by Talat Zehra, MBBS, FCPS, Assistant Professor, Jinnah Sindh Medical University


As many of us are aware, pathology is an integral part of medicine both in terms of management as well as diagnostics. Despite its critical role, there is a global shortage of pathologists; particularly, in developing parts of the world. Developing countries contain the majority of the world’s cases of disease - not only the endemic diseases such as tuberculosis (both pulmonary and extra pulmonary), malaria, typhoid, cutaneous leishmaniasis, etc. but also tumor cases. The shortage of pathologists in developing parts of the world is associated with increased morbidity and mortality of patients. Many believe that a portion of the morbidity and mortality can be prevented with more timely diagnoses. For this, and other reasons, I believe that digital pathology and AI solutions should be employed in the developing world.


Digital pathology is a cutting-edge technology and I believe its use is inevitable, even in developing parts of the world.  It can help fill the pathologist gap because cases can be shared with any part of the world via a single click once the slide becomes digital. Remote pathology helps alleviate the many barriers between patients and clinicians and clinicians and pathologists. Sometimes patients, specimens, blocks, and glass slides must move or travel a long distance for their diagnosis. During this long journey, either by road, train or air, there is risk of specimen and glass slide damage.


I’d like to share an example from my personal experience that highlights the benefits of telepathology by contrasting it with how a lack of digital remote diagnosis negatively impacted the care of a patient. A while ago, a case reached us from a remote area four days after the surgical removal of an axillary mass from a 13-year-old boy. By the time we received the sample, it was improperly fixed. We changed the formalin immediately and then processed it, but when we got the slides it came out as partly autolyzed Hodgkin Lymphoma. We had to provide a guarded opinion and we advised marker studies even though marker studies will not usually give adequate results in an inadequately fixed specimen. It’s well known that Hodgkin lymphoma, if diagnosed in a timely manner, is associated with excellent outcomes as it is a very radiosensitive tumor.  Now think about the level of frustration of the patient, clinician, and pathologist caused by issues that could be addressed using digital pathology!


Outside of primary diagnosis, digital pathology still provides benefits and supports the best standards of care. For example, second and third diagnostic opinions, which can be common practice in tumor cases can be simplified using telepathology systems. In doing so, it creates both time and cost efficiencies due to electronic transmission vs physical transportation of slides. Digital solutions may also make consultations possible that would have been impractical beforehand, concerning the time constraints of clinical care.


Last but not least, is the promise of using Artificial Intelligence solutions to provide targeted, preemptive guidance in addressing diseases. Because developing parts of the world contain so many of the world’s disease cases, they are a big source of data that can be used to create and validate disease models and predict the disease trends. By adopting AI in the developing world, the models would be more robust, and the results would be more apparent.


There clearly are challenges as we explore implementing these techniques in the developing world, however, my background as a histopathology student and digital pathology enthusiast leads me to believe that we can find solutions. I personally believe that the best way to address these challenges is to practically adopt digital pathology solutions in the real, developing world. In doing so, we will create our own implementation knowledge and the technology vendors will be able learn the needs of pathologists and organizations in low resource countries. We will be able to prove the benefit of these solutions with our own data and blaze a trail for those who are also thinking of adopting these techniques. That audience is larger due to this given the era of uncertainty caused by the pandemic, which has taken away millions of precious lives in the span of a year. While there are other difficult questions to address, like the expense of these solutions and the logistics and operations in a developing world environment, we must start somewhere.


I believe it is high time for technology inventors to come to developing parts of the world. Let’s shake hands together. Please come forward in the name of humanity, irrespective of discrimination and borders. Humanity should be the champion in war against disease!


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.