Digital Pathology Blog

As a first-year pathology resident, one of both the most daunting and exhilarating experiences of your training was presenting at tumor boards. The preparation to do so as a junior resident, meticulously reviewing every slide and picking the best ones to show the pertinent findings, was in and of itself a laborious task. Reviewing them again with your attending to confirm the slide(s) you chose showed the pertinent features also took time. Thinking about what to read in the report during the course of the tumor board was another task, planning for when the moderator says, “Can we review the pathology?” and what your spiel was going to be.

My maternal grandfather was a glazier. He was orphaned at a young age and raised in an orphanage on the West side of Chicago with 2 brothers. One of those brothers died during adolescence. My grandfather and his oldest brother fought in World War II and became part of America’s Greatest Generation. He and his brother started Chicago Glass which became the largest glazier company in the city. For over 30 years, my grandfather hung glass on some of the tallest buildings in the world at the time. Sears Tower, John Hancock, Lake Point Tower, Standard Oil, you name it, he worked on it. Buildings downtown had to be “glassed in” by November 15 if the electricians, plumbers, elevator, drywall and carpet guys were to have a chance to work through the winter for spring occupancy on a residential or commercial high rise. In the winters, my grandfather drove a cab between “indoor” jobs such as hanging mirrors, repairing windows or building storm windows. He would drive me around in his large Checker cab and point out what buildings he worked on and what he did, what worked and what didn’t, if he got injured, or one of his men did, and when they “glassed” it in.

A radiologist, an internist, a surgeon and a pathologist go duck hunting. The radiologist is up first and a flock of ducks fly overhead. He raises his shotgun but does not shoot. The surgeon asked him why he didn’t shoot to which the radiologist replied, “They had the outline of ducks, their contrast looked like ducks, but I wasn’t sure they were ducks.” The internist is up next. When the next flock flies overhead, he raises his shotgun in the air but does not shoot. The surgeon, getting irate at what is happening, asked the internist why he did not shoot to which the internist replied, “They looked like ducks and quacked like ducks, but I wasn’t sure they were ducks.”

There is a joke among surgeons and oncologists -- the pathologist at a tumor board is like the guy whose funeral that you are attending; you can't do it without him, but you don't want him saying too much. 

Nearly 2 years ago, our tumor boards went "virtual". Like billions around the world, we scrambled to get Zoom, GoToMeeting, WebEx and other applications up and running to hear each other’s voices and share screens to show radiology and pathology images. We anticipated that by the Summer or Fall we would be back to "normal".

Recently I received a call from an oncologist. After giving me the patient’s name, she asked “What does the gene panel show?”

I responded we didn’t have the patient’s biopsy yet, that he was scheduled to undergo a CT-guided needle core biopsy, and we would process it overnight and review tomorrow as we normally do.

The oncologist acknowledged the patient was undergoing the biopsy in the afternoon, and we hadn’t even yet done an immediate fine needle aspiration rapid on-site assessment prior to the core biopsy.

Surgical pathology is increasingly becoming more based in molecular diagnoses rather than morphologic diagnoses. For 150 years, morphology has been an accurate predictor of clinical behavior with standardized criteria for both histological grading and pathologic staging of tumors. While there are certainly “gray areas” in morphology and classification of disease, a traditional approach of classifying tumors based on location, gross pathologic findings and histologic findings combined with immunohistochemistry, over the past 30 years, has served our patients well in terms of classifying tumors for appropriate therapy and management.

My grandfather, who was self-employed, made a living as a glazier and drove a cab in the winter when he couldn’t hang 10-foot panes of glass 100 stories above the city if it was too windy. The jobs required him to be aware of his surroundings constantly, whether high above the city putting glass on a skyscraper or running the one-way streets around the downtown Loop.

Telepathology, the ability to view remote pathology images, and more specifically, the technology to allow this to happen, has been available for more than 50 years. 

In the past several weeks we have all seen or been directly impacted by a worldwide pandemic.

Nearly 1/3 of the world’s population is currently on “lockdown”, “shelter in place”, “stay at home” or other similar orders from local, state and national authorities in respective parts of the world. My parents told me about when the city swimming pools had to be closed over concern of poliomyelitis, but few of us have experienced anything like this before. Epidemiologists and sociologists will have plenty to study for the next decade and break down.

Yogi Berra, the Hall of Fame New York Yankees catcher has famously said “It's tough to make predictions, especially about the future”.

The Jetsons had us believing that by 2020 we would have instant food, video phones and flying cars. Two out of three isn’t bad. So far. Some innovative folks are working on drone-like vehicles that can sustain human flight. Let’s see what happens this year with that.

Ten years ago, digital pathology was leaving infancy and becoming a toddler, learning to walk and run and read and write and communicate. The notion that slide images could be viewed from anywhere, anytime, was still a novel idea, not so much from a technological perspective, but rather from a professional one.