Emerging trend in Pathology

Introduction

The future paradigm of pathology will be digital. Instead of conventional microscopy, a pathologist will perform diagnosis through interacting with images on computer screens and performing quantitative analysis. The fourth generation of virtual slide telepathology systems, so-called virtual microscopy and whole-slide imaging (WSI), has allowed for the storage and fast dissemination of image data in pathology and other biomedical areas. These novel digital imaging modalities encompass high-resolution scanning of tissue slides and derived technologies, including automatic digitization and the computational processing of whole microscopic slides. Moreover, automated image analysis with WSI can extract specific diagnostic features of diseases and quantify individual components of these features to support diagnoses and provide informative clinical measures of the disease. Therefore, the challenge is to apply information technology and image analysis methods to exploit the new and emerging digital pathology technologies effectively in order to process and model all the data and information contained in WSI. The final objective is to support the complex workflow from specimen receipt to anatomic pathology report transmission, that is, to improve diagnosis both in terms of pathologists' efficiency and with new information. This article reviews the main concerns about and novel methods of digital pathology discussed at the latest workshop in the field carried out within the European project AIDPATH (Academia and Industry Collaboration for Digital Pathology).

Digital pathology and WSI technology have the potential to improve diagnostic accuracy, increase workflow efficiency, balance workloads, and better integrate images in information systems. The amount of information that can be extracted from a tissue sample using complex, automated, and miniaturized devices will continue to increase thanks to sophisticated computer-based algorithms, which will assist in the integration of all information.

The two main aspects that will help to foster the use of digital pathology in clinical routine are the use of standards and the development and validation of image analysis tools.

Standardization is needed for pre-imaging steps (e.g. consistent staining and optimal slide preparation without artifacts), image acquisition (e.g. optimal resolution), processes after imaging (e.g. color calibration), and sharing/transmission of digital images (e.g. interoperable file formats).

Furthermore, as more image analysis algorithms and computer-assisted diagnosis tools get developed and validated for clinical use, they will empower pathologists to become more efficient, precise, and reproducible at quantifying prognostic biomarkers. Moreover, laboratory and tissue-based diagnostics will increase their capacity to provide a safe guide to therapy. Enhanced imaging capabilities will allow groups of pathologists to share information on tissue-based diagnostics. Pathologists sharing knowledge of histopathology, disease-related molecular processes, and laboratory diagnostics will be the integrators of information related to the molecular, biochemical, and cellular processes underlying the patient's disease, complications, and symptoms.

Finally, we believe that all of these challenges are affordable and, therefore, digital pathology will continue to transform the practice of pathology, which will provide opportunities for developing and evaluating new and more effective treatments that will benefit the patients.

Future perspective of digital pathology imaging from inspection in the bright field over the right treatment to the right patient. FISH = Fluorescence in situ hybridization; ISH = in situ hybridization.

“Medicine as war” is a metaphor commonly used in the field of healthcare. Whether it is a “war on diabetes,” a “war on HIV” or a “war on cancer,” government leaders often employ the analogy as a means to communicate their national health priorities and agendas. The implication of this conceptual metaphor is clear: the disease in question is the enemy while the entire healthcare system and its stakeholders jointly fight to prevent and overcome its destruction.

In this war, pathologists are like reconnaissance teams responsible for determining the enemy’s disposition, intention, composition, and capabilities. Any information or intelligence they gather about the illness or disease helps guide doctors in formulating the best strategy for attack (treatment and patient management). Their active involvement in continuous medical research further contributes to the overall progress of medicine.

Technological advancements today are changing the game for pathologists, acting as a powerful enabler in the gathering, processing, and relaying of the right “enemy information” in a time-efficient manner. Embracing such innovations will be key to helping pathologists gain the upper hand in healthcare’s frontline in 2019.

1. The explosion of biomedical information

It is expected that by 2020, medical information will double every 73 days. With the introduction of sophisticated diagnostic tools and genetic tests that are further unlocking doors to greater discoveries, we are bound to know more about diseases than ever before. While this is good news for both patients and physicians, the growth in biomedical knowledge is adding a layer of complexity for medical professionals.

The goal of any diagnosis is to get it right the first time. However, the sheer magnitude of evidence-based knowledge pathologists need to obtain, learn, process and, most importantly, apply in their day-to-day practice is simply impossible to keep up with as an individual. While investing time in independent learning is highly encouraged, pathologists should look to clinical decision support (CDS) tools able to help them navigate and make sense of the complex web of information. Such reference and decision support solutions transform top-quality, static reference information into real-time, dynamic, actionable knowledge. Today, CDS solutions are seen as the best weapons in combatting variability, giving healthcare professionals the greatest chance for delivering the best possible evidence-based care.

Two CDS solutions from Elsevier tailored specially for pathologists are Expertpath and Immuno query. ExpertPath is an interactive decision-making support tool for diagnostic pathology. This cloud-based solution contains over 4,000 medical overviews and diagnoses written by industry experts and clinicians, as well as 51,000 expert-selected pathology images. 

ImmunoQuery is evidence-based decision support for immunohistochemistry. Drawing from a vast database of peer-reviewed literature, it suggests to pathologists the right antibodies reject or confirm a suspected diagnosis. Together, these CDS solutions help pathologists improve diagnostic confidence while saving time and removing costly, unnecessary testing.

2. The rise of precision medicine

A major goal of modern medicine is to increase patient specificity so the right treatment is administered to the right patient at the right time in the right dose. In the area of oncology, for example, treatment methods are moving away from one-size-fits-all approaches. Knowing the unique molecular mutations driving a person’s condition allows us to design therapies that can target those specific alterations.

With precision medicine, pathologists today must be able to integrate information derived from various tests and correlate them with clinical information. Increasingly, this means pathologists will need to leave the laboratory and play a more active role in clinical decision-making at the bedside.

This new frontier of medicine underscores the need for pathologists to work more closely with clinicians. We predict that interactions between pathologists and the patient care team will increase in the future. A pathologist in a Taiwan hospital we spoke to said: “Clinicians shall offer the first-line clinical information to the pathology department so that pathologists can understand a patient’s actual condition and offer a diagnosis that is more beneficial to the patient.

“This is how pathologists and care teams will support each other and ultimately drive better patient outcomes,” she continued. “Communication will be key.”

In light of this trend, we expect that digital platforms focused on facilitating more direct, effective, and efficient communication between interdisciplinary teams will be developed in the future.

3. AI in healthcare

Conversations and discussions around the promise of artificial intelligence (AI) to improve outcomes in healthcare have taken off in recent years. In fact, the industry is not new to AI technology. Currently, AI-based technology is widely used in radiology for image recognition and in prediction models that alert providers of high-risk patients. At the same time, there are other areas where AI is still developing – from AI-assisted robotics surgery to deep analytics solutions that aid doctors in making more precise clinical judgment and diagnosis – and its potential is far-reaching.

While there remains some uncertainty around the role of AI and its true impact on pathology, it is important to recognize that AI-based technologies or machines will never replace pathologists. Instead, such innovations will play an assistive role, augmenting the decision-making capabilities of pathologists and helping them perform better and faster. Ultimately, the value of human life far outweighs anything and everything. This is a responsibility that no machine or algorithm could – or should – ever shoulder.

Conclusion

Global healthcare is at the frontier of change. As medicine continues to progress, with precision medicine and AI set to impact care delivery, pathologists need to readily embrace new digital health solutions tasked with helping them work more efficiently and collaboratively. Ultimately, such technologies are not designed to replace but rather support them in making faster, smarter, and more precise decisions to improve patient care.

By:- Vikas Tiwari