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Inside the Lab Technology and innovation, Profession, Digital and computational pathology

Digital Pathology Is Not Our Enemy…

Are we ready for digital pathology?

We’ve been asking ourselves this question for so long that it reminds me of my children riding in the backseat of the car on a long trip – “Are we there yet?”

I started my own long trip with digital pathology in 2003, as a junior resident presenting a poster at my first College of American Pathologists conference. I clearly remember thinking that it felt like every company in attendance was developing slide scanners. At the time, it took these devices 30 to 60 minutes to scan a single slide. Today, not only are they much faster – with scanning times as short as 30 seconds – but the images are also much better.

Since my first introduction, digital pathology has become a passion for me. At the University of California, Davis, I implemented digital pathology sarcoma tumor boards, which gave both me and my clinician colleagues a better understanding of our cases. We even correlated them with digital radiology to further expand our knowledge.

The turning point for me, though, came during my visiting professorship at the Rizzoli Orthopedic Institute in Bologna, Italy. During that month (July 2011), I was still consulting on all the bone and soft tissue cases at UC Davis. I had no problem diagnosing those cases even though I was on a different continent nine time zones away! The histological images had the same quality and accessibility as if I had been looking at them under my light microscope in my California office. That’s when I lost all doubt that digital pathology would be the future of my specialty.

We pathologists have to understand that digital pathology is not our enemy. Instead, it can be our strongest ally. Digital pathology gives us the ability to access slides from anywhere, at any time. We can seek consults on difficult cases from experts anywhere in the world. We have the potential to get an answer in a very short time – much faster than waiting to send outside cases by parcel post.

With digital pathology, we can review previous slides in the blink of an eye.

Every pathologist’s nightmare is having a clinician call the next day for results on a patient with metastatic cancer to the lung and a previous history of cancer. To make that diagnosis, the first thing we would like to see is the previous biopsy, so that we can compare the tumor morphology. But the slides from that previous case, which may have been years earlier, are probably in storage – perhaps at a hospital several states away – and it would take far too long to receive them for review. With digital pathology, we can review previous slides in the blink of an eye and correlate them with our present findings.

These are only a few of the advantages of digital pathology and its application to daily clinical practice!

In April of 2017, digital pathology reached a major milestone – the FDA approval of the first digital pathology solution for primary diagnostic use in the United States. I – and many others – had been waiting anxiously for that day. We were sure that, when it happened, we pathologists would be ready to sign out cases digitally right away – and yet, it seems that most hospitals are still a long way away from embracing the change.

This summer, I was the keynote speaker at the 3rd Digital Pathology Congress in Chicago. I was surprised to find that most of the attendees were vendors; relatively few pathologists were there. Even the pathologists who attended the event did not really seem convinced when I told them that digital technology could replace light microscopes. It seemed to me that they preferred to stay in their small basement offices and sign out cases “the old way.”

I must add, at this point, that I have nothing against the old way. I like to sit in my office and sign out cases while listening to classical music, too. However, we must remember that business is business – and health care is big business in America. Big laboratories are always looking for more revenue. They would be pleased to get more cases, and happy to have the ability to run their labs 24/7. If a representative from such a lab went to the CEO of a small hospital and proposed a faster turnaround time for surgical cases at a cheaper price, I feel sure that the CEO would be thrilled to sign up. He or she would certainly prefer to pay less – and perhaps even provide fewer benefits for those pathologists remaining in the basement.

If we do not wake up soon, we will become consultants without benefits. We will be paid less. We will work for big companies instead of hospitals. I think it’s well past time for us to get out of the basement and start thinking more seriously about digital pathology opportunities.

Are we pathologists ready for digital pathology? We’d better be – because if we don’t make the most of this opportunity, somebody else will.

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About the Author
Dariusz Borys

Dariusz Borys is Professor of Pathology and Orthopedic Surgery, Chief of Orthopedic and Pediatric Pathology, and Director of the Digital Pathology Lab, Loyola University Chicago, Maywood, USA.

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