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Inside the Lab Digital and computational pathology, Software and hardware, Technology and innovation

Filling a Global Gap

Disease detection, diagnosis, and treatment decision-making rely on information and insights from pathology, laboratory medicine, and radiology. All three are crucial contributors to patient management – but it’s pathology that currently faces the greatest obstacles. Although most life-threatening illnesses, such as cancer, require the expertise of qualified pathologists, there remains a significant shortage of experts to provide essential diagnostic services.

A recent workforce audit uncovered global deficits in the number of pathologists worldwide. Although the audit identified over 100,000 pathologists practicing in over 130 countries, it also highlighted the fact that two-thirds of the world’s pathologists are located in just 10 countries. In North America, there are an estimated 50 to 65 pathologists to every one million people. Other countries have only a few laboratory medicine professionals to serve millions of patients’ healthcare needs – and still others have none at all.

The scarcity of pathologists coupled with a growing incidence of disease begs the question: how does this shortage impact patient care and what can we do about it?

The answer likely lies in technology – specifically the intersection of digital pathology, artificial intelligence (AI), and access to the Internet.

AI to the rescue?

In light of the severe and growing workforce issues, the healthcare industry has begun to investigate technological innovations that may be able to help. In fact, recent publications in pathology report on a wide array of applications to improve detection, increase diagnostic accuracy, and alleviate the workflow constraints inherent in the traditional manual reading of pathology slides (1).

One such solution is the development of slide scanning systems capable ofcreating a digital version of an entire pathology slide for subsequent analysis. Instead of needing to prepare a physical slide and mail it to a qualified pathologist for review, labs can now share digital images of samples with experts anywhere in the world. With little more than a stable Internet connection, pathologists from different laboratories or institutions can seamlessly evaluate slides and provide their diagnoses remotely. This distributed capability using digitized images allows patients in even the remotest regions to access high-quality pathology services that may not exist within thousands of miles of their location – just as they can already routinely access teleradiology.

New computational methods can also analyze pathology slides for abnormal histology characteristic of disease. This approach has been used both to triage slides prior to pathologist evaluation and to screen previously evaluated cases for potentially missed entities. This ability to combine digital pathology with computational analysis opens up the possibility of a “second look” – a quality control review of the slide – either locally or through a distributed network of collaborating laboratories. As a result, providers can improve the screening and diagnostic detection of disease, ultimately making the diagnostic process more accurate – and more consistent.

Finally, pairing digital pathology with evolving computational methods may allow us to standardize aspects of pathology that have historically been plagued by the inherent subjectivity of human interpretation, such as the grading of malignancies and chronic diseases. By mathematically characterizing histologic morphology, computational pathology promises to bring robustness and reproducibility to all established grading systems – and opens the door to expanding those systems’ features, which have thus far been limited by subjectivity. This will perhaps be one of the technology’s greatest impacts – affecting guidelines and democratizing treatment decisions across the globe.

Embracing the future

As new technologies continue to advance and demonstrate clinical validity, it is apparent that they can help address the shortage of pathologists and simultaneously improve pathology standardization globally. Embracing digital processes in the lab will yield more complete reports with a higher degree of standardization – regardless of location – and, ultimately, support better patient outcomes.

Like other industries and even other areas of healthcare that have adopted new technologies, pathology too has the opportunity to evolve. Our goal is to give every patient the most accurate diagnosis, the most appropriate treatment, and the most reliable monitoring possible. Data and AI will power continued personalization and keep the spotlight firmly focused on improved healthcare for all – no matter where in the world they may be.

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  1. S Cohen et al., “Artificial intelligence in pathology,” Am J Pathol, 191, 1670 (2021). PMID: 34391718.
About the Author
Gerardo Fernandez

Co-Founder and Chief Scientific Officer at PreciseDx, New York, New York, USA.

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