Digital Pathology Blog

On Tuesday, December 6 at 9 am ET, The Pathologist will be hosting a forum on Digital Pathology & Artificial Intelligence. Dr. David Wilbur, Corista’s Chief Scientific Officer, will join speakers from Dell, Inify Laboratories, Owkin and Proscia to discuss these technologies and their role in Pathology.

Dr. Wilbur focuses on how the use cases and workflow solutions of digital pathology compare to those in the clinical environment. While both of these are well established in the clinical setting, image management systems need some additional features to satisfy the requirements for research. Use cases and workflows are similar in how the user interacts with the digital environment but can be quite different in how they relate to the ultimate task and output.

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.”

The strains of the last two plus years have forced us to make many changes to our daily routines, both on a personal and a professional level. Remote interactions have become the norm, with families “zooming” for the holidays and family events, elbow bumps instead of hand-shakes, and remote work conferences and meetings in all walks of life. We are all looking forward to the return to many of our previous lifestyles, but the old adage remains true, out of adversity comes opportunity.

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".

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.

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.

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.

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.