Digital Pathology Blog


Posted by Robin Weisburger 04/20/2017

CAP Inspection Update: Telepathology and Remote Data Assessment

Telepathology and whole slide imaging have become integrated into pathology laboratories worldwide. With applications in teaching and research well established, it is now recognized that digital pathology has a role in the clinical realm as well. 

Digital pathology provides clear advantages for pathologists’ quality assurance processes and performance evaluations as well as streamlined workflows for consultative expert collaborations and multi-disciplinary tumor boards. With the advancement of artificial intelligence and histopathology analytics, there is no limit to the application of digital techniques to the practice of pathology.

Topics: Studies/Reports

Posted by Keith Kaplan, MD, Chief Medical Officer 04/11/2017

Who has the most important job at Starbucks?

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?

Topics: Healthcare, Pathology, Management

Posted by Keith Kaplan, MD, Chief Medical Officer 02/14/2017

Lessons to Be Learned from Super Bowl LI and More

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!”

Topics: Management

Posted by Keith Kaplan, MD, Chief Medical Officer 01/24/2017

Liquid Biopsy: Are We Ready?

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.

Topics: Pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 01/10/2017

What Does New Leadership in 2017 Mean for Pathology and Laboratory Medicine?

Regardless of your politics or mine, on January 20th a new administration will assume leadership of our country. A few months ago, if you told me I would be hearing “The Cubs won the World Series” and “Donald J. Trump will be our next President,” I would have thought the likelihood of either or both happening would be unlikely. It has been quite seachange of events since November. Although too early to think about the next election process, I am predicting the Cubs to win the World Series in 2017.

Topics: News

Posted by Corista 10/18/2016

Who’s looking at your digital atlas?

In the pre-PowerPoint era of the 1980s, armed with a carousel filled with 35mm slides, I traveled the country giving an introductory presentation on ploidy and cell cycle analysis. We now lightheartedly refer to this period as my “What’s a pixel? talk” years. To create the slides, I sketched out the layout for each on a sheet of copy paper, and then faxed them to Houston where a delightful gentleman named Jim would magically create the Kodachromes. This usually involved a phone call or two to talk about colors and fonts, following which Jim would mail the slides to me a week or two later.

Topics: Digital Pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 10/11/2016

What do you do for a living? I am a pathologist but not the kind you are thinking of

During training, I had an attending who actually called the autopsy the "awfultopsy," as in "awfultopsies are not that bad if you only have to do one every other year" – which I think was his personal goal. Sometimes the autopsy pathologist would be out and others would cover if there happened to be a case; so many of my attendings did not have conducting posts as part of their routine practice.

Topics: Pathology

Posted by Corista Marketing 10/04/2016

Optimize your lab’s operations with digital pathology

How can a Digital Pathology Platform help you optimize your laboratory operation?

Topics: Digital Pathology

Posted by Keith Kaplan, MD, Chief Medical Officer 09/14/2016

Role of Pathology and Pathologists in 2017

It doesn't even seem like a real number but the year 2017 is close.  High school freshman this year were not born yet on September 11, 2001, which does not seem like that long ago.  15 years have passed since the day when my generation will always recall where they were when they heard/saw what was unfolding – much like my parent’s generation can tell you about Kennedy’s assassination like it was yesterday.

Topics: Pathology

Posted by Corista Marketing 08/09/2016

Digital Study Sets Come of Age

During a recent family dinner our 17-year old was discussing her post-high school plans, which led to a walk down memory lane for her parents. While sharing our own ”ancient” college experiences, she was intrigued (rather than horrified) to learn that I had spent the lion’s share of my last year as an undergrad in the morgue gathering specimens at autopsy. Seems old moms can be cool after all!

During my senior year, we were running a study (using specimens from posts) to search for a protocol that might lead to a pre-symptomatic diagnosis of pancreatic carcinoma – particularly for tumors located away from the duct, in the body or tail. Even then, finding a way to diagnose pancreatic CA “early” was the Holy Grail – and strongly correlated with a vastly better survival rate.

My senior thesis required the collection of dozens and dozens of pancreatic FNAs, which meant hundreds of smears were created and stained. In those long-ago days, this translated into box loads of unwieldy, fragile glass slides needing a permanent place where they could be organized and filed for future retrieval – slides that must be kept carefully segregated from those generated in our clinical lab. In addition, demographic data needed to be “attached” to correlate with microscopic findings. In short, a “study set” was created for each autopsy. In the dark ages of pathology, study sets consisted of a clear plastic “holder” containing a large sleeve to hold patient data on a 3” by 5” card, and four slender sleeves to hold glass slides.

Over time, there was inevitable attrition among our study sets. The plastic holders would crack as they aged. Irreplaceable slides would become broken. If not stained or coverslipped properly, slides would dry out or fade over time. Other slides might be borrowed for publication, presentation, teaching, or further study, and never returned to their sleeve. Often we would pull a much-needed study set, only to find a plastic sleeve containing a sole index card with no slides.

Fast-forward to today, and the valuable “study set” is now a dynamic, searchable, easily accessed, portable, sharable, and reproducible resource – no longer limited by the boundaries of geography or sample size or type of preparation. The advent of digital slides has transformed this cornerstone of pathology, making the creation of unlimited virtual study sets both simple and affordable. When incorporating searchable, text-based functionality across case metadata (tissue description, grossing data, demographics, patient history, and reports), pathologists gain a powerful tool for creating, annotating, sharing, storing, and coordinating cases for publication, training, and clinical utility. A few areas where digital study sets are of particular use include:

Digital study sets seem tailor-made to document correlation in a wide array of comparative situations; histo-cyto, colposcopic-histo, and gross-micro. With the press of a button, images are quickly available for comparison – whether for QA, research, publication, teaching, or to build a more complete, robust diagnostic picture.

Changes over time
Watching a patient over time is critical when evaluating certain conditions. A good example is when patients undergo solid organ transplant. Over time, repeat serial biopsies are taken to assess for graft rejection and the health of the graft, to see if the primary disease has recurred. Digital slides make it possible to review all the former prior biopsies quickly and efficiently, and in context of the most recent biopsy.

Prognostic picture
Building prognostic study sets goes beyond the basic H&E or Pap stain. The ability to easily include immuno and molecular stains, photos of gross specimens, and even radiologic images, provide a more comprehensive picture upon which a tailored therapeutic protocol can be built. For a breast cancer patient, this might include several H&Es of the tumor (if the grading is heterogeneous throughout), along with immuno stains for ER, PR, and HER2 – and even a cytokeratin cocktail stain for micromets in an axillary node – all visible on a single screen.

Temporary preparations
Immuno and molecular fluorescent stains can vanish in the blink of an eye. Whether for clinical documentation, publication, or training, building digital study sets of these ephemeral slides provide the shelf life missing in their glass counterparts.

Training and test sets
When learning to diagnose rare lesions – or common ones for which there are challenging differential diagnosis – the only way to gain proficiency is extensive repetition. The ability to duplicate and share digital study sets removes any barrier to access, easily encouraging repeated exposure.

Recently, I uncovered a dusty archive box with the intent of going through the contents in preparation for disposal. It had been buried in the back of my office storage closet for decades, so I was fairly certain nothing precious was inside, but what a sight awaited me. It was filled to the brim with 35mm slides still loaded in their carousels, and old glass-based study sets stored in plastic sleeves. Not quite buggy whips, but antiques nonetheless. Using today’s digital slides, the entire box would fit into one small corner of a reproducible, pocket-size, multi terabyte drive, with room left over for plenty more!

Topics: Slide Management