Embracing the Future of Digital Pathology

In an era of rapid medical advancements, the shift from traditional to digital pathology no longer seems like a luxury, but a necessity. Pathology laboratories around the world are recognizing the immense benefits of digital pathology, which encompass heightened efficiency, enhanced patient safety, and the remarkable potential to harness cutting-edge technologies such as artificial intelligence (AI). This shift is revolutionizing diagnostic processes and setting new benchmarks in patient care and medical innovation.

However, taking the first step towards adopting digital pathology can be intimidating. To ease this transition, we’ve compiled valuable insights from three laboratories: IMP Diagnostics in Portugal, Pathlab in New Zealand, and Technical University (TU) Munich in Germany.

Embracing Digital Pathology for Technological Advancement and Efficiency

For New Zealand's Pathlab, the transition to digital pathology was driven by the demand for technological advancements, the need for improved efficiency, and the potential for enhanced patient care. They understood that the ability to remotely share and view images and annotations could provide significant gains in efficiency and productivity, as well as increased security in their workflows.

“We felt it was time to embrace digital or be left behind.” 
- João Sousa Pimentel, Co-CEO of IMP Diagnostics

In Portugal, IMP Diagnostics was inspired by the potential of digital pathology to transform its practice. Co-CEO João Sousa Pimentel highlighted the importance of staying ahead of technological trends, stating, “We felt it was time to embrace digital or be left behind.”

The introduction of high-throughput scanners and the development of AI algorithms for pathology further motivated IMP to transition to digital, aiming to improve diagnostic accuracy and patient care.

Digital Pathology Enables Remote Collaboration

“We’ve learned how important it is to have slides available to researchers; digital images make this possible.” 
- Katja Steiger, DVM, Head of Comparative Experimental Pathology at TU Munich

At TU Munich, the transition to digital pathology was driven by the need to support both research and clinical care. Katja Steiger, DVM, Head of Comparative Experimental Pathology at TU Munich, emphasized the importance of digital slides for facilitating collaboration and enhancing research capabilities. “We’ve learned how important it is to have slides available to researchers; digital images make this possible. When images are digital, we don’t have to sit at the microscope together to work together. We can be in different locations at TU Munich – or even working remotely – and access the same slide at the same time, or even sequentially, to facilitate dialogue, exchange information, and annotate the images digitally,” she explained.

The COVID-19 pandemic further accelerated their adoption of digital pathology, highlighting its benefits for remote work and collaboration. "Digital work enables day-to-day exchange between veterinary pathologists and clinical pathologists," comments Steiger. "This unique setup enables us to efficiently connect across Europe to enhance our understanding of cancer and support patient care."

Overall, these laboratories opted to transition to digital pathology to leverage technological advancements, improve efficiency, enhance diagnostic accuracy, and ultimately provide improved patient outcomes.

Thoroughly Review Your Processes First

“Just buying a scanner is not doing the job. You have to build a secure process around that technology.”
- Corinne Hill, Lead Scientist at New Zealand's Pathlab.

Before implementing digital pathology, it’s essential to thoroughly review existing processes. Pathlab’s Richard Massey and Corinne Hill recommend starting with a bottom-up review of all processes and then focusing on codifying the digital workflow. “Just buying a scanner is not doing the job. You have to build a secure process around that technology,” advised Hill. “In our experience, the actual implementation of the digital component of the workflow is the final step of the whole process. It’s not the first thing you do.”

IMP Diagnostics also prepared for digital pathology by planning the project’s feasibility, raising funds, and assembling a diverse project team to ensure readiness for full digital implementation.

Take a Stepwise Approach

Adopting a step-by-step strategy can help facilitate a smooth shift to digital pathology. IMP Diagnostics did so by acquiring high-throughput scanners as an initial step, followed by an in-house assessment of IT integration requirements and initial vendor negotiations. They began with a test-scanning phase and gradually moved towards digitizing their routine tasks, starting with single subspecialty areas and eventually scaling up to full digitization. Diana Felizardo, Clinical Lead of Digital Pathology at IMP, emphasized “The stepwise approach meant pathologists and the technical team could learn and adapt to digital over time, and that was central to our success.”

