Unexpected Benefits?

Catalyzed by pandemic-related needs and propelled by post-pandemic realities, digital pathology is realizing its potential to improve lab efficiency, reduce lab costs, and advance patient care. But there are also some unexpected benefits. We spoke to three experts in the field who had much to say on the topic: David Ferber, pathologist and Senior Medical Science Liaison at Leica Biosystems; Azzam Ismail, a consultant neuropathologist at Leeds Teaching Hospital in the UK; and Alfredo Molinolo, Director of the Biorepository and Tissue Technology Share Resource at the University of California San Diego.

As medical professionals with many decades of experience, Ferber, Ismail and Molinolo know that the benefits of digital pathology go well beyond the improved ergonomics of not having to look through a microscope most of the day. For instance, a global survey of pathologists found that two benefits of digital pathology were improved workplace flexibility for individual pathologists and pathology groups, and access to capabilities beyond the microscope, such as image analysis and counting and measuring tools. Here, our three experts explore five clear benefits to digital pathology.

1. Collaboration across the globe
 

First and foremost, Ferber, Ismail and Molinolo agree that collaboration is the top benefit of digital pathology, specifically the ability to receive input from the right expert for a specific case – and to do so quickly. For Ferber, it’s been a pleasant surprise to learn just how easy it is to direct cases to a colleague and be able to view the images simultaneously. He can discuss the case in real-time, when the patient history and specifics of the case are top of mind – an approach he finds truly impactful. 

Molinolo agrees, saying, “Collaboration across sites is significantly better [than slides]. It’s easy to share and consult on cases because images are at your fingertips.” 

2. Enhanced quality and precision
 

Digital pathology also enables precise comparisons among regions of interest on several slides and immunohistochemical stains. “With standard microscopy, it is time-consuming and difficult to compare corresponding regions among serial sections,” says Ferber. “With digital, it’s quick and easy to compare multiple IHC stains and an H&E in a particular region and obtain a side-by-side comparison.”

Precise slide management was top of mind for Ismail, who notes, “Coding is much easier and better with digital images and automated tracking numbers compared with glass slides and manual numbers. The risk of errors is essentially eliminated; you don’t even need to check. Everything is secure, safe and confidential.”

Molinolo highlights the potential to quantify and analyze tissue features in a whole slide image (WSI). “Detection and delineation of tumor cells in a sample is a tedious process that takes substantial time,” he explains. “WSI makes this process simpler with high-quality images that are easy to annotate and share.”

Ismail adds, “Digital image quality can be excellent, and the ability to mark things is amazing. I just use the function snapshot and mark right on the image. Done!”

3. Tumor board engagement
 

Our three experts also agree that the benefits of digital pathology resonate beyond the pathology department, highlighting tumor boards as a significant benefit.

“If I had to pick the top benefit of digital for tumor boards, I’d say it’s the ability to share images. Doing so improves the process for everyone involved,” says Molinolo. “A close second is how much easier tumor board prep is with digital. It’s so much less time-consuming.”

Ismail notes, “[...] tumor board colleagues have positively commented on the strength of the pathology reports with digital. For me, that’s an additional affirmation of the technology.”

Our three pathology experts remark about the ways digital pathology enables them to support clinicians and their patients, such as by providing more effective reporting and communication. With digital pathology, it is much easier to include annotated images to better demonstrate the pathological findings to the treating physician and to the patient. “A picture is worth a thousand words and enhances the communication among pathologists, clinicians, and their patients,” says Ferber.

4. Enabling AI and future technologies
 

Ferber, Ismail and Molinolo expect the positive impacts of digital pathology to unfold in many ways as we move into the future. Implementation of digital pathology is the first step towards accessing the tools of computational pathology, which can integrate whole slide image data, multi-omics data, and clinical informatics. Computational pathology can reduce errors, aid in diagnosis, and make precision medicine a reality.

Digital and computational tools may also make the pathologists’ job more pleasant by helping with repetitive and time-consuming tasks, such as cell or mitosis counting, and obtaining tumor measurements. 

A great deal of effort is now being channeled into the development of AI algorithms and computational tools that will improve the practice of pathology and result in better patient care.

5. Enhancing the practice of pathology for current – and future – pathologists
 

Perhaps the greatest benefit of digital pathology, believes Ferber, is how it infuses the profession with fresh energy and optimism, keeping existing pathologists practicing while enticing new entrants into the field.

Ismail observes how the “new generation” prefers digital and are “more comfortable” with it, citing a recent interaction with trainees who were looking at the same screen as him but from a different location. “They were engaged and relaxed, which facilitated their learning,” he says.

For an instructor, digital pathology can make once arduous tasks easy. “One example is teaching boxes,” explained Ismail. “I used to have to ask the lab to cut another section to keep it for teaching boxes. Now, I click on digital to add to the teaching file with the exact name, and it’s there. When I go to teach at Leeds University, I can access the whole slide and show them everything. It’s like I am looking into a microscope and 200 or 300 students are looking with me.”

Ismail and Molinolo both note how digital pathology brings a newfound flexibility to their work. “[Just last week] I had cases for which I needed a colleague’s input. Even though she was at home and I was in the office, we could get online and review the cases together,” says Ismail.

Molinolo echoes this sensibility, commenting, “We can develop or deepen relationships with colleagues who share a passion for improving patient care through digital pathology. These relationships provide a wealth of knowledge and open doors to new opportunities for growth and development.”

Physical burnout factors are also mitigated; the physical discomfort caused by years of pushing slides across the stage and contorting one’s head, neck and back to accommodate the microscope can come to an end. “I wasn’t expecting it, but I got rid of the back pain, the neck pain, all the physical problems I had with the microscope,” says Ismail.

“Digital pathology brings a new kind of freedom to the job I love and inspires me to keep learning and working on behalf of patients,” concludes Ferber. “I look forward to continuing to unearth the possibilities that digital can contribute to our practice and, most importantly, to patient care.”