It can often be difficult to describe digital pathology without getting too technical. However, it is rapidly gaining momentum as a proven and essential technology; with specific support for education, tissue-based research, drug development, and the practice of human pathology throughout the world.
Digital pathology is an innovation committed to the reduction of laboratory expenses and an improvement of operational efficiency. It enhances productivity and improves treatment decisions and patient care.
What is Digital Pathology?
Digital pathology is a sub-field of pathology that focuses on data management based on information generated from digitized specimen slides. It is a dynamic, image-based environment that enables the acquisition, management, and interpretation of pathology information generated from a digitized glass slide.
Digital pathology utilizes virtual microscopy through the use of computer-based technology. Glass slides are converted into digital slides that can be viewed, managed, shared, and analyzed on a computer monitor. With the practice of Whole-Slide Imaging (WSI), which is another name for virtual microscopy, the field of digital pathology is growing and has applications in diagnostic medicine.
Its goal is to achieve efficient and cheaper diagnoses, prognoses, and prediction of diseases due to the success of machine learning and artificial intelligence in healthcare.
Digital pathology incorporates the acquisition, management, sharing, and interpretation of pathology information — including slides and data — in a digital environment. Digital slides are created when glass slides are captured with a scanning device, to provide a high-resolution digital image that can be viewed on a computer screen or mobile device.
Evolution of Digital Pathology
The evolution of digital pathology, or whole slide imaging (WSI), has taken almost 20 years and is quite similar to that of the mobile phone. It has progressed from attaching a camera to the lens of a microscope to the development of the first scanners to what we have today: technology that is quickly becoming indispensable in the anatomic laboratory.
The first scanners were clunky instruments taking up large footprints – with long processing time (up to 6 minutes) expensive storage, and limited use cases. Scanners today can scan slides in as little as 30 seconds. They can also be configured at multiple magnifications and handle up to 1,000 slides at a time. Storage, now available in the cloud, is affordable, secure, and accessible. Computational applications incorporating artificial intelligence (AI) offer a myriad of ways to analyze and present images to the pathologist.
With the evolution of whole-slide image scanners, digital pathology as a practice has taken off.
How Does Digital Pathology Work?
Digital pathology is the process of digitizing glass slides using a whole slide image scanner and then analyzing the digital images using an image viewer, typically on a computer monitor or mobile device. An image viewer works similarly to the traditional standard light microscope. This enables pathologists to move slides around in the same way.
Lab technicians scan glass slides using whole-slide imaging scanners. A pathologist can then view, manage, share, and analyze the digitized slides on a computer monitor in addition to or as a replacement for a microscope. The pathologist will use digital pathology software to view, store, manage digitized slides, and share the images with colleagues. Analysis tools help them study and diagnose the digitized slides on a computer. Their case management software can integrate with or replace existing workflows, like a Laboratory Information System (LIS), to make the process as seamless as possible. Finally, they create a report of their analysis that they send to the physician.
Although the basic viewing functionality has not changed drastically, it has brought about amazing advancements in pathology lab efficiency, workflow, and revenue enhancements.
How is Digital Pathology Used?
There are three main ways in which digital pathology is used today.
First, research institutions, such as pharmaceutical companies, CROs, and academic medical centers. It also uses digital pathology in robust study design, data collection, and database management for the millions of specimens that it currently manages and seeks to leverage.
Second, clinical labs use digital pathology on select cases for remote consultations, education, or quantitative analysis.
The third and fastest-growing use case centers on clinical labs moving to an all-digital workflow. These labs use computational-enabled digital pathology powered by AI to help assign cases to pathologists, manage the workflow into worklists, offer quantitative image analysis for specific case types, integrate information into their existing Lab Information System (LIS), and expand access to cases beyond the brick-and-mortar walls of the lab itself.
With digital pathology, diagnosis no longer needs to be delayed by the physical shipment of tissue samples or the wait times that result when pathologists are out of the office.
The 7 Steps to Digital Pathology
The process of embracing digital pathology can transform an organization. So, it is important to know the steps and how to get started.
