Digital Pathology

3 I saw the future of pathology – and it‘s digital Healthcare is going digital. No doubt about it, Prof. Hufnagl predicts. Information and communication technologies have gone beyond moving data from one place to the other; they are triggering stellar improvements in healthca- re: diagnoses are becoming ever more precise, therapies ever more personalised. The extent to which the individu- al clinical disciplines have progressed in their technological development varies greatly. In pathology, for example, change has only just set in. However, it is already obvious, that digitisation will change the discipline forever.  Scepticism towards digital systems is still widespread and fundamental questions re- garding the sense and purpose of the new technology in the pathology department continue to be raised. These concerns are primarily caused by the significant necessary financial investments in hardware and soft- ware. Basic equipment encompasses slide scan- ners, data storage devices and an image management system. There are many opi- nions as to whether and when the purchase of these digital pathology devices makes economic sense. Clinicians, normally not interested in viewing histological slides, are sometimes enthusiastic if they get brilliant overview images via DICOM access. Ho- wever, there are – throughout Europe – very encouraging examples that demonstrate the successful step-by-step transformation from microscope-based histopathological dia- gnostics to digital diagnostics. ‘Unfortunately, these positive examples are not sufficiently published in the pathology community’, says Professor Peter Hufnagl, Head of Digital Pathology at the Institute of Pathology at Charité, Berlin, and President of the 13th European Congress on Digital Pathology in Berlin in 2016. ‘The two types of workflow, digital and analogue, can co- exist very well and, for some institutions, such a two-pronged approach might be the best solution in the long run. That means you don’t have to wait until you can afford fully-fledged digitisation. Start small!’ Workflows in the pathology lab will benefit with only one third of the diagnostic task being digitised. Communication with clini- cians will become faster, simpler and more effective. For large institutes involved in re- search and teaching complete digitisation makes sense, Professor Hufnagl underlines: ‘The biobanks being established in the aca- demic environment particularly profit from a digital slide archive, since it allows larger sample groups to be selected and to check whether certain slides are suitable for a re- search project.’ Many pathology labs are still hesitant to jump on the digital bandwagon although the industry has recognised the market potenti- al long ago and is actively driving its rapid growth through technological innovation. The fact that the use of a virtual microscope saves a lot of money on expensive samples is only one of the arguments manufacturers use to lure new customers. More impor- tantly, however, digital pathology optimises quality assurance and thus contributes to a lab’s competitiveness. Digitisation provides a better overview of comparable cases; it allows the application of quantitative me- thods to check diagnoses and accelerates obtaining second opinions. Hufnagl is convinced that it is only a mat- ter of time before digital pathology will pre- vail. In radiology, he points out, there were very similar concerns regarding on-screen readings – today this is standard operating procedure. The fact that, due to image vo- lumes in pathology – 150.000 x 300.000 = 45000Mpixels – digitisation is taking root 20 years later than in radiology, is an ad- vantage. We can learn from radiologists’ experiences and from many of their solu- tions, because they can be translated into the questions that need answering in pa- thology.’ Having said that, there are indeed also fundamental differences between the two image-based disciplines. The different CT slices, for example, are automatically adjusted – a step that is not so easy with histopathological samples that consist of three-dimensional tissue, such as a tumour. ‘The registration of slides with different stains from the identical block is sometimes difficult. Differences between slides, such as pressure points, tiny fissures etcetera are originated by mechanical alterations in the lab or switching the lab during processing. Software programmers have not yet found a solution to deal with all different artefacts in a sufficient manner.’ In addition to diagnostics with the virtual microscope, digital pathology is being pu- shed ahead by other technological innova- tions, such as molecular pathology, parti- cularly Next Generation Sequencing (NGS). This procedure can detect gene mutations much faster and simpler than before. This allows inter alia precise characterisation of tumours, which in turn translates into cu- stomised cancer therapies. Today NGS is considered the path-breaking technology towards personalised healthcare, because it is expected to have a crucial impact on dia- gnosis and prognoses of cancer and other diseases. ‘Thus digitisation makes pathology much more visible in the landscape of clinical dis- ciplines’, Peter Hufnagl confirms, adding: ‘This development is being supported on the organisational level, for example by the establishment of tumour boards that inclu- de pathologists and it will be accelerated by the new technologies.’ Consequently not only the work environ- ment and the ‘job description’ of a patholo- gist are undergoing radical transformation; the image of the pathologist is also chan- ging. For years, pathology has been strugg- ling with recruiting problems. Digitisation is giving the field a fresh, modern look and more junior physicians are becoming intere- sted in this field. KAROLINE LAARMANN Peter Hufnagl, Head of Digital Pathology, Charité Berlin A pathologist’s work is undergoing radical transformation Wednesday, May 24th • 5.30 PM–7 PM • Room: Hörsaal The 13th ECDP – a scientific overview P. Hufnagl, Berlin, Germany

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