A killer app comes out of the crowd

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Consequently, Dr. Balis is optimistic that HistoQuery, if widely adopted, could become the “entry point to a larger scale opportunity involving computation and machine learning.” Theoretically, crowdsourcing tools such as HistoQuery have the potential to generate statistics about the population of a given rare disease entity much more quickly and easily than other methodologies. Therefore, if the global community adopts HistoQuery en masse, Dr. Balis says, the tool could become “a publicly curated repository of rare cases” that could be used by machine-learning experts to train algorithms to assist pathologists in rendering suggested diagnoses for rare cases.

“The most difficult part of machine-learning activities,” Dr. Balis continues, “is generating the curated datasets needed for training, particularly with rare cases. The beauty of this crowdsourcing vehicle is you get rare cases in tandem with the crowdsourced wisdom of the most likely diagnosis. It’s everything you need to create a curated training repository.”

Dr. Friedman

Bruce Friedman, MD, emeritus professor of pathology at the University of Michigan, agrees. “As the creater of HistoQuery,” Dr. Friedman says, “Dr. Balis doesn’t want to be in a position to speculate about how the tool might be used in the future [for other than training purposes]. I’m not encumbered by any of those same restrictions.”

Dr. Friedman, who also was not involved in developing HistoQuery, is interested in how the tool can be used by practicing pathologists. If the site attracts a sufficient amount of traffic, he says, surgical pathologists could use crowdsourcing in a very practical way to buttress convictions about a particular case in their daily work queue. “A practicing pathologist would never use this tool for a challenging case where he or she didn’t already have a good idea of the diagnosis or for which they required a consultation by a national expert,” he continues. Therefore, he’s not suggesting that HistoQuery would replace the services of consulting pathologists. However, it could provide diagnostic support in cases where a surgical pathologist is already fairly certain of the diagnosis.

Dr. Friedman too imagines the tool could have global health implications, particularly in developing countries with an acute shortage of pathology services. By using HistoQuery, he says, clinicians in those countries would, at the very least, receive a crowdsourced diagnosis from the international community.

“Dr. Balis is appropriately calling this a teaching tool, for now,” Dr. Friedman says. And in this capacity, he adds, HistoQuery has the potential to provide rich material for pathology training programs in smaller hospitals. “Someone who trains in pathology at a prestigious institution will come across a broad array of unusual cases,” he explains. “As part of the curriculum, it could be stipulated that residents at [smaller hospitals] review cases submitted to HistoQuery on a continuing basis, which, in turn, would expose them to a broader array of cases.”

In every subspecialty, says Dr. Owens, picking up the thread of the conversation, there are tricky diagnoses that even the experts routinely have trouble with—in gastrointestinal pathology, a good example is the grading of dysplasias in precancerous conditions of the esophagus, such as Barrett’s esophagus. “We see thousands of those cases here [at the University of Michigan],” he explains, “but there are places where pathologists don’t have that opportunity.” HistoQuery, he adds, could expose trainees and pathologists to a greater array of such cases.

To this end, Dr. Owens conducted a test of the site’s usefulness by submitting a deidentified image from his caseload. He had already secured a consult on the image, a case of fungal infection in the GI tract, from a colleague who sub-subspecializes in such contagions. While some of the answers submitted to HistoQuery differed from what he knew to be the correct diagnosis, the accurate response received the majority of the votes.

Dr. Owens foresees situations in which pathology departments use Histo­Query for intramural consultations as well, particularly institutions that have buildings throughout a city, with experts in different subspecialties located blocks or miles from each other. In that situation, HistoQuery could be used to poll various specialists on a case more quickly and easily than via email.

Taking its potential use a step further, Drs. Owens and Friedman concur that HistoQuery could be integrated into a laboratory’s quality assurance practices. Laboratories might “upload one in 10 cases to HistoQuery” and receive a “sufficient number of crowdsourced diagnoses to function as a QA tool,” Dr. Friedman says.

Dr. Balis is quick to acknowledge that it was the programming team in Michigan’s Division of Pathology Informatics that allowed such possibilities for HistoQuery. The site, he explains, uses much of the same code as PathTrack, the real-time geospatial pathology specimen tracking system the University of Michigan implemented last summer. (See “For one laboratory, a workflow transformation,” CAP TODAY, June 2018, www.captodayonline.com.) “The good news is [the team] was already primed on how to build an ultra-high concurrency application that works in real time. Building this tiny little application was child’s play compared to PathTrack,” he says with a laugh.

HistoQuery, he adds, could not have been completed so quickly if Michigan’s Department of Pathology didn’t have its own full-stack IT development team—evidence he uses to make the case that pathology departments should maintain at least some degree of independent programming capability. “Great ideas come along in every department. If you’re entirely dependent on central IT and you tell them you want to finish a project in eight weeks, they’re going to look at you like you’ve got three eyes,” he says, half-joking.

Dr. Balis sought to develop and release HistoQuery in a short time frame because he envisioned it fulfilling an urgent and fundamental need. “It crossed my mind that if the tool could be implemented correctly, you would have one of the so-called killer apps for pathology education which needs to exist but doesn’t.”

Adds Dr. Friedman, “He’s the expert in this. If he calls it a killer app, I’ll call it a killer app.”

Charna Albert is a writer in Chicago.