[author: LeAnna Jacobs]
Photo by Sieuwert Otterloo on Unsplash
The process of creating traditional pathology slides for review is quite cumbersome, and the manual workflow requires many steps. A new and more efficient process using digital pathology (and artificial intelligence capabilities) is on the horizon as technology continues to cast it net wide within the medical industry.
The current method of obtaining and preparing pathology slides for review is a multi-step process. Once tissue is collected from the patient for processing, it is then placed on a glass slide for microscopic viewing. The pathologist is then required to view these slides on site at the lab or hospital where they were created. If a patient needs a second opinion, it can be delayed days while the glass slides are physically transferred to another physician for interpretation.
This technological advancement is an exciting time for the world of the pathology department considering that they rely heavily on the fragility of glass slides for diagnosis. This excitement is due to the continued use of whole slide imaging (WSI) technology. “In addition, in the last 5 years we have witnessed an increasing use of machine learning (ML), deep learning (DL) and artificial intelligence (AI) tools making their way into healthcare as well as diagnostic pathology workflow”. (Parwani)
With the development of WSI, the pathology slide is scanned in its entirety into an image that creates microscopic type viewing and is of diagnostic quality. This technology allows for the easy transference of materials which will be beneficial for both the patient and the physician. This new technology will cut down on the physical space needed for storage of pathology glass slides as well as lessen the risk of slides fading over time. According to the Digital Pathology Association (DPA) “Another dependency comes from the vision of the lab regarding keeping glass slides. Eventually, digital slides might replace conventional slides, when storage is adequately covered including disaster recovery plans, etc. If any image analysis is performed, then the original image along with the mark-up image and any meta data associated with the analysis needs to be stored for the same period of time that the glass slide.”
· More accurate readings and diagnosis in patients.
o Within the medical community there has been a growing consensus that WSI could actually provide for a more accurate read for the diagnosis of pathology materials. WSI has been used in many training areas and it is tested against conventional readings to identify and gauge its accuracy, with promising results. AI in pathology has allowed for MI to take over and track algorithms that identify certain patterns, mitotic figures, and the presence and grading of various cancers. With this continued AI technology, the hope is that this will allow for the prediction of cancer cells in the future.
· Reduced costs for pathology review and second opinions for patients.
o In the healthcare industry there is always the pressure of cost reductions and the pathology lab is no exception. The first and most obvious cost reduction is the turnaround time (TAT) on pathology review. TAT’s are based on “the point of case accession to the time of a reported diagnosis by a pathologist and/or second opinion”. WSI can provide real time consultations and eliminates the need for couriers which can be significantly high for some hospitals. WSI can provide real-time consultations and virtual collaborations on pathology review and diagnosis.
· Cost-effective expert review in medical-legal application.
o Currently, when pathology slides are needed to confirm or challenge diagnosis, glass slides are hand delivered to medical expert witnesses within the guidelines and processes of guaranteed possession. Abiding by these rules and requirements of hand-to-hand transfers can be very costly when utilizing medical experts from all over the country. Having the capability of using WSI for expert review would substantially cut down travel costs and shorten review times significantly.
As WSI continues to gain traction both in practices and accuracy, this new technology could also find its way into the legal industry.
“Current progress concerning these and other issues, along with improving technology, will no doubt pave the way for increased adoption over the next decade, allowing the pathology community as a whole to harness the true potential of WSI for patient care. The digital decade will likely redefine how pathology is practiced and the role of the pathologist.” (Pantanowitz et al.) As it stands now, the expense of turning a lab completely digital is extremely costly and regulations are still being tightened. Nevertheless, it will be only a matter of time before digital pathology labs will be the new normal, without glass slides, and the infamous laboratory microscopes beginning to collect dust.
Parwani, Anil V. “Next Generation Diagnostic Pathology: Use of Digital Pathology and Artificial Intelligence Tools To Augment A Pathological Diagnosis”. Diagnostic Pathology, vol 14, no. 1, 2019. Springer Science and Business Media LLC, doi:10.1186/s13000–019–0921–2.
Digitalpathologyassociation.Org, 2020, https://digitalpathologyassociation.org/_data/files/Archival_and_Retrieval_in_Digital_pathology_Systems_final.pdf.
Pantanowitz, Liron et al. “Review of the current state of whole slide imaging in pathology.” Journal of pathology informatics vol. 2 (2011): 36. doi:10.4103/2153–3539.83746