| STEPS | KEY COMPONENTS |
|---|---|
| 1. Champion digital pathology | Choose both an executive sponsor and a pathologist Understand the benefits of digital pathology Read case studies and research best practices Survey barriers and high-level needs Use visual management to create a new workflow Compile the business case Seek buy-in, get feedback |
| 2. Define needs and goals | Map out a detailed new workflow Initiate needs list including equipment, processes, teams/roles Pilot a proof of concept test |
| 3. Specify infrastructure and Laboratory Information Systems (LIS) needs | Prior to full adoption, use both digital and non-digital processes. Compare, analyze, and refine digital workflow Offer lunch and learn, peer-to-peer, tutorial, and other training methods for stakeholders in all locations Hold ongoing status meetings to determine progress and gaps Recognize that full conversion takes time |
| 4. Build workflow | Write a statement of work for each phase of digital conversion (image acquisition, pre-analytics, image management and analysis) |
| 5. Configuration and training | Select a project technology leader and ensure buy-in from IT Determine networking, storage, and security needs Compare requirements to tools, budgets, and timelines Prioritize specifications for short and long-term |
| 6. Rollout | Fully convert manual processes to digital Leverage benefits at full rollout volume |
| 7. Analyze and expand applications | Prior to full adoption, use both digital and non-digital processes. Compare, analyze, and refine digital workflow Offer lunch and learn, peer-to-peer, tutorial and other training methods for stakeholders in all locations Hold ongoing status meetings to determine progress and gaps Recognize that full conversion takes time |
Advantages of Digital Pathology
In conventional histopathology, the physical transfer of glass slides from the laboratory to the pathologist is a prerequisite for the analysis. The pathologist then analyzes one slide at a time using a light microscope. By using digital pathology and whole slide imaging, it is possible to avoid usual transport processes and to simultaneously analyze several slides.
Digital pathology makes it possible to rapidly and simultaneously analyze several regions of a tissue section in any magnification. Using various digital tools, including annotations, measurements, and counts, it is possible to analyze clinical and morphological changes in a more detailed and in-depth way.
Digital pathology allows on-screen quantification of predictive and diagnostic biomarkers, which is beneficial for rapid and accurate decision-making. The provision of artificial intelligence applications further improves the quality of pathology services.
Various algorithms have been developed for on-screen image analysis, including pattern recognition algorithms. Computer-guided image analysis tools have been developed to quantify disease biomarkers, providing all pathologists with the same index for scoring pathological findings and classification of diseases.
The easy and rapid process of sharing digital information makes it possible to consult with other pathologists across the world (telepathology). This network between pathologists is particularly vital for the clinical fields where only a few specialists are available.
Furthermore, digital pathology has opened up more flexible and remote job opportunities for pathologists and other medical personnel.
Future Trends in Digital Pathology
Various novel digital pathology technologies are emerging to improve the connectivity between specimen collection and the generation of pathology reports with new information.
Multiplexing is a novel method of measuring or localizing multiple proteins in a single specimen. The inclusion of novel multiplexing methods, such as automated multispectral slide imaging, is expected to revolutionize the field of digital pathology.
Another novel method is the use of automated molecular fluorescence tagging and imaging systems, which can provide information on the subcellular colocalization of multiple proteins on a tissue section. The characterization of molecular phenotypes as well as the analysis of cell-specific proteome using this novel method can provide novel information regarding the impact of the cancer microenvironment and heterogeneity on malignant progression.
Tyramide signal amplification is a part of the Opal multiplex immunohistochemistry. This method is an improved version of standard immunohistochemistry, and thus, is more suitable for complex assays where antibody cross-reactivity could be a problem.
Analysis of protein co-expressions, signaling pathways, and cell-cell interaction by multispectral methods can facilitate the development of combination therapeutics, especially in the field of oncology.
Combining q-dots with multispectral imaging is another novel approach to quantitate colocalization of gene expression in clinical tissues. The q-dots are photostable nanoparticles with broad excitation spectra and narrow emission spectra.
The integration of these emerging imaging technologies in digital pathology could potentially improve diagnostic accuracy, reduce workloads, increase work efficiency, and incorporate digital images into information systems more efficiently. The complex and automated imaging devices together with computer-assisted algorithms can play a magnificent role in extracting vast amounts of information from a single tissue section.
Benefits of Digital Pathology
Glass slides aren’t going anywhere, and for good reason. Pathology starts with collected tissue. Glass slides are necessary, even if they are later transferred to a digital scan. But today’s pathology goes beyond tissue or scans. It is all about improving quality, productivity and more.
Digital pathology can improve quality in meaningful ways:
Improved Analysis:
- Algorithms for analyzing slides are objective, accurate and quicker than microscopy
- Rapid access to prior cases
- Data Storage allows for long-term predictive analytics
Reduced Errors:
- Eliminates breakage
- Barcoding reduces risk of misidentification
Better Views:
- Offers live zoomed and multiple-angle views
- Ability to measure multiple AOI
- Allows for team annotation of slides
- Provides a dashboard view of data and annotations
Improved Workflow
- Fosters collaboration
- Central storage enables easy access in streamlined workflow
- Curbs trend toward outsourcing
- Allows for automation, flex work schedules and remote access
Reduced Turnaround Times:
- Faster access to archived digital slides
- Reduces time retrieving, data matching and organizing
- Speeds up access to samples and improves turnaround time versus manual reviews, especially in complex cases
More Innovation:
- Big data allows pathologists to become more specialized
- Allows practices to extend to broader geographies
- Delivers better tools for teaching and training
Another major benefit of digital pathology is digital archiving, which facilitates error-free allocation of digital slides and easy and rapid access to digital information. All these factors are collectively associated with higher patient safety.
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