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Inside the Lab Digital and computational pathology, COVID-19

Digitize to Overcome

Want to hear Monika Lamba Saini’s experience of the pandemic – in her own words? Listen to our audio interview below!

The pandemic has had a deleterious effect on health care systems worldwide. The influx of patients with COVID-19 overwhelmed not only clinical, but also diagnostic facilities. Laboratories were particularly badly affected – and the paucity of pathologists became all too clear. Without sufficient personnel, how can we continue to cope with the demands of not just our usual workload, but a pandemic as well? I believe the answer lies in digitization.

Image digitization technology has progressed in the last decade, and it’s time for pathology to benefit. Whole-slide imaging (WSI) scanners can now produce scans with excellent resolution that pathologists can manipulate just as they would a glass slide. And it’s not just useful for research and education, but also for diagnostic surgical practice (1). Many countries have recently stepped up efforts to integrate digital pathology systems into routine hospital workflows to enable efficient remote second opinions and consultations (2), keeping people safe as we tackle COVID-19.

As patients return to hospitals [...] our ability to work remotely becomes increasingly important for coping with our growing caseload while keeping ourselves and our families safe.

The pandemic also precipitated a change in the regulatory climate. In March 2020, the College of American Pathologists won a waiver from Centers for Medicare and Medicaid Services regarding remote pathology work (3). A month later, the FDA issued guidelines for the remote reviewing and reporting of pathology slides (4). This guidance has helped boost the practice of digital pathology for primary diagnosis; now, pathologists can access slides and perform remote consultations from their homes. As patients return to hospitals for everything from elective surgeries to clinical trials, our ability to work remotely becomes increasingly important for coping with our growing caseload while keeping ourselves and our families safe.

Although COVID-19 prevention has spurred these changes, their benefits go far beyond pandemic safety. Digital pathology adoption helps with remote consultations and second opinions – not just in developed countries under lockdown, but also in resource-restricted settings. With technologies that reduce the cost of WSI, digital pathology can help small, independent laboratories in these settings share their cases seamlessly across laboratories and countries. Better storage facilities in the form of cloud computing aid easy retrieval, assist in review during clinicopathologic consultations and meetings, and provide an excellent teaching resource. And, having worked with digital pathology for the last three years, I can vouch for its ergonomic benefits!

To improve diagnostic accuracy, WSI can be combined with image processing techniques. The introduction of algorithmic intelligence provides pathologists with tools that can assist their decision-making process. When applied to WSI, artificial intelligence helps assimilate clinical, genomic, and pathologic data for diagnosis and prognosis, helping to reduce inter-observer variability and enhance reproducibility – and ultimately leading to better clinical outcomes.

Digital pathology’s time has come. It has helped pathologists work remotely during the pandemic, but it will continue to be an important tool in the post-pandemic era. It helps to make the science of pathology more robust, addresses our discipline’s workforce shortage, and helps us to grow, collaborate, and share. And, as every pathologist knows, sharing makes a great pathologist!

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  1. S Al-Janabi et al., “Digital pathology: current status and future perspectives,” Histopathology, 61, 1 (2012). PMID: 21477260.
  2. L Browning et al., “Digital pathology and artificial intelligence will be key to supporting clinical and academic cellular pathology through COVID-19 and future crises: the PathLAKE consortium perspective,” J Clin Pathol, [Online ahead of print] (2020). PMID: 32620678.
  3. Centers for Medicare and Medicaid Services, “Clinical Laboratory Improvement Amendments (CLIA) laboratory guidance during COVID-19 public health emergency” (2020). Available at: go.cms.gov/33y8vJw.
  4. US Food and Drug Administration, “Enforcement policy for remote digital pathology devices during the coronavirus disease 2019 (COVID-19) public health emergency: guidance for industry, clinical laboratories, healthcare facilities, pathologists, and Food and Drug Administration staff” (2020). Available at: bit.ly/2GZXLMg.

About the Author

Monika Lamba Saini

Pathologist at HistoGeneX, Antwerp, Belgium.

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