EDUC ATION
Benefi ts accrue as pathology’s traditions morph into digital
By Karen Lynn T
raditionally, pathology has been a manual process: A pa- thologist views a stained tissue sample on a glass slide and provides a qualitative assessment of the histology, staining pattern, and intensity of the stain in a selected area. If a second opinion was desired, the slide had to physically be transferred to another pathologist, says Jason Christiansen, PhD, senior director of Operations at HistoRx. Digital pathology tools, however, allow operators to annotate and mark up images to better communicate diagnostic background in real time. With electronic image fi les becoming the primary data source, the ability to produce large databases of image and diagnostic information becomes possible, Christiansen notes.
The ability to mine huge databases of virtual slides can provide pathologists with the ability to spot more biomarkers that indicate signs of disease, which can help save lives.
And, thanks to digital pathology, pathologists can avoid what also traditionally has been the cumbersome process of getting a second opinion. With digital pathology, those stained tissue samples on glass slides are scanned by an automated microscopy system, creating digital images that may then be viewed, ana- lyzed, shared, and managed locally or remotely by any number of reviewers, says Ron Hagner, MS, MT(ASCP), group vice president, North America at CellaVision.
Another key advantage of digital pathology is its ability to apply image-analysis algorithms — sophisticated computer programs — to digital slides, enabling quantifi cation of medical information, reports Ole Eichhorn, chief technology offi cer at Aperio. Digital pathology has had a signifi cant positive impact on pathology consultation and medical education, as well as workfl ow effi ciency in the laboratory — resulting in better patient care and reduced costs. Gross images, voice-to-text dictation, standardized information templates, and fi nal slide images all help to form a deeper context for a patient story, which can be shared with clini- cians and patients, adds Joel Servais, marketing manager/product manager of Digital Imaging Products at Milestone. The acceptance of digital pathology has increased steadily over the last fi ve years due to a progressive lowering of barri- ers to its adoption and an increased understanding of its utility, Christiansen says. New instrumentation and storage infrastructure initially proved to be expensive. The cost for storage has de-
creased and instrumentation throughput has improved, however, along with a better integration with existing laboratory workfl ow. Furthermore, a large number of platforms have received regula- tory clearance in the last fi ve years. With this adoption in research and clinical laboratories comes the opportunity to exploit the expanded capabilities provided by digital pathology, allowing the technology to be carried to the next level.
There needs to be a way for pathologists to process samples
more effi ciently, says David Fletcher-Holmes, PhD, product manager of Clinical Research and Digital Pathology Systems at Cambridge Research and Instrumentation, and digital pathology is the answer. Using a computer can save a pathologist valuable time by providing automated scoring values based upon algo- rithms for which he can train and then use. The ability to share virtual slides leverages the expertise of remote experts on esoteric pathologies. The ability to mine huge databases of virtual slides can provide pathologists with the ability to spot more biomarkers that indicate signs of disease, which can help save lives. Adds Christiansen, “In medicine, there is a strong movement toward electronic patient records which encompass all the de- tails of patient diagnosis, treatment, and care. Digital pathology methods help forward this process for the fi eld. As radiology has moved from fi lms to PACS, so, too, is anatomic pathology moving from glass slides to digital records.” Furthermore, and most importantly, the advanced analyti- cal tools and the new assays (or newly refi ned assays) coming out of digital pathology are providing additional information that can lead to improved patient care using objective, rational scoring methods that are not subject to the pitfalls of traditional practice, Christiansen says. The ability to accurately identify and select groups of patients for personalized treatment will only be truly realized using advanced analytical tools coupled with improved assay methodologies built on the foundation of digital pathology.
Not to be ignored are the statistics for the anticipated growth of lab testing for the baby-boomer generation and the necessity for labs to maintain quality and security with testing that will have to be supported with increased technology. New technolo- gies will enable easier documentation of compliance with testing guidelines, development of a digital chain of evidence for patient assets, and more sophisticated patient reports for clinicians, Servais adds.
Karen Lynn is a freelance medical writer.
28 December 2010 ■ MLO
www.mlo-online.com
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