New digital pathology book, co-authored by Dr. Andrew Evans, Genitourinary Pathologist and Director of Telepathology, Laboratory Medicine Program (LMP), University Health Network (UHN) provides a balanced overview of whole-slide imaging (WSI) digital pathology for those interested in implementing the technology. The various chapters in this book highlight specific clinical and non-clinical uses for WSI as well as the exciting possibilities for WSI in the future. The book also gives readers a realistic presentation of current barriers to adoption.
Read Dr. Evans’ Q&A below to learn more about digital pathology and the newly released book which is available HERE.
What is digital pathology and telepathology?
Digital pathology refers to viewing glass microscope slides as high-resolution digital images as opposed to using a light microscope. There are a number of different digital pathology modalities that can be used including WSI and robotic microscopy (which we use or have used in LMP) as well real-time video microscopy and hybrid real-time video-WSI devices. Telepathology is then using digital pathology over some kind of distance, where you use the internet to connect a digital slide in one location to a pathologist in another. The technology can be used for clinical diagnoses as well as quality assurance.
Why have you and fellow experts in the field come together to create this book?
We’re at the point now where validation studies from numerous pathology groups around the world have demonstrated this technology can be used safely for patient care purposes. Enough studies have been done comparing the review of cases using both digital platforms and light microscopy to dispel the notion that “digital pathology is an unproven technology”. This will be underscored by the granting of regulatory approval for this technology from the U.S. Food and Drug Administration in mid-late 2017, which is expected to generate appreciable interest in digital pathology in the United States. As such, the editors of the book, Drs. Liron Pantanowitz and Anil Parwani, were asked by the American Society of Clinical Pathology to create a comprehensive resource allowing those interested to learn about the technology – especially if they are considering implementing it in their own practice.
How might it change someone’s opinion of digital pathology?
I think people will see two things. The first being that the technology can be used safely for patient care, but the other is that it requires a fair amount of work in order to implement an admittedly disruptive technology. It’s not a simple plug and play solution – there is a lot of development work and it requires a multidisciplinary approach, including pathologists, histotechnologists, lab managers, information technology and business development staff, and financial planners. It’s a major undertaking, but it also generates significant opportunities that would not be exist if pathology remains in the glass slide-light microscope paradigm of the last 100 or so years.
How were you selected as an author?
Like any technologies that are still on the early part of the adoption curve, the community of people championing the technology is fairly small. So having been involved in digital pathology guideline committees with the College of American Pathologists and the American Telemedicine Association I’ve worked closely with the book editors over the last several years and they simply asked if I would like to participate.
How much of your content is based on personal experiences and studies with digital pathology at UHN/LMP?
Well, I was selected specifically for the chapter covering clinical applications of whole slide imaging because of UHN/LMP’s experience in validating and implementing the technology for clinical service. Our primary diagnosis validation study, which was one of the first large scale studies comparing digital whole slide imaging to light microscopy included over 1500 cases, from 11 different specialties with input from 29 different pathologists. The study involved LMP pathologists prospectively reviewing cases first digitally and then using a microscope. Our results showed that over 98 per cent of the cases could be reported by digital review without a perceived need to review glass slides. This study greatly informed our implementation of digital pathology for primary diagnosis at one of our partner hospitals, Lakeridge Health.
Where do you feel UHN/LMP stands as a digital pathology centre?
I think UHN is recognized as one of the leaders in the adoption of digital pathology for patient care in a number of niche applications, particularly in the area of frozen section coverage where we have been using telepathology at Toronto Western since 2004. However, we’re still essentially a glass slide and light microscope department. I think in the immediate future we’re poised to build on what we’ve done in digital pathology and leverage the experience we’ve gained over the last 13 years. The challenge now is to move forward in a way that demonstrates real value-added, and not just simply digitizing everything for the sake of being one of the first pathology departments to move to high-volume digital reporting. There is opportunity for meaningful and relevant adoption of the technology in a way that improves efficiency and quality over the traditional glass slide-light microscope paradigm. This is where image analysis and computer-aided diagnostics comes in as part of the next iteration of digital pathology.
What’s next for digital pathology at UHN/LMP?
We are attempting to move forward with the development and implementation of image analysis and various other measures that would allow us to really leverage the power of digital pathology over and above simply looking at scanned slides on a computer monitor and making visual diagnoses – but it’s the type of thing that costs time and money to develop. In the current fiscal environment these can be significant obstacles to innovation. Now we need to look outside, to create opportunity through partnerships between UHN and industry to move this initiative forward. Our department with its considerable subspecialty expertise and experience in digital pathology is currently attractive for such partnerships. However our window of opportunity is not boundless, so we are actively exploring the best way to get moving before others in the digital pathology space seize the day.
Dr. Evans has been a major factor in UHN/LMP’s early adoption of digital pathology and has helped implement the technology as a primary diagnosis tool for several LMP partner hospitals. But, he’s also quick to point out that constructive skepticism plays an important role in the evolution of any emerging technology, saying, “Those reluctant to adopt it can provide sound reasons as to why. This ultimately assists in implementing the technology in a safe and prudent manner.”
Dr. Evans serves as Chair for the College of American Pathologists’ Digital Pathology Committee, and the book, Digital Pathology (available here) is published by the American Society for Clinical Pathology.