Pathology in the Digital Age

In 1958, Dr. Don Penner, the first editor of the CAP Newsletter, returned from a visit to the exhibits at a scientific meeting and wrote: "It would appear that the autoanalyzer is now a useful and practical instrument for a number of routine biochemical procedures, especially blood sugars and ureas," and that, "the Coulter red cell counter was very favorably presented." With hindsight, almost 50 years later, such comments seem to greatly underestimate the impact these technologies have had on laboratory medicine.

Over the past few weeks, and again at the recent CAP meeting in Victoria, I have had the opportunity to look at some of the equipment utilizing digital imaging for examining gross and microscopic specimens and voice recognition for reporting. I've heard the skeptics remark that these will never have a significant role in routine pathology, cytology, or hematopathology, that they are simply nice toys, or that they have too many limitations to be useful. I beg to differ and am prepared to predict that digital pathology is the way of the future and will become as established and routine over the next three to seven years as the autoanalyzer and automated cell counting.

The implications of this, even if only partly correct, are profound, and will revolutionize the way we (anatomic pathologists, cytopathologists, and hematopathologists) work. This will, moreover, change and hopefully optimize workflow within departments, slide tracking, reports, consultations, and archiving. In short, prepare for major change! Exit the microscope, enter the high-definition flat panel; exit the slide trays, enter the file of images; exit the lost slides, enter the electronic record; exit the laboratory office, enter the virtual laboratory.

So, what is this potential new environment? Envision, first, the grossing station equipped with a high-resolution digital camera which can rapidly record to file the gross pathology with accurate measurements and the side of the blocks delineated on the photograph. Couple this with voice recognition and immediate review and filing of the transcribed description and grossing, presumably by a well-trained pathologist's assistant, becomes an efficient one-stage process.

Processing of blocks, cutting, and coverslipping will be further streamlined, slides barcoded, and after coverslipping loaded directly to a scanner that will create a high-resolution digital image of the entire slide, which becomes immediately available for reporting. The slides are filed immediately for future reference, if required. Gone are the piles of slide trays, delayed delivery to pathologists' offices, and the subsequent, apparently inevitable, accumulation there. The digital images can be moved, magnified, and manipulated just as a glass slide, but access to them can be from any location, with computer access to the system files. Gone is the tie to an "office," the running around with slides to other offices for second opinions, the constant search for misplaced slides, and all those other irritations that we have learned to live with. Cytology and hematopathology will undergo similar changes. The "virtual laboratory" is at hand.

But, I hear you cry, the resolution isn't good enough, the pixellation is too annoying, the file structures and manipulation are cumbersome, or simply won't work. There is some validity to these comments, but it's the early days, and the technology and software design will catch up. Our diagnostic imaging colleagues, and indeed some surgical colleagues, are already quite comfortable with remote review of digitized images from home or office, while even elderly grandparents cheerfully swap digital photographs without a second thought. I suggest it's time for us to get into the same zone! Welcome to the digital age.

At least that's how I see it.

Reproduced with permission from the CAP Newsletter.

Pathology in the Digital Age

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John Jacques, MD

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