by Talat Zehra, MBBS, FCPS, Consultant Histopathologist in Pakistan

 

It has been about two decades since the introduction of the whole slide imaging (WSI) scanner. During this time, various WSI devices have transformed the field of pathology. Digital and computational pathology, partnered with artificial intelligence (AI) software and machine learning, set the stage for a groundbreaking shift in laboratory operations. Digital pathology enables the pathologist to perform most of their work at home. Numerous validation studies have been published indicating that WSI is a reliable tool for routine diagnosis in surgical pathology.

 

In Pakistan, digital pathology is still not practiced on routine basis because of few reasons, one of the reason may be that digital pathology tools like pathology slide scanners and digital microscopes are expensive tools for the people of developing countries. In addition, AI based software’s are also quite expansive. But in the era of Covid-19 pandemic where most of the activities got stuck and work from home emerged, the need of telepathology gives a ray of hope for the pathologist to continue their work. I conducted this study to know the basic knowledge of digital pathology among the Pakistani pathologists working in different parts of country and also to evaluate the importance of digital pathology and AI tools in this pandemic and beyond.

 

This was a Performa based cross sectional study conducted across the country. A total of 147 pathologist took part in the study. The study was conducted from 1st September to 1st October 2020. Pathologists from all disciplines participated. Only those pathologist were selected who were working in laboratories. Pathologists confined to only academics were not included.

 

From a total of 147 pathologist,

  • 54 (36.7%) were male and 93(63.3%) were female.
  • In specialty, majority were from Histopathology 47 (32%), after that there was hematology and microbiology respectively.
  • There were 38(25.9%) resident and 91 (74.1%) consultants (Fig.1).
  • 111 (75.5%) of the pathologists had the idea of digital pathology, while 38 (25.9%) had no idea of digital pathology (Fig 2).
  • 106 (72.1%) pathologists had the idea of digital microscope while rest of the pathologists had no idea (Fig 3).
  • 102(69.4%) pathologists had the idea of pathology slide scanner (Fig 4).
  • Out of 147 pathologists 100 (68%) found difficulty in working during Covid-19 Pandemic (Fig 5).
  • 125 (85%) pathologists were in favor that routine pathology is possible from home if there labs have the facility of digital microscope or slide scanner (Fig 6).
  • 140 (95%) pathologists were in favor of telepathology for remote areas even after the end of this global pandemic (Fig 7).
  • 82 (55.8%) pathologists had the idea of whole slide scanner (WSI) (Fig 8).
  • Less than 50% (72, 49.5%) pathologists had the idea of artificial intelligence and deep learning (Fig 9).
  • 45 (30.6%) pathologists knew about the Digital Pathology Association (DPA) (Fig 10).
  • Lastly when we asked about the pathologists that what they think about digital pathology and can it really bring change in the conventional practice of pathology, overwhelming majority favored digital pathology as the feature of modern pathology. Only 10 (6.8%) pathologists were not in favor of digital pathology or they have no idea about it.

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But this adaptation was very slow in developing nations mainly because the costs of pathology slide scanners were very high (US $100,000 to US $1,50,000 per piece) and additional hidden costs of training of staff and pathologists, technical support, digital slide storage systems, and regulatory or licensing costs.  

 

In Pakistan, unfortunately, digital pathology tools are not routinely practiced and a large no of Pathologists are not familiar with this technology which can easily be appreciate from the result of this survey. In this study we try to highlight the importance of digital pathology, its basic definitions and acceptance among Pakistani Pathologists. Digital Pathology and its applications defiantly provides a ray of hope and alternate choice in the era of hopelessness and darkness due to this deadly pandemic which took away more than 1.5 million documented precious lives in just a span of one year. No one knows how long we will have to face this pandemic but defiantly we will have to change our strategy as most of the pathologists agreed in this study.

 

The recent approval of US FDA to a WSI system for its use in primary surgical pathology diagnosis has opened new horizons for wider acceptance by pathologists across the world in routine practice.

 

Conclusion

Though digital pathology and its applications are highly promising and results a change in the thought process of pathologists working in developing countries like Pakistan but still phase barriers like cost, technical support regulatory and validation requirements also need to be adequately addressed, especially for the developing nations. The developed nations need to guide the pathologists of our country to learn the dynamics and technicalities of digital pathology tools in order to help the entire humanity to come out with this pandemic which paralyzed the world irrespective of geographical borders and economic status of the countries.

 

Disclaimer: In seeking to foster discourse on a wide array of ideas, the Digital Pathology Association believes that it is important to share a range of prominent industry viewpoints. This article does not necessarily express the viewpoints of the DPA, however we view this as a valuable point with which to facilitate discussion.