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Year : 2021  |  Volume : 64  |  Issue : 1  |  Page : 6-7
Digital pathology: the future is now

1 University of Salerno, Department of Medicine and Surgery, University Hospital “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy
2 Department of Pathology, University Hospital “San Giovanni di Dio e Ruggi D'Aragona”, Salerno, Italy

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Date of Submission14-Mar-2020
Date of Acceptance24-Mar-2020
Date of Web Publication8-Jan-2021

How to cite this article:
Caputo A, D'Antonio A. Digital pathology: the future is now. Indian J Pathol Microbiol 2021;64:6-7

How to cite this URL:
Caputo A, D'Antonio A. Digital pathology: the future is now. Indian J Pathol Microbiol [serial online] 2021 [cited 2022 Jan 27];64:6-7. Available from: https://www.ijpmonline.org/text.asp?2021/64/1/6/306501

Adopting digital pathology has some very interesting implications, the most exciting of which will be briefly discussed in this article.

   For Routine Diagnosis Top

The most obvious improvements are in routine diagnostic activity. Measurements of all kinds can be obtained on digital slides: some, like simple length measurements and mitotic count, are only faster and more accurate than with conventional microscopy; others, on the other hand, are so tedious to obtain with conventional microscopy that one could say that virtual microscopy enables the pathologist to obtain them. These include, for example, nonlinear lengths, surface area measurements, cell counts, average cell diameter, or even nucleolar size. The percentage of cells positive for a marker (e.g. Ki67) can be obtained with unprecedented speed and accuracy. If combined with artificial intelligence (AI), this system can even count only cells of interest, such as epithelial cells excluding stromal cells.[1],[2]

Consultations will not require shipment of glass slides or paraffin-embedded tissue blocks, but simply sending a link to the chosen colleague. Frozen sections can be handled in a conceptually similar way, but with a different system in keeping with their time-sensitive nature: robotic, remote-controlled microscopes exist, with a remote-streaming camera instead of oculars, so that the slide placed beneath the objective can be examined instantly by a pathologist even from a distance. The pathologist can move the stage, adjust the focus, and change objective from another hospital or from his home. After all, “it is often easier to move an image around than it is to move a patient or a pathologist.”[3]

?Numerous studies have assessed the non-inferiority of digital pathology versus conventional pathology in many aspects of routine practice, including for primary diagnosis of a wide variety of surgical pathology cases.[4],[5] In the vast majority of cases, the same pathologist renders the same diagnosis using virtual microscopy and conventional microscopy.[4] Reading time is also similar, with a clear learning effect: pathologists that are initially slower with virtual microscopy tend to reach similar proficiency and comparable reading times with experience.[4]

   For Laboratory Technicians Top

In a properly designed laboratory, the racks of glass slides that come out of the stainer/cover slipper can be inserted directly in the slide scanner.[6] The digital slides will be delivered to the pathologists automatically and instantly once they have been scanned, and the rack coming out of the scanner can be archived right away. For the same reason, retrieval of an old case from the archive will not involve any friction, because each slide will be instantly accessible from the workstation.

   For Teaching Top

As with glass slides, interesting cases can be gathered, annotated, and used to assemble teaching files. The difference with digital teaching files is that they can benefit all interested people simultaneously, from all around the world. A notable example is the Juan Rosai Collection of Surgical Pathology Seminars, which includes over 18,000 cases.[7] Along the same lines, annotated digital slides can be used for quality assurance to ensure homogeneous reporting worldwide.[8] Teaching files for residents can contain verbose descriptions and annotations.

   For Research Top

AI in pathology, another frontier, is also advancing quickly. One big drawback of AI is its requirement for large amounts of data to train algorithms. Hundreds if not thousands of human-annotated cases must be fed into an algorithm to train it before it can be of any use. This has been slowing down the adoption of AI because of the effort required to build such datasets. With digital slides, on the other hand, building a digital slide archive will be much easier and faster.

Despite all its benefits, there are some issues that must be addressed to ease the adoption of digital pathology. Adopting a digital pathology workflow requires changing numerous procedures, acquiring instruments and setting up the technical infrastructure to link everything together. An already-running laboratory will indeed face some inertia while attempting this change. In addition, in contrast with digital radiology, there is no way to acquire the image directly in digital form without going through all the tissue processing steps. Economically, this means that the cost of the slide scanner is simply added to that of the rest of the instruments, and it does not substitute any instrument (except for the microscope, which arguably and understandably will not leave pathology labs anytime soon).

Finally, one more benefit of digital pathology deals with a very current topic. The ongoing coronavirus disease 2019 (COVID-19) pandemic has called for drastic measures, including the lockdown of more than 3.9 billion people (more than half the world's population). However, even in countries where no quarantine has been imposed, reducing interpersonal contact is essential to prevent the spread of the disease. The possibility for pathologists to work (mostly) from home, together with advancing technology allowing more and more people to work from home, is surely a major achievement of our time.

   References Top

Bankhead P, Loughrey MB, Fernández JA, Dombrowski Y, McArt DG, Dunne PD, et al. QuPath: Open source software for digital pathology image analysis. Sci Rep 2017;7:16878.  Back to cited text no. 1
Caputo A, D'Antonio A, Memoli D, Sabbatino F, Altieri V, Zeppa P. Ki67 in gleason pattern 3 as a marker of the presence of higher-grade prostate cancer. Appl Immunohistochem Mol Morphol 2020. doi: 10.1097/PAI.0000000000000835. [Epub ahead of print].  Back to cited text no. 2
Fraggetta F, Pantanowitz L. Going fully digital: Utopia or reality? Pathologica 2018;110:1-2.  Back to cited text no. 3
Mukhopadhyay S, Feldman MD, Abels E, Ashfaq R, Beltaifa S, Cacciabeve NG, et al. Whole slide imaging versus microscopy for primary diagnosis in surgical pathology. Am J Surg Pathol 2017;1:39-52.  Back to cited text no. 4
Rao V, Subramanian P, Sali AP, Menon S, Desai SB. Validation of Whole Slide Imaging (WSI) for primary surgical pathology diagnosis of prostate biopsies. Indian J Pathol Microbiol 2020. (In press)  Back to cited text no. 5
Rossi E, Fraggetta F, Garozzo S, Zannoni G, Pantanowitz L. Routine digital pathology workflow: The Catania experience. J Pathol Inform 2017;8:51.  Back to cited text no. 6
[PUBMED]  [Full text]  
The Juan Rosai Collection. Available from: http://www.rosaicollection.net/; [Last accessed on 2020 Mar 23].  Back to cited text no. 7
European Union bowel cancer screening pathology examples. Available from: http://www.virtualpathology.leeds.ac.uk/eqa/specialist/eu/examples.php; [Last accessed on 2020 Mar 23].  Back to cited text no. 8

Correspondence Address:
Alessandro Caputo
University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Largo Citta d'Ippocrate 1, 84131 Salerno
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_247_20

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