Digital Pathology Blog

Authored by:

David C. Wilbur, M.D.
Chief Scientist, Corista LLC
Professor of Pathology Emeritus
Harvard Medical School

The microscope has been around for hundreds of years and has reached a plateau of efficiency. Certainly, in my own practice over the last 40 years, the physical process of microscopy has not changed. I still use today the microscope I bought as a resident. Sure, some advances have been made, like tilting heads and automatic turret changes, but these are designed to prevent chronic issues, such as neck and back pain and carpal tunnel syndrome, respectively. They have little to do with the daily efficiency of the process.

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.

The acceptance of digital pathology and its implementation across the United States have been met with a fair amount of challenges. Many equate digital pathology’s evolution in the laboratory with radiology’s move from film to digital media. Despite obvious advantages like immediate availability of images for viewing and image storage being reduced to computer drives as opposed to rooms full of film, it took time for radiology to convert to using digital media as a routine matter of business. Pathology is experiencing much of the same resistance.

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.

This article is the fourth in a four-part series highlighting the evolution of digital pathology and its impact on the access to pathology services throughout the world. If you missed it you can find Part 1 here, Part 2 here, and Part 3 here.

This article is the third in a four-part series highlighting the evolution of digital pathology and its impact on the access to pathology services throughout the world. If you missed it you can find Part 1 here and Part 2 here.

This article is the second in a four part series highlighting the evolution of digital pathology and its impact on the access to pathology services throughout the world. If you missed it, you can find Part 1 here.

Many pathology practices associated with academic medical centers have begun using digital pathology to facilitate the sharing of cases through the use of internet services, private networks, and now, cloud technology. As the use of whole slide imaging (WSI) and digital pathology consultations becomes more widespread, hospitals can access experts in any pathology subspecialty from any location around the globe. Secure, web-based access to expert centers and remote subspecialist colleagues is now a reality.¹

This article is the first in a four part series highlighting the evolution of digital pathology and its impact on the access to pathology services throughout the world.

"In 2012, there were 14 million new cases of cancer reported and 8.2 million cancer-related deaths worldwide. The number of new cancer cases will rise to 22 million within the next two decades.”¹

With cancer among the leading causes of death worldwide, the demand for pathology services is becoming more critical. However, the number of new pathologists entering the field is decreasing while the projected demands of the patient population are expected to grow by more than 150% over the next 20 years.

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…)