Advances in Digital Pathology

Research advances in technology are increasingly being utilized to automate and digitize healthcare processes and lab workflow. These advancements have helped speed up clinical diagnosis and treatment, thus improving patient outcomes. One such technology is digital imaging, which has transformed the field of pathology, specifically digital pathology, by enabling high-throughput scanning of samples collected from patients.  

The traditional way of preparing a tissue sample for anatomic pathology investigation is as follows: A histotechnologist segments the sample into thin slices and then mounts them onto glass slides. These are next processed to improve the final image quality. The prepared slides are then sent to the pathologist who examines the samples under a microscope to determine or confirm a diagnosis. 

While these steps are mostly still followed, digitization has begun to transform anatomic pathology and laboratory workflow management at the final step by converting the glass slide prepared for microscopy into a more flexible digitized image (digital pathology workflow).

Defining Digital Pathology and Digital Pathology Solutions 

Digital pathology is the digitization of prepared slides, facilitating the digital pathology workflow such as acquisition, management, and interpretation of anatomic pathology information (pathology lab management). The glass slides traditionally viewed under a microscope are now scanned to produce high-quality digital pathology images that can be viewed on a monitor. 

The microscope here is replaced by a digital pathology scanner, which captures high-definition images of a slide (whole slide imaging) and transmits the captured images directly to the pathologist's screen.

So what are the benefits of digital pathology?

The pathologist can share these digital pathology images quickly and easily with the rest of the medical team instead of having to transport the slides from one clinical setting to another. This improves turnaround time and operational efficiency, leads to collaboration, and ultimately improves patient outcomes.

Digital Pathology Workflow with Image Scanners

A histology scanner or digital pathology scanner is a piece of equipment that can handle around 1,000 glass slides at a time, depending on their size, to capture digital pathology images and transmit them to an attached computer’s screen. 

The scanners need to be stored within the lab on a countertop, where no vibrations from other lab equipment such as centrifuges or stirrers can blur the image quality. These scanners are integrated with a digital pathology camera or slide viewer, an attached monitor, and an image management system or software application. 

Digital pathology scanners can be chosen according to their routine application in the lab. For example, if a pathologist needs images with high magnification (40X), he or she can choose a machine that achieves higher magnification. 

Image acquisition through digital pathology scanning is thus accelerated in digital pathology solutions, improving turnaround time for clinical diagnosis within laboratory information systems (LIS). Though the diagnostic aspect remains the same, digital pathology has increased lab efficiency, decreased lab costs, and improved lab workflow. 

Today’s digital pathology scanners can capture and process images within a minute, adjust them to multiple magnifications, and handle large volumes of slides.

The best digital pathology scanners are customizable to a lab’s needs. Here are two examples of that customization that a lab can utilize:

• Complete automation (where the end-to-end process of capturing digital pathology images of the whole slide to transmitting them to a computer is fully automated)
• Semi-automation (where the pathologist loads the digital pathology slides and views them to manually select the best viewing regions on the slide) 

The scanner should also be compatible with pathology lab software (laboratory information systems) so that the digital pathology images can be acquired, labeled, and stored automatically.

Digital Pathology Workflow with Image Analysis Software

Through digital image analysis, LIS pathology labs leverage artificial intelligence (AI)-based analytical tools and algorithms to improve a pathologist’s lab workflow and decrease the chance of human errors that may arise during sample processing. 

Analysis of acquired images is semi-automated through digital pathology software, which allows a pathologist to investigate a slide by directly annotating the digital pathology image with measurements made within the laboratory software system. 

Image acquisition management within the laboratory software system and pattern analysis on digitized images enable the interpretation of pathology information for clinical diagnosis. Pathologists can evaluate and compare their diagnoses with historical data that is stored in the cloud and processed within the same image analysis software. 

Diagnostic digital pathology thus supports reproducible interpretations, empirical measurements, and increased confidence in the pathologist’s findings. 

Benefits of Digital Pathology

Digital pathology systems are increasingly being adopted by anatomic pathology labs for numerous reasons: 

