Twenty Years of Digital Pathology: Lessons Learned 


High-quality pathology requires a depth of knowledge gained by subspecialization; subspecialty practice requires a critical mass of Pathologists and specimens that is achieved by consolidation of multiple pathology laboratories. However, there are challenges to servicing multiple locations in an analog world. One of these is the provision of intra-operative consultations that demand immediate attention. In 2003, I set out to find a solution to provide real-time cost-effective subspecialty intraoperative consultations in a multi-site pathology department. The implementation of robotic microscopy taxed my patience as I waited for glass slides to move around the microscope stage and watched images de-pixilate, and I rapidly converted to the concept of using whole-slide images (WSI) that had recently become commercially available. With this new technology in hand, the idea of moving from microscope to monitor was only a step away – the challenge was to organize individual WSIs into cases for a pathologist to view efficiently. Working with vendors, we built the integration of WSIs with the laboratory information system (LIS) and by 2010, I could see a new 2020 vision of pathology. The goal was harder to achieve than originally anticipated; the challenges of cost, lack of infrastructure and human fear of change seemed almost insurmountable, but sparks of hope emerged in different places and at different times. There are many lessons that I would teach to my 20-year younger self, but as 2023 draws to a close, we see that vision of digital pathology slowly emerging from behind the curtain. The digitization of glass slides paves the way for the development of computer-assisted quantification and detection of rare features, as well as more sophisticated artificial intelligence (AI) to enhance pathologist interpretation. Digital pathology with AI algorithms can improve the speed and diagnostic accuracy of the average pathologist, reduce errors due to fatigue and distraction, and provide every patient access to the right diagnosis in a timely fashion, but there are risks.  Will AI replace Pathologists? Will the wrong AI outcomes discredit pathology in the future? How will we ensure that the role of pathology is enhanced as we race to achieve the unattainable?  The importance of pathology cannot be overemphasized, as every patient’s treatment and prognosis is dependent on this critical discipline. It is our responsibility to harness the speed and endurance of AI to support and assist the increasingly knowledgeable subspecialist Pathologists who will continue to serve as the basic and translational science experts of multidisciplinary care teams.



  1. Understand the role and importance of Pathology in healthcare
  2. Learn lessons from the history and evolution of Digital Pathology
  3. Appreciate the opportunities and threats of AI applications in Pathology


Presented by:


Asa CropSylvia Asa, MD, PhD


University Hospitals Cleveland


Dr. Sylvia Asa obtained her MD from the University of Toronto in 1977; after completing a residency in Pathology in 1982 followed by a PhD in 1990, she climbed the ranks of the Faculty of Medicine and was promoted to Professor in 1998 based on her work as a Clinician-Scientist with a focus in Endocrine Pathology. As head of the largest academic pathology department in Canada from 2000 through 2015, Dr. Asa made innovative changes to the practice of the discipline, with emphasis on subspecialization, molecular diagnostics, biobanking, automation, pathology informatics and digital pathology. In 2019 she joined the Faculty at Case Western Reserve University and University Hospitals Cleveland to drive the implementation of digital pathology.