by Hoa H.N. Pham, MD, PhD Candidate; Department of Pathology, Nagasaki University Hospital
Nobody denies that digital WSI scanners and diagnosis-assistance software created by industry and computer scientists are elements that have brought a significant jump of conventional pathology into the era of digitalization. This brings significant potential into different fields such as diagnosis, consultation, cross-discipline collaboration, education and research. But the key factor in maintaining and improving digital pathology is the actual pathologist’s involvement. The role of digital pathology in the pathologist’s daily work has been widely discussed, but not the role of pathologists in digital pathology. Pathologists are the end-user of modern techniques, therefore they have the keys to assess and decide the developmental direction of their particular hardware and software.
Improvement of digital pathology in the pathological workflow has gone through various challenges, related to factors such as legality, security and standardization, as well as the high cost of techniques and relatively high storage requirements. Computer scientists and vendors have adapted themselves quickly to this technology, but the rate of adoption among pathologists is significantly lagging. “Pathology is quite conservative,” said Han van Krieken in The Pathologist. My opinion is that his statement is true for one reason, namely, computer scientists or vendors and pathologists are essentially very different, with the former having a background of informatics technology and the latter’s background being mainly in medicine. Although digital pathology is a tool created for pathology, from the point of view of many pathologists, it is much more complicated compared to traditional tools. Lacking knowledge and therefore confidence in digital pathology are some of the main barriers that prevent pathologists from considering this new technique as a primary choice in their daily work.
Most pathologists are skeptical about diagnosis-assistance programs and their accuracy, which they think is not equal to their own experiences. In addition, there is a lack of information and approach to digital pathology for plenty of general pathologists. Numerous hospitals and institutes don’t have digital pathology resources. Many people in pathology still have a limited understanding of digital pathology as whole-slide images that can only be applied for consultation or education in seminars and are unaware of the many other applications.
Multiple challenges make digital pathology forums very important. This is where people can find advanced achievements in the field, and form a bridge between computer scientists, vendors and pathologists. There are, in fact, numerous benefits of digital pathology, but to make this information accessible to general pathologists, we need to attract them to digital pathology conferences.
For pathologists, the deciding factor to attend a conference is the amount of knowledge they can gain from it. Besides an update on digital pathology, they want to know more about pathology itself. Currently, almost all digital pathology conferences mainly focus on digitalization-related topics. These presentations focus on pathologists and researchers who are already familiar with digital pathology. However, many pathology departments or hospitals cannot provide digitalization of pathology so pathologists working there are not aware of the conferences or familiar with the content.
Perhaps it would be beneficial to expand the content of digital pathology conferences by the addition of general pathology topics. This may help to diversify the content of the conference and make the audience more interested and focused, as there would be a mixture of topics in the program. For example, a seminar or a workshop with pathological education purpose using whole-slide image can fit criteria on both sides. This may attract junior pathologists and residents who have the ability to better adapt.
It is also challenging to attract senior pathologists and specialists, due to their workload in special pathological topics. They are well placed in the hospital hierarchy to help control and decide upon the change. Here also a coordination and collaboration between the Digital Pathology Association and classical pathology conferences would assist in the progress of the industry.
Potential of digital pathology in developing countries
There is too little focus in adoption of DP in developing countries, perhaps because of the belief that digital pathology is an advanced modern technique that can only be applied in developed countries. However, there is digital pathology equipment which is inexpensive and reasonably priced for low-income groups, and it is now common to find the required high-speed internet in larger cities of developing countries. More and more conferences on digital pathology have just recently taken place.
Developing countries seek collaborations with developed countries for the purposes of education, consultation of complex cases with abroad specialists and for a two-sided medical research. Digital pathology is useful here, as we know its advantage over geographic distances and its ability to tie the two together. In addition, the improvement of artificial intelligence requires big data and other resources to develop software in pathology, so it’s optimum to have a collaboration of work from pathologists all around the world.
Many developing countries have unstable social systems, but they may be better to adapt to change compared to developed countries which normally have steady and balanced configuration, because they are more conservative and less in need to an overall improvement in healthcare. With collaboration and guidance from digital pathology organizations and hospitals of developed countries, there is a chance that digital pathology can spread out widely in the near future and be used intensively in developing ones.
In conclusion, the opinion of this pathologist is that digital pathology has high potential and despite the current hurdles, will make great progress in the future. Pathology is the core of digital pathology; therefore, the pathologist should be the primary driver to maintain and improve patient care and the digital pathology community.
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.