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.
If they don’t currently have digital pathology technology in their own facility, a majority would like to obtain it. In some cases, oncologists have encouraged lab and hospital administrators to do so – but cite initial start-up costs, time invested to implement new technology and expense for ongoing support as internal barriers to adoption.
Oncologists see the value of digital pathology and will champion the cause for their laboratories, insisting upon the latest imaging technologies including molecular testing. Perhaps more so molecular than digital pathology, but oncologists I spoke with see it is a continuum in terms of appropriate tumor selection from whole slide images for block dissection.
That being said, I have recognized for some time that whether the clinician is an oncologist, infectious disease specialist, hematologist, surgeon, pulmonologist, etc., what they require of their laboratories – and what we as their pathologist colleagues must provide – is timely and accurate diagnoses. At the end of the day, whether we make the diagnosis on a certain kind of instrument, analyzer, scanner or microscope, clinicians simply want the right answer quickly. Following this, they tell us what additional analytes, proteins, antigens or mutations we should look for – again not the specific platform or technique, just what questions they need accurately answered and in a timely manner.
This is both good and bad news for pathologists. The good news is that our clinical colleagues largely respect the work we do, while not necessarily recognizing the way we accomplish this. The bad news is that our clinical colleagues may not distinguish that there are other ways to get a timely accurate answer, and that we may require their support to obtain the necessary tools.
There is a saying in the lab business that goes, “You can have it fast, cheap or accurate. Pick any two.” As long as it doesn’t cost more and meets the standard of care, clinicians choose fast and accurate. If we ask our clinical colleagues for their assistance in obtaining additional microscopes to support onsite FNAs, or scanners, or analyzers – perhaps with support from their budgets to simply replace one tool with another – it probably won’t happen.
If discussions at ASCO 2016 were any indication, I believe oncologists will increasingly ask laboratories and pathology groups to use digital pathology, whole slide imaging, teleconsultation, and image analysis and analytics, etc., to provide more timely and accurate diagnoses – if we as a community of their peers support its use as well. At the end of the day, and over time, our clinical colleagues can have it fast and cheaper and accurate.
Download the white paper on how the Dartmouth-Hitchcock Medical Center implemented Digital Pathology in their labs.