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Digital Pathology

4 Needed: an umbrella organisation to link path, lab and IT experts Morphological medicine and pathology will boom Professor Klaus Kayser, former Head of the Institute of Pathology at Heidelberg University Hospital’s Thorax Clinic, may be retired but he continues to be a leading figure in his discipline, a visionary, famous for this critical and ‘out of the box’ thinking. During the run-up to the European Congress on Digital Pathology (ECDP), Ralf Mateblowski asked the expert about telemedicine and standards and, even more importantly, a discipline in transition. As a mere communication tool, telepathology crosses time and space barriers by enabling data analysis from anywhere and at any time, no matter when and where the data were generated. The crucial advantages of digital pathology (DP) lie in its time independence and the ability to ‘turn back the hands of time’: the evaluation of histological specimens involves much more than loo- king at the slide and wobbling it back and forth; rather, it requires returning to the original, switching between the original specimen and its stained or marked version. A modern routine lab that processes 50,000 to 60,000 cases per year covers two major areas: lab and pathology. At first, digitisation cre- ates more work in the lab, since the scanner has to be loaded with slides, a cumbersome procedure that requires some getting used to. The process is speeded up when the pathologist receives his specimens pre-sorted, e.g. the liver and lung specimens. If – and only if – DP is optimally organised, the lab techni- cian no longer needs to move around, but can perform all necessary steps at the workstation, such as transferring the digitised slides, including suggestions for analysis, to the pathologist. Ideally, results are made available to the departments via the HIS. Efficiency, however, is not only a matter of the degree of digitisation and organisation; to a large extent it is a matter of having access to pathologists who are spe- cialised in certain organs. They can be found in large institutions such as Charité in Berlin, or the Uni- versity Hospital in Heidelberg. Currently, ‘human’ routine pathology, unlike experimental pathology in the pharmaceuticals industry, it is struggling with standardisation even though defined strategies are available for all parameters in order to reduce impre- cise measurements, such as thickness, intensity of the dye, or correct lighting in order to be able to as- sess suspect areas in a tumour specimen. In Heidelberg, algorithms were developed that provide high sensitivity and specificity (95%) for difficult-to- diagnose tumours such as mesothelioma, or metastatic adenocarcinoma, and can be applied for breast and lung carcinoma. Even if the software programme itself is not yet perfect, the algorithms work and routine usage is around the corner with confirming parallel studies the only component missing. Nevertheless, morphological medicine and pa- thology will experience an enormous boom as scanners with a €100,000 price tag are becoming obsolete since US-American drones feature entirely new optics. Cheap iPhone lenses can be combined with scan- ners – such projects are underway in China, Finland and the US. If these ideas really pan out, scanner pri- ces will drop by factor 10 and high investment

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