Moving pathology to the digital age is well under way. It has already shown to improve efficiencies in workflow, secondary consults, tumor boards, peer review, clinical trials, research, training, and more.
What is digital pathology?
Digital pathology is an image-based environment that provides the technology and workflow for image acquisition and archival, image and workflow management, and the interpretation of pathology case information. Digital pathology enables the pathologist to move from a glass slide to a digitized image that was originally created from the glass slide.
Use cases for digital pathology are vast and include: primary diagnosis including faster access to immunohistochemistry (IHC) and special stains, remote frozen section diagnosis, remote rapid assessments on radiology directed biopsies, consultations or second opinions from within the practice, backup coverage for subspecialty pathologists, secondary consultations from outside experts, in-sourcing of consultations from other countries, education and training of histologists, medical students and pathology residents, validation and verification of new stains, peer review, tumor boards, quantitative analysis of biomarkers such as estrogen and progesterone receptors, and research applications, including clinical trials.
Who uses and benefits from digital pathology?
The benefits for pathologists are varied depending upon the application area for digital, however, overall benefits include speed, accuracy, and efficiency. Digital pathology reduces the necessity of a pathologist to read a slide through a physical microscope, improving diagnostic capabilities by allowing the technology to zoom at various levels (while still allowing pathologists to monitor their progress through the entire specimen), quickly finding areas of interest, and allowing pathologists to annotate, measure, mark, and comment on the image itself. Pathologists can also capture regions of interest and thumbnail images from a digital slide which can be incorporated into the patient’s pathology report, along with the diagnosis, and be sent to the ordering, or treating, physician.
Pathologists can also self-validate for primary diagnosis using the CAP guidelines for “Validating Whole Slide Imaging for Diagnostic Purposes in Pathology,”1 allowing them to securely share their images and findings with colleagues and experts through email or over the web. They can also coordinate in real-time with specialists for secondary reads and consultations, regardless of their location or time zone. This opens up opportunities for pathologists to work from any location, at anytime, that is most convenient for them. This, in turn, opens doors to work with facilities they may have an interest in, but don’t want to relocate to. It also allows pathologists to provide their skills to multiple remote facilities.
Digital pathology also opens routes for pathologists that are looking into semi-retirement, allowing them to work hours that are best suited to them, while new pathologists entering the field can benefit from working remotely in locations they may not have considered previously.
Digital pathology is quickly becoming a proven, standard technology that significantly contributes to the reduction of laboratory expenses, improves operational efficiencies, increases productivity, and provides faster, more accurate diagnosis, treatment decisions, and patient care.
Digital pathology provides the opportunity for incremental business with telepathology through secondary consults, expanding reach into remote areas, and to efficiently source (and route) cases based upon available resources, regardless of location. There is also a reduction in the expense of transporting slides and/or the overnight delivery of slides for secondary reads. We all know the expense of read twice, get reimbursed once.
Be sure to choose the right digital pathology partner; one who can standardize the image formats into DICOM and whose viewer is web-based. This will allow one to view slides from any and all scanners at any location with secure internet. Therefore, an organization only needs one digital image viewer no matter how many types of slide scanners it may have. Another benefit of the ability to standardize image formats is providing the secure, cost effective archival of pathology images, thereby reducing storage expenses and integration challenges. Digital pathology vendors who are able to support the latest compression methodologies can provide storage at a fraction of the cost of other available methods and vendors.
Let’s consider the movement of glass slides prior to digital pathology. The risk of shipping glass (ie: breakage, lost shipments, not receiving all of the slides back, etc.) along with the cost of actual shipments, not to mention the time involved—all equal high cost. The time to send glass from a technical performing (TC) location to a professional performing (PC) location alone can be a day or more. Note, this certainly does not support or lend itself to frozen sections; which limits reach and increases overall expense.
Expenses can be significantly decreased while quality and turn around times (TATs) can be significantly increased. Healthcare facilities now have access to pathologists anytime and anywhere—giving them the ability to hire the best and the most affordable staff. Healthcare facilities with digital pathology are more competitive and attractive for pathologists’ services by allowing pathologists to work from their location of choice and on their timeframe. It also decreases the time to route cases and images to remote (or in-house) pathologists based upon availability and specialty. If additional specimen stains or views are required, the pathologist can order it from a lab who can then send the digital image back within hours (or less).
An organization needs to choose the right digital pathology vendor who will work seamlessly with the IT department to ensure a smooth implementation and integration with existing systems. Finding a vendor that is hardware and software agnostic and has the expertise and experience in supporting both healthcare applications and digital pathology will make an IT manager’s job easier, and reduce the time and effort in rolling out the technology. A vendor who follows all of the latest standards in compression, image format conversion, and secure file storage will also remove a heavy burden from the IT group at the adopting facility.
Patients will have access to specialists, experts, and the best diagnostic technology offered. The typical time from securing an appointment with a specialist once a patient or their physician identifies they need it through the evaluation, testing, reading, and receipt of a diagnosis typically ranges from 4-12 weeks. Digital pathology offers patients a faster diagnosis leading to a faster treatment plan. In addition, digital pathology allows patients to view and discuss their pathology findings directly with the pathologist over the internet.
More and more pathology laboratories are wading into digital pathology by scanning all of their IHC’s. This gives them an easy entry point for common biopsies including breast, prostate, uterine, and more.
Laboratories that are looking to prove the ROI or manage the rollout of their digital adoption should focus on an area that is going to benefit the most from automation with the least change in workflow. Once pathologists recognize the impact to their workflow and ability to easily complete cases, the word of advantages and benefits will spread.
Following is a list of how digital pathology can impact cancer diagnosis and outcome:
- Primary diagnosis: Faster access to the digital image, capability to view all relevant case information, clinical findings, and any prior history (including comparing prior images). Quickly identify areas or regions of interest, validate having seen all margins and entire core, and zoom in and out of various magnifications. Automatically perform measurements, counts, annotations and record findings, and interpretation.
- Tumor boards: Better review and discussion of complex, rare, interesting, and/or difficult cases.
- Remote consults: Access to specialists and experts around the globe leading to more accurate and faster diagnosis and improved outcomes.
- Clinical trials: Speeds the process of monitoring and measuring tissue based research, drug development, and drug efficacy.
- Education and research: Provides the ability to collaborate globally on the training and education of new pathologists, clinicians, and technologists entering healthcare.
The key to unlocking the future of diagnostics begins with having an enterprise level digital pathology workflow management system that provides digital capabilities across the enterprise; where physical facilities, working location, and case type are no longer barriers to adoption. All of which eliminates the necessity of pathologists being mired in navigating technology and information that is irrelevant to their workflow, providing rapid and more accurate diagnosis, resulting in faster determination of treatment plans for patients.
- CAP. Validating whole slide imaging for diagnostic purposes in pathology. https://www.cap.org/protocols-and-guidelines/cap-guidelines/current-cap-guidelines/validating-whole-slide-imaging-for-diagnostic-purposes-in-pathology