Digital Pathology Blog

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.

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

If the dialogue at ASCO this month was any indication, oncologists, who I tremendously respect, actually know about digital pathology.  In many instances their research and/or clinical facilities already use the technology.  Oncologists were familiar with whole slide scanning, image analysis and analytics, and the ability to have cases reviewed quickly without the need to transport glass slides – having seen it successfully used for tumor boards and education in their own institutions. 

Several years ago Tiger Wood’s former golf coach wrote a book with the above title. Among providing glimpses of Tiger’s personal life, his work ethic, practice routines, diet, interaction with his wife, etc… the author of course talks about Tiger’s presence on the golf course, his swing mechanics and level of focus on the course.