Similarly, Pathlab in New Zealand started with multidisciplinary team meetings (MDTs) to familiarize themselves with the technology before expanding its use. “We integrated our digital system first with MDTs because we saw that as an easy way to get familiar with a technology without it being too onerous on the pathologists,” states Hill.

Engage with Colleagues and Stakeholders

“You need the support of people in leadership positions, as well as the technical people involved day to day. If both those groups are supportive, it’s easier.”
-Katja Steiger, DVM, Head of Comparative Experimental Pathology at TU Munich

Engaging colleagues at all levels is essential for the successful adoption of digital pathology. Steiger from TU Munich emphasizes the importance of support from both leadership and technical staff: “You need the support of people in leadership positions as well as the technical people involved day to day. If both those groups are supportive, it’s easier.”

IMP Diagnostics also formed a diverse project team, including a clinical lead, IT representative, and business lead, to ensure comprehensive involvement and insights from the beginning.

Think Early and Often About Data Management and Storage

Data management is a critical consideration in digital pathology. Katja Steiger from TU Munich advises, “Think early and often about data management: a catch-all term for a set of topics including data throughput.” For instance, ensuring a robust network environment is essential for scanning and providing slides on a server.

TU Munich’s approach to data management includes recognizing regulatory requirements, such as the European Union’s mandate to store research data for at least 10 years and local regulations in Germany that require data to be stored locally. Steiger notes, “We require a storage room and personnel to manage our data, and we must keep revisiting our needs to ensure we plan for appropriate storage capacity and have an ability to easily store and access images.”

IMP Diagnostics also highlights the importance of managing the investment and choosing the right solution, as well as monitoring hardware and software developments, regulatory actions, and clinical evidence publications.

Consider Cost and Efficiency

Cost is a significant factor in the transition to digital pathology. And while the initial investment in digital pathology can be significant, it’s important to consider the long-term benefits. Digital pathology can provide better support for pathologists, enhance service quality, and prepare laboratories for future technological advancements.

"It's about quality, and it is about the future. Over time, the cost is negated because you're looking at a higher-quality and more efficient service." -Corinne Hill, Lead Scientist at New Zealand's Pathlab

Pathlab’s Corinne Hill acknowledges that the cost-to-efficiency ratio can be a barrier but advises considering the long-term benefits of new technology. Specifically, how the new technology is “providing support for the pathologist, providing better service. It’s about quality, and it is about the future. So over time, that cost is negated because you’re looking at a higher-quality and more efficient service.”

The integration of AI into digital pathology holds immense potential for improving diagnostic accuracy and patient outcomes. AI tools can assist pathologists in tasks such as measurements, annotations, and even predicting therapy responses.

"AI will enable us to better serve clinicians and their patients. It is our commitment to them that drives us to continue to innovate."
-Isabel Macedo Pinto, co-CEO of IMP Diagnostics

"AI will enable us to better serve clinicians and their patients. It is our commitment to them that drives us to continue to innovate," says Isabel Macedo Pinto, co-CEO of IMP Diagnostics.

The Role of Artificial Intelligence in Pathologists’ Treatment Decisions

Digitizing pathology slides provides a firm foundation to fully leveraging AI. This further allows for developing and implementing AI algorithms that can enhance clinical decision-making and improve patient care. "Digital pathology is the substrate for AI," explains Vivian O. Tan, Computational Pathologist at IMP Diagnostics. "AI enables researchers to identify biomarkers that can be useful in the clinical setting to aid in treatment decisions."

Leading the Way in Digital Pathology

As the field of pathology continues to evolve, embracing digital technology is essential for laboratories aiming to provide the highest quality of care. By carefully planning the transition, engaging stakeholders, and preparing for future advancements like AI, pathology laboratories can position themselves as leaders in the digital pathology space. "For the labs that aren't looking at digital pathology yet, it’s a matter of when, not if," concludes Richard Massey, Director of Anatomical Pathology at Pathlab.

By sharing these insights and experiences, we hope to inspire and guide laboratories on their journey to digital pathology, ultimately improving patient care and advancing the field of pathology.