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

Looking Through a New Lens

Pathology is at a crossroads.

The COVID-19 pandemic has been a significant driver of digital pathology adoption. Labs worldwide rapidly adopted, or expanded their adoption, of digital technologies and telepathology as a means to remain operational during pandemic-induced lockdowns. In 2020, we estimate that about five percent of pathologists were asking questions not about how to scan slides, but about what they could do with the scanned image. Now, that number is more like 25 percent. This is good news!

Unfortunately, the transition happened so fast that it is not proving sustainable. As we settle into the post-acute phase of the pandemic, we see labs beginning to revert to traditional glass slide-driven pathology. Although this may feel comfortable, it is also a mistake. We must maintain our forward momentum. In that spirit, we propose a focus on digitizing pathology, rather than on digital pathology. This is not wordplay; on the contrary, adopting this language compels a shift in mindset and encourages acknowledgment of our vital role in patient care.

Why is this warranted? Pathologists are in a sweet spot. We are in the right place at the right time because we can now make use of digital images to expand our positive impact on quality and patient care. Technology is available to capture, store, retrieve, and share pathology images. Solutions range from simple image capture on cell phones to sophisticated scanning devices. A patient can have their sample reviewed in real time by a pathologist. We recognize, of course, that there is much work to be done to optimize the process of digital transformation, especially for those with limited personnel and financial resources – but, that said, our work can’t begin and end within the pathology department. If it does, we’re shortchanging patient care.

Digitizing pathology is a journey we must take as a global pathology community. We believe that something on the order of 10 percent of labs currently have the technology, expertise, and leadership to digitize pathology. We need to connect that first 10 percent to the other 90 percent who are earlier in their journeys. Doing so will benefit all. New platforms, such as Digital Pathology Connections, allow pathologists from all over the world to learn together. Pathologists just starting their journey can now easily access and connect directly with those farther along the path. Developed and developing countries can learn from one another. Academic centers can share knowledge with private provider practices.

The phrase “digitizing pathology” accurately reflects the continuum of work we must undertake, which stretches far beyond a switch from glass slides to digital images. Our remit includes not only that transition, but also work to establish quality policies and standards, to agree on “ground truth” data sets and computational models for use worldwide, and to align on outcome measures, including new types of measures such as impact on lab workflows or patient disease. Although it’s still early days, we are starting to see the publication of peer-reviewed studies that document the benefits of digitizing pathology. As this body of evidence grows, patients and clinicians will demand the use of such tools to improve patient care. This will take time, of course, but we anticipate an acceptance trajectory similar to what we experienced with immunohistochemistry. Digital pathology is a tool – but digitizing pathology is a process change and people engagement journey with the end result of improving patient care and outcomes.

Robert Frost’s well-known poem, “The Road Not Taken,” extols the potential of the untraveled road. We concur – and we recognize that pathologists need to walk the road to digital together on behalf of our patients and our profession.

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About the Authors
Catarina Eloy

Head of the Pathology Laboratory, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.


Junya Fukuoka

Professor and Chair, Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences; and Chair, Department of Pathology, Kameda Medical Center, Kamogawa, Japan.


Anil Parwani

Anil Parwani is Professor of Pathology and Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.


Colin White

SVP and General Manager, Advanced Staining and Imaging, Leica Biosystems, Melbourne, Australia.

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