Digital Pathology Blog

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.

Quality is Job 1

This of course was Ford Motor Company’s marketing slogan in the early 1980s. The message was clear – in the wake of some issues, Ford was going to build in quality to its automobiles rather than make it a checkbox at the end of the process. Over the years, Ford prospered while its major domestic competitors, General Motors and Chrysler, struggled to compete with Ford as well as foreign automakers.

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…)