Diagnosing Cancer With Confidence

An interview with Filippo Fraggetta

What does digital pathology mean to you?
Even though the term “digital pathology” has been gaining momentum over the years, digital pathology is just pathology. It is how we implement it into our own laboratories that matters. Back in 2015 we made the shift to a digital workflow and incorporated artificial intelligence (AI) into our toolbox to help manage our increasing workload.

How did you approach this?
With an array of innovative AI tools, it can be difficult to know where to begin. A good first step is to understand how a given tool can help improve an existing diagnostic process. We approached ContextVision about its AI tool for prostate core needle biopsies and we quickly understood how INIFY Prostate Screening could fit into our digital workflow – and we also saw the improvements it could bring.

We were also impressed with a simple, but important choice INIFY presents: you can ask to be pointed in the right direction before manually making a diagnosis – or you can choose to approach the diagnosis yourself before checking the tool’s suggestion. For those who take pride in the confidence of their assessments, rest assured this is not a forced diagnosis; rather, you have the freedom to simply consider the suggestion alongside your own opinion and expertise. Quality patient care is at the heart of our work and that freedom of choice has proven valuable in our laboratory. For example, consider a case that was going to be signed off as negative for cancer until an AI tool caught suspicious areas the human eye had missed… In fact, the pixel accuracy outline of suspicious cancer areas is a unique feature of INIFY – and provides an extra boost of confidence in making a diagnosis.

What are the cornerstones of using AI tools in pathology decisions?
It is an “all or nothing” approach. To reap the full benefits of an AI tool within your workflow, LIS integration is key. A standalone tool forces you to step outside your workflow to receive results, interrupting the efficiency of the process. We worked closely with ContextVision and our LIS vendor, TESI, to integrate INIFY into our LIS. We also realized that the quality of support from the providers is just as important as the product itself. Just as patients want to feel listened to by their doctors, pathologists want to feel listened to and have impact on the people who supply their tools! Today, the LIS automatically recognizes the prostate biopsy samples we scan and sends INIFY a link to the digitized whole slide images – and then we receive an answer that highlights and quantifies any suspicious areas. When time is working against the patient on the other side of the sample, the importance of efficiency throughout the process cannot be underestimated.

What do you think the future holds for pathology?
In the past, if you wanted a second opinion from a colleague, you had to walk down the hall and show them the slide. With a digital workflow, the process is streamlined within the hospital – and it doesn’t stop there. Pathologists have long faced the isolation of working in a laboratory. A digitized future offers us the ability to work remotely without feeling alone – knowing there is a pathologist in another hospital, perhaps in another country, who is working with you on your case. A collaborative approach that joins up pathologists across the world and accesses the power of AI is the future of pathology. And, for some of us, the future has already arrived.

A shortage of pathologists does not have to equal a shortage of resources. It’s time for pathology departments to embrace the digital future with workflows that support the pathologist every step of the way. To pathologists who are still skeptical about implementing digital pathology, I usually say: try out a digital workflow and see for yourself the benefits it can bring to your laboratory. In my experience, once a pathologist gets a taste of AI and a digital workflow, they never look back. That’s the beauty of digital and of tools like INIFY – they will make you question how you were ever efficient with a manual workflow.

What benefits do you see from this change?
Justifying the cost of a digital transition can be a barrier to change in some hospitals – but the true return on investment is measured in the benefits it brings to patients. My view: if we can improve the quality and speed of diagnosis, we should do so – no matter the cost. But let’s not forget that putting patient needs first also confers a financial benefit; early, accurate diagnosis and treatment is much more cost-effective than treating an advanced stage of disease.

AI tools like INIFY are here to shape digital pathology, helping us tackle the key issues we face as a profession, while still placing us – and our patients – at the heart of the solution.

Filippo Fraggetta is the Director of Pathological Anatomy at Azienda Ospedaliera per l’Emergenza Cannizzaro, Catania, Italy.