breast, and lung cancer can be embedded into the regional clinical workflow to reduce subjective interpretation and turnaround time.
• CAP validation guidelines (minimum 60 cases, 95% diagnostic concordance between light microscopy and WSI) are a critical quality gate before deploying digital pathology for patient care.