Digital Pathology Blog

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.

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).