• Taking pathology digital simplifies the process of image-sharing through digital pathology software, allowing collaborations among a team of pathologists to accelerate diagnosis times. Digital images can also be transmitted online to other team members for a second opinion. 
• Digital pathology images can be instantly, securely, and permanently stored on the cloud. This improves accessibility for peer consults, for example, yet keeps confidential patient information safe from theft, fire, and other events. 
• Digital pathology solutions include analysis tools within the software that can be deployed to empirically measure, for example, levels of a specific tissue biomarker that indicates disease. 
• Image analysis software enables robust investigation through AI-guided accurate diagnosis. Cloud storage also allows pathologists to compare their results to historical specimens, or to compare multiple specimens side-by-side, improving the predictive power of software algorithms.
• There is little risk of misidentification since slides are labeled with a barcode that is matched to a patient’s information. 
• Patients receive their diagnoses faster despite the increasing number of cases that anatomic pathology labs are tasked with handling.
• Pathologists can improve their expertise by interacting with big data collected from the samples. 
• A digital pathology workflow provides a solid foundation for automation, thus allowing pathologists to implement better flexibility in their work schedules. 
• The image acquisition software and digital pathology workflow can be integrated into the lab information system (pathology information system) deployed within the lab.
• A secure digital archive of the patient’s sample is kept instead of having to keep a slide or frozen section that takes up valuable physical storage space and adds to storage costs.
• Physical samples are subject to degradation whereas digital pathology ones are not.

The Integration of Digital Pathology Solutions and Laboratory Information Systems

Digital pathology solutions have advanced greatly in only a short amount of time, thanks mainly to the many benefits they offer anatomic pathology groups. One key area of advancement has been in the integration of digital pathology solutions and laboratory information systems (LIS systems). 

The best LIS system software is both comprehensive and flexible, and labs that operate with modern LIS systems are at an advantage when it comes to adding new technology like digital pathology to the overall lab workflow. 

Here are a few of the many advantages that come from a seamless digital pathology - LIS software integration:

• Efficient Workflow: Digital pathology integration streamlines pathology lab management by allowing the smooth transfer of data and images between two different laboratory software systems. This reduces manual steps, minimizes errors, and speeds up the overall diagnostic process.
• Enhanced Accessibility: Digital pathology enables remote access to images and data, facilitating strong collaboration among pathologists regardless of where they are located. This greatly improves collaboration by adding a layer of consultation that may not have been possible in the past.
• Improved Accuracy: Digital pathology solutions often come with advanced image analysis tools that aid pathologists in diagnosis. Integration with laboratory information system software ensures that all relevant patient data is readily available during analysis and easily transferable into the LIS system, leading to more accurate and comprehensive diagnostic reports.
• Centralized Data Management: The best laboratory information system software works closely with all digital pathology solutions to enable the centralized storage and management of pathology data within the LIS system database. This improves data integrity, security, and accessibility while simplifying data retrieval for such things as audits and quality assurance purposes.
• Cost Savings: The long-term benefits of digital pathology and lab information system integration include reduced storage costs for physical slides, improved resource utilization, and potential savings from faster turnaround times and more accurate diagnoses.
• Scalability: Digital pathology solutions that are integrated with LIS system software can easily scale to accommodate growing volumes of cases and data. This scalability ensures that laboratories can adapt to increasing workloads without compromising on either efficiency or quality.
• Compliance: Digital pathology integration with LIS software helps laboratories comply with regulatory requirements by ensuring proper documentation, traceability, and data security measures are in place. This simplifies the accreditation process and reduces the risk of compliance-related issues.
• Patient-Centric Care: By providing quicker access to pathology results, digital pathology integration with anatomic pathology LIS systems supports faster treatment decisions, leading to improved patient outcomes and more patient satisfaction. Patients also benefit from enhanced communication and transparency regarding the diagnostic process and their test results.
  

The Future of Digital Pathology Workflow

The U.S. healthcare system is facing increasing challenges due to the sheer volume of data that is generated during diagnostic processes. 

Sophisticated and innovative digital pathology solutions are needed to cope with the increasing demands of diagnostic lab workflow. Advances in machine learning and big data processing will be increasingly incorporated into many areas, including diagnostic digital pathology. Complex image analyses, such as multiplex analysis (which measures more than one marker within the same tissue sample), can be deployed by digital pathology solutions to delineate signal intensities between different markers. This kind of quantitation is difficult to achieve manually, under the microscope, due to the diffusion of some stains specific to different markers in a tissue sample. 

Another exciting prospect for digital pathology laboratory software systems lies in their potential to be combined with other clinical diagnostic methods to improve the prognostic value of a diagnosis. For example, the read-out of a biomarker expression calculated by a digital pathology image analysis software can be compared with protein expression levels calculated from a mass spectrometric analysis of the same tissue sample. This allows diversification in diagnostic tools that can complement one other’s functionalities to improve the clinical diagnosis workflow. 

Finally, the availability of image acquisition management systems, coupled with the rapid strides being made in regulatory policies for data sharing, both offer exciting prospects. 

Digital pathology has ushered in a positive change from the classical methods with computer-based virtual microscopy, cloud-based data storage, and the many tools available that use AI and machine learning to support pathologists in their work.