Digitizing Pathology

A look at the increasing role of digital pathology in disease diagnosis as demand for precise diagnosis increases.

As demand for value-based care and more precise diagnosis continues to increase, pathology will play a critical role in the detection and treatment of complex diseases. While pathology is a necessity in the examination and study of diseases, traditional pathology workflows have innate delays built into the processes. Transferring unique glass slides runs the risk of loss and when collaborating with others-whether they are specialists, consults or other sites-and is challenging, leading to frequent delays and obstacles in communication.

In the U.S., regulatory clearance of digital pathology for diagnostic use varies among vendors. In other regions, such as Europe, it is marketed for in vitrodiagnostic use. As such, pathologists in those regions are able to use a digital solution as an aid in diagnosis for routine pathology for increased efficiencies within and across lab sites.

Complete Digital Diagnosis

The Laboratory for Pathology East Netherlands Foundation (LabPON) is the largest pathology laboratory in the
Netherlands, consulting on more than 55,000 histological cases each year and over 300,000 patient slides. Anticipating on the future increased demand for pathology services LabPON identified the need for a further increase in efficiency. Initially, through digitization of diagnostics, LabPON envisioned logistical improvements in remote consultations and revisions, and then planned to address improvements to ergonomics for pathologists.

Digitizing images that are normally viewed through a microscope can help improve the operational efficiency of a lab. Direct access to files and integration with the Laboratory Management System (LMS) can make diagnosis-in particular, consults-simpler, more efficient and safer. It lowers barriers for internal and external consults and can be done more quickly as colleagues can view the same case at the same time, increasing a lab’s quality and speed. A digital workflow is the prerequisite to unlock the huge potential of future digital analysis in pathology.

Strategize. Operationalize. Implement.

In July 2015, LabPON became the first laboratory to completely convert its histopathology diagnostic procedures to digital. They began creating a long-term plan that would allow for efficient and high quality services for physicians and hospitals. As part of an investment in its future, the digitization of the pathology process involved a complete overhaul of physician and technician workflow. By approaching the transition in phases, LabPON was able to ensure adoption by the team as the laboratory adjusted its workflow and processes.

In addition to working with the classic microscope, the pathologists were given the option to be able to work digitally as well-to begin incorporating it into their routines with the understanding that it would eventually become an established practice. For the pathologists, the most difficult part of the transition was learning to trust the digital image. Once they realized that the image on the screen was still just as valuable as what they could see through the microscope-if not, more so-acceptance was quick.

A flow analysis showed that the digital diagnostics approach is faster when the entire logistical process is taken into consideration. Although an experienced pathologist will establish a diagnosis just as quickly using either digital pathology or microscopy, the improved logistics ensured a faster workflow and turnaround time (TAT). Next to this, some features in the digital workflow can help to speed up diagnosis, such as instant access to previous cases, side-by-side viewing of slides with different staining, measurements, counting, annotations, and simplification of internal and external consults. The future use of image analysis software could help pathologists to further accelerate diagnosis.

Connecting Services

As part of the effort to provide intraoperative services, the pathologist must travel to the surgery site for frozen section services along with a technician, and wait for the surgery to be complete. By allowing a technician to perform the technical work on location and supply the digital section to the attending pathologist, the pathologist can evaluate the case study from behind his or her desk, and more easily consult a colleague if necessary, and work in an optimally-adapted environment. This approach will ultimately help ensure a better quality of diagnosis and reduce overall costs.

Improving Patient Care

Digital pathology has offered several benefits in the laboratory, from offering greater efficiency in diagnosis to the optimization of our pathology staff. By connecting the pathology teams across sites, digital pathology has enabled remote communication and collaboration-regardless of location and specialty. The unification of clinical teams and physical data will enable an integrated analysis to support a more informed diagnosis and treatment. In addition, these broader sets of clinical data have opened doors to new insights and opportunities in pathology studies and improved patient care.