Digital Pathology Blog

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.

Access to healthcare services is in the midst of a fundamental change. Independent community hospitals and academic health centers are consolidating into larger networks across the nation. Furthermore, these networks are also developing global affiliations and partnerships to increase access to diagnostic care worldwide. As a result, patient point-of-service, laboratory services and the professional review of a case may exist in independent locations, sometimes spread over large geographic distances. Pathology department transformations embody this shift.

Multidisciplinary Tumor Boards (MTBs) are a standard of practice in all academic medical centers. Studies show that they contribute to improved diagnoses and treatment plans and often lead to improved patient outcomes.¹ Moreover, these conferences provide valuable real-life education and training to residents and fellows in all represented disciplines.

Historically, pathologists have encountered unique challenges when participating in MTBs. Even with access to digital images for their presentations, the images are often time consuming to attain and in a static image format. Navigation to other regions of interest within the slide is often not possible, and the patient’s case data is usually in a separate lab information system (LIS). Assembling the case, often in Powerpoint, is time consuming, limiting and frustrating.

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 Control (QC) and Quality Assurance (QA) activities in anatomic pathology are embedded into the daily work. These efforts are put into place to assist with error reduction and prevention and for improved patient safety. No one denies their value.

Digital pathology has played a role in laboratory workflows for decades. Early use of static images for teaching and tumor boards has grown to include today’s clinical applications including remote assisted fine needle aspirations and frozen sections and the use of whole slide images (WSI) for expert consultations and quality assurance (QA).

In April, the field of digital pathology achieved a major milestone with the FDA giving clearance to Philips Medical Systems to market its whole slide imaging (WSI) system for primary diagnosis. While a significant step forward, there is still much work to be done before digital pathology (DP) becomes a mainstream technology for clinical use. 

Growing up as an avid member of the 60’s TV generation, one of my favorite genres included nature shows. In the years long before YouTube, we often arranged our week to be home in time to watch Marlin Perkins’ Mutual of Omaha's Wild Kingdom on Sunday evenings. And of all the spectacular scenery shown, a very specific type of photography captured my imagination – time-lapse video. 

You’ve seen the same amazing footage.  It begins with a barren desert that looks almost choked off from life, with the exclusion of a few scraggly cacti and perhaps a plodding reptile or two.  Next comes the torrential rainstorm, and a vivid rainbow of breathtaking plants seem to blossom out of nowhere.  Clearly, the stunning display was hiding in place all along.  With the “magic” of time-lapse photography, we are given the rare opportunity to view the entire picture from start to finish.

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.