Digital Pathology Blog

I have been attending tumor boards on a weekly basis in some capacity or another for over 20 years, since starting my pathology residency. Prior to then, I observed as a medical student on a regular basis. Even if I was on a rotation, like family practice or pediatrics or OB/Gyn, if I had the time, I would try to attend one of the many tumor boards on the hospital campus. I kept the schedule in my PalmPilot Personal Digital Assistant at that time.

Digital imaging, when most of us consider it in medicine, is primarily used in radiology. Radiology has taken the lead on digital imaging for decades.

25+ years ago, as a resident, the hard(er) part was looking at the slides and the easy part was writing the report. Before breast conserving therapies, when mastectomies were standard of care, for example, a report might read: “Breast, right, mastectomy: Invasive mammary carcinoma, grade 3, measuring 3.4 cm; deep margin and nipple negative for tumor.” With the header, all the necessary elements in the report, the logo, gross description and disclaimers you could get this onto 1 page. And have space left over. With large fonts (the initial MUMPS based laboratory information systems did not give you the option of 500+ font styles and types with bold, italics, etc…)

Late last month, the CEOs of Amazon, Buffett and JPMorgan Chase announced they were teaming up to form an independent healthcare company for their employees.

The details were scant and vague but mentioned the new corporation would be “free from profit-making incentives and constraints”. Mr. Buffett is quoted as saying, “The ballooning costs of health care act as a hungry tapeworm on the American economy… Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

Probably not the best analogy considering tapeworms are easily treated with oral generic medications that are very low cost.

There is a lot of talk currently about artificial intelligence. AI- in short, is the ability for computing systems to be programmed to perform tasks AND to learn from those tasks to refine their abilities the next time a problem or question or decision is faced by the system tasked to perform the operation.

The American Recovery and Reinvestment Act (ARRA) 2009 introduced the Health Information Technology for Economical and Clinical Health (HITECH) Act with the aim to incentivize “meaningful” implementation and usage of Electronic Health Records (EHRs) throughout the nation. Under HITECH, two incentive programs for Medicare and Medicaid were introduced which allow eligible professionals (EPs) to claim thousands of dollars in incentives over several years, if they could meet the requirements set out for different stages of Meaningful Use.

Growing up as an avid member of the 60’s TV generation, one of my favorite genres included nature shows. In the years long before YouTube, we often arranged our week to be home in time to watch Marlin Perkins’ Mutual of Omaha's Wild Kingdom on Sunday evenings. And of all the spectacular scenery shown, a very specific type of photography captured my imagination – time-lapse video. 

You’ve seen the same amazing footage.  It begins with a barren desert that looks almost choked off from life, with the exclusion of a few scraggly cacti and perhaps a plodding reptile or two.  Next comes the torrential rainstorm, and a vivid rainbow of breathtaking plants seem to blossom out of nowhere.  Clearly, the stunning display was hiding in place all along.  With the “magic” of time-lapse photography, we are given the rare opportunity to view the entire picture from start to finish.

I’ve spent a lot of time in Starbucks, and over the years, it seems little has really changed with the basic operations. The line to the register is flanked by food options and souvenirs leading to someone who takes your order and your money (The Register). Your order moves to someone standing at the espresso machine (On Bar). Other Starbucks associates are simultaneously working the Drive-Thru customers (On Drive-Thru).

Another associate is grinding beans, ensuring the coffee urns are full, teas are brewed, cups, lids and cup protectors are in place, and coolers are well stocked with sandwiches, croissants and breakfast sandwiches (Customer Support).

So, who has the most important job at Starbucks? The Register? On Bar? On Drive-Thru? Customer Support?

My grandfather was born on Groundhog Day in 1915. If he had not passed away 10 years ago, he would have been 102 this year. Given what he ate, drank and smoked, it is a miracle he lived as long as he did. When I was about 8 or 9 years he told me to “Never bet against Notre Dame football, Joe Louis or the New York Yankees”. Today he would have to replace the entries on that list with, among others, the New England Patriots.

During this year’s game, how many people went to Netflix or their e-book reader half way through the third quarter? I tweeted that, apparently, the balls were harder to catch when fully inflated and “Go Patriots!”

Liquid biopsy is defined as, “A test done on a sample of blood to look for cancer cells from a tumor that are circulating in the blood or for pieces of DNA from tumor cells that are in the blood. A liquid biopsy may be used to help find cancer at an early stage. It may also be used to help plan treatment or to find out how well treatment is working or if cancer has come back. Being able to take multiple samples of blood over time may also help doctors understand what kind of molecular changes are taking place in a tumor.”*

Often times the test is regarded as “non-invasive” as it can be performed with simple venipuncture specimens or voided urine samples.

These tests are gaining traction within the industry as a viable alternative to traditional screening methods for cancer. Study results are turning up positive data in favor of the tests, and a recent report by financial services firm Cowen & Co. said annual sales for the tools could surpass $10 billion.