Digital Pathology Blog

Don’t get me wrong based on the title; I am not advocating for proficiency testing (PT). After Medical Boards, Resident In-Service and Board exams, I never thought I would be thinking about any more testing at all. There are better ways to test for ongoing real proficiency. Exercises that test “real-world” skills, such as focused review of signed out cases or concurrent reviews - with feedback – not only lead to better outcomes (patient safety) but also improve practice (constructive feedback). But testing is an unfortunate part of modern life. It’s a metric, and regulators like metrics. For years we dealt with the specter of impending gynecologic cytology PT. Based on the complexity of the federally mandated glass slide testing format, the organizations capable of producing such a monumental effort appeared to reach a détente with CMS, and no testing took place for many years after the federal regulation went into effect. However, when one organization came up with a program, the seeming détente was at an end, and CAP and ASCP were essentially forced to enter the fray.

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.

Digital pathology, in one form or another, has been with us for several decades supporting clinical, research and academic applications world-wide. Early use cases for pathology focused primarily on research and teaching. Today, however, whole slide images are playing a larger role in the clinical realm offering remote support for intra-operative procedures, consultations with subspecialty experts and, most recently, primary diagnosis reporting.

Much of the excitement related to digital pathology comes from the ability to rapidly move cases from one place to another. Remote access from home, speedy consultations, rapid review of archival material, and access to cases for clinical conferences are just a few of the benefits that accrue from moving from glass slide analog to a digital slide environment. All of these workflows can be accomplished with glass slides but require the presence of the physical case material. With digitization the need for the physical case is negated which leads to the obvious advantages that slides need not ever be “pulled” from the files, and multiple individuals can view the same case at the same time – think about slides traveling to conferences or for consultation which then are needed immediately for clinical care or quality assurance activities. Clearly the digital pathology laboratory facilitates these processes and makes them more efficient (and safe).

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.

Corista, an integrated pathology solutions leader, has received from the USPTO a Patent Grant for the Virtual Slide Stage (VSS). The VSS is an interface device that greatly improves the ergonomic efficiency of digital slide viewing for pathologists. Use of the device should  ease the path to greater adoption of digital pathology platforms, via mitigation of what is now a laborious and physically tiring process when using currently available technology.

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.

Digital pathology continues to gain momentum and is becoming­ more commonplace in pathology laboratories around the world. The list of compelling reasons to move to a digital pathology platform grows longer every day. A single image of a critical specimen can potentially aid in a patient’s diagnosis, help determine their course of treatment, play a role in research and help educate the next generation of practitioners.

But at its core, moving to a digital pathology platform facilitates the sharing of pathology cases and images among colleagues and teams whose networks are expanding every day.