The UAB Department of Pathology has been strategically planning its digital pathology effort since well before its initial launch in 2024, but what is digital pathology? And why is this new initiative so important?
Digital pathology aims to modernize pathology services by enabling remote diagnosis, improving efficiency, and ensuring quality patient care through easier access to expertise. More specifically, it’s the process of pathology glass slides being captured with a scanning device to provide high-resolution digital and interactive images. Digital pathology also supports faculty recruitment and retention by providing greater flexibility and strengthens education programs with state-of-the-art infrastructure for trainees.
As the first installment in our three-part series highlighting digital pathology’s impact on UAB Pathology’s clinical, research, and teaching missions, we interviewed Oyedele Adeyi, M.D., FRCPC, C. Bruce Alexander Endowed Professor, Division Director, Anatomic Pathology, and digital pathology enthusiast, to explain how this effort will propel the department’s clinical mission forward.
How will digital pathology make pathologists more efficient?
Oyedele Adeyi, M.D., FRCPC
“Our primary clinical goal is to care for our patients through accurate and timely diagnoses and testing. Digital pathology will only accelerate the good work that is already being done in the Department of Pathology, and I’ll explain how with specific examples:
- Pathologist interaction with tissue: Digital pathology will grant us ease of access to the whole tissue on the slide. When we use microscopes, we can only see so much of an area. The more tissue we’d like to examine in one look, the lower the magnification must be. Digitized images are going to give us panoramic views of the entire tissue with high resolution. It’ll also allow us to review multiple levels at once or different stains on the same block side-by-side.
- Easy access to cases: Right now, I can only look at my cases from my microscope. With digital pathology, I could view cases anywhere. Last week, a surgeon asked us to review a case together. While I’m always happy to help, it took five days to do this. The slides had to be pulled from filing during work hours, a suitable time to meet had to be found, and I had to photograph the slides as best as possible to show in real time via Zoom or in person without a microscope. Digital pathology would have eliminated all unnecessary steps.
- Access to objective and easily reproducible metrics that determine patient management options: Digitized images remove most, if not all biases, and have the strength to provide more objective measurements with well calibrated tools. Pathology has become central in determining personalized care and treatment outcomes, and parameters must be accurate. For example, imagine you’re examining a case of colon adenocarcinoma that has moved into the submucosa, but not beyond. If the tumor is less than 1,000 microns deep in the submucosa, management will be different than if it’s more than 1,000 microns. As much as we train to determine these details objectively, measurement remains subject to interobserver biases. This is probably one of the biggest benefits of digital pathology.
- Artificial intelligence: AI algorithms only further remove observers’ biases. For example, we are quite good at recording the difference between Ki67 of 5-10% versus 10-20% in terms of neuroendocrine carcinoma grading, but when the values are closer together, say the difference is 19% versus 21%, it becomes more difficult to differentiate. Well-validated ki67 algorithms, made possible only with digital pathology, removes this subjectivity. The list of helpful algorithms we can use as quality assurance is almost endless.”
Our digital pathology effort will be going live with Sectra in June. How will this impact our clinical practice at UAB?
“Our digital pathology journey has covered many miles, but we still have many more to travel. The impact will be deliberately gradual for three reasons. The design of the workflow we have in place can only be tested when in operation. We expect there will be several tweaks as we learn along the way. Secondly, individual pathologists transitioning from glass slides to digital will not be instantaneous. The goal is to allow everyone time to get used to this new platform and ultimately discontinue use of glass slides at their own pace. Thirdly, the process of deploying validated workstations to more than 35 pathologists could take a year or longer, so not everyone will go live with digital in June.
The excitement is in the air, and we project that in the next two years or sooner, most of our pathologists will be actively utilizing digital slides either fully or in some measure. We also foresee our ability to adopt FDA-approved AI algorithms to follow quickly. We do expect services such as tumor boards, reviewing cases with residents, and pathologist-to-pathologist internal consultations to quickly transition to digital deliveries within the first couple of months.”
What are tumor boards and how will digitizing them help pathologists?
“Tumor boards are meetings in which a team of pathologists, medical and surgical oncologists, radiologists, nurses and other healthcare members gather to discuss patients’ tumor diagnosis and collectively design personalized treatment plans. Digitizing tumor boards will remove the hours of preparation time that involves slide pulling and reviews. Our Image Management Software (IMS) makes it easy to save images into a folder to present at these tumor boards. The slides and the patient reports are all together on the same platform, and so, accessing relevant portions of the report before and during tumor boards will be much easier.”
How many pathologists will be diagnosing cases digitally by the end of 2026?
“A modest estimate is four pathologists after our June launch but depending on how quickly we navigate to a seamless workflow and bring in more workstations, we could have six to seven pathologists using digital pathology by the end of 2026.”
Which sub-specialty is going to implement digital pathology first, and why?
“Gastrointestinal (GI) pathologists will be the first subspecialty to utilize digital pathology, largely because of the expressed interest of the group. GI biopsies also provide opportunities to scan tissue with various parameters, including single small tissue or multiple fragments. The next group likely to adopt digital are the breast pathologists, who are already planning to adopt AI tools for breast carcinoma diagnosis. Once we work through our initial groups, all subspecialties will follow.”
What has the response been from our clinical pathologists to the implementation of digital pathology?
“It has been largely positive! While the degree of enthusiasm ranges from nervous excitement to eager anticipation, everyone agrees that digital pathology is the future of the field, and I am grateful to be on this journey with a team of practitioners who are willing to use new tools to drive our clinical mission forward.”