Digital pathology now, and where to from here

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December 2022—Nearly 800 registrants were at the Digital Pathology Association’s Pathology Visions meeting this fall, and 54 companies exhibited. “There was a great vibe at the meeting. People were mingling, collaborative. Digital pathology is picking up,” says DPA president Esther Abels. Her term as president will end this month and Liron Pantanowitz, MD, PhD, MHA, of the University of Michigan, will step in as president on Jan. 1.

Both spoke with CAP TODAY publisher Bob McGonnagle in October after the meeting (in separate conversations) about digital pathology and artificial intelligence, and Dr. Pantanowitz shared what is at the top of his agenda for the DPA that is now more than 3,000 members strong.

Next year’s Pathology Visions meeting will take place Oct. 29–31 in Orlando.

The Pathology Visions meeting was said to be the most successful thus far, with a large uptake of exhibits and people in attendance. What is your characterization of the meeting?

Dr. Pantanowitz

Liron Pantanowitz, MD, PhD, MHA, professor of pathology and director of the Division of Anatomic Pathology, University of Michigan: It was enormously successful and had the largest attendance in number of participants, including exhibitors, which reflects the emphasis being given to digital pathology. A large component was artificial intelligence, which reflects the hype around it and the many AI startup companies and the interest labs have in artificial intelligence, which serves as a catalyst.

Several factors contributed to its success. One, it was one of the first in-person and not hybrid meetings post-COVID, and people wanted to connect. Two, there was a larger-than-usual number of pathology trainees at the meeting. For the first time I saw a large number of posters and many people applying for travel awards. It’s good that we’re reaching not just the pathology community but also trainees; it helps push the science.

I also saw a lot of business meetings. Some partnerships caught my eye that I hadn’t thought about coming together. The venue not only promoted the field but also brought people in, so the networking and business opportunities were good.

The scientific content is also good, as usual. The show has moved from a show-and-tell vendor meeting to a full-on scientific meeting.

I was surprised that pathologists were only about 19 to 20 percent of all attending. It means a lot of other people are interested in digital pathology besides pathologists—certainly vendors, exhibitors, and industry but also veterinary people, scientists, computer scientists, and others.

Quite a few laboratory executives attended, which shows that digital pathology is becoming more mainstream in the thinking of health systems and departments. In the early days and for a number of years, it seemed like digital pathology interests were talking to one another and not to too many others. But we’re well along the adoption curve now. Can you comment on that?
Dr. Pantanowitz: If one thinks of the Gartner hype cycle, where new technology is introduced, then you move to the top, where everyone’s excited, and then you hit the trough of disillusionment—I think we’re back to a plateau phase and it’s mainstream. The people who attend now no longer see digital pathology as a niche. They see it as a technology with tools that support the practice of pathology itself. It’s not special; you just can’t do what you want to do—strategize, plan for the future, and address some of the needs in medicine today—without using these tools. There are people who are less interested in the tools and more interested in the application to the practice of pathology, whether it’s on the research or clinical side.

I saw an announcement that Tribun Health and GE Healthcare are going to collaborate, with GE Healthcare excited about digitizing pathology images and having pathology in its oncology offering. That is another milestone in digital pathology. There is an increasing interest, based on press releases and what I’m hearing from people, in companies coming together to offer what I might call a critical mass of solutions and one-stop shopping, not only for digital pathology and its many components but also in combination with AI. Can you speak about that and where we are today?
Dr. Pantanowitz: There are good and bad aspects to the vendors coming together to offer an interoperable solution. One of the main barriers in this field up front was, number one, these systems are not interoperable. They do not interface or interact with each other well. The burden was often left on the client to get systems to fit together and plug and play.

Second is we didn’t push standards—for their own with proprietary software, such as viewers, file formats, et cetera. It’s nice to see the industry players coming together to provide an end-to-end solution. However, it speaks to the fact that there are few vendors that provide an end-to-end solution. And the criticism of those that do is they have locked-down systems. They don’t want anyone else to plug into their systems, which is not a great environment in which to practice. It’s still a patchwork. Although they may shake hands on the exhibit floor to work together, when you try to deploy it, it’s still not easy and doesn’t work well. A lot of burden falls to the lab itself. I’m not complaining—we’re moving in the right direction, but maybe not enough.

In terms of more industry discussion, collaboration, and agreement, we still have well-known financial challenges in digital pathology. And part of that is, will there be room for huge success for multiple vendors or will we need to have alliances, even consolidation, of vendors and offerings, just to have the financial throwaway to survive? Do you think that’s a plausible theory?
Dr. Pantanowitz: I’m never in favor of monopolies because not everyone can use them, prices are higher, and they’re often less flexible in customizing to clients’ needs. I am in favor of a much broader offering of hardware and software solutions, which is where we are now, even though we need to get them connected. It’s interesting we have both in the field of digital pathology—some monopolies that have been around for a while and many smaller vendors that are coming up with alternative, novel solutions.

What amazed me at the meeting was there were vendors whose names or products I’d never seen, and the products were quite mature. And yet I’m involved in the field, connected, on several subcommittees, and vendors talk to me about their products. It’s good to see innovation still happening and that the field’s not stagnant.

Digital pathology took off in Europe in particular when there was a serious shortage of surgical pathologists, and digital pathology, whatever its expense or technical challenges, was proving to be a solution to the shortage. Do you think some of the current excitement around digital pathology in the United States is owing to what is now a severe shortage of surgical pathologists in the U.S.?
Dr. Pantanowitz: Some of it is. But COVID has also been a catalyst in that pathologists can now work from home. And some of the folks in leadership roles see the business-use case in using telepathology to support their businesses—regional centers of excellence, peripheral networks of pathologists to get cases read out. It doesn’t make sense for large reference labs and large, interconnected health care systems to ship slides around.

The narrow margin in health care is also forcing this. Why have redundant labs? Let’s use technology. You need just one central histology lab and several pathologists working remotely as opposed to giving every pathologist their own histology lab with their own slides in the room next door. That doesn’t make sense anymore. People have been looking to find their return on investment, and now they have found a business opportunity. It’s hard to get pathologists, especially senior pathologists, to come into labs every day. So why not let them sign out remotely?

It makes sense even for academic medical centers to go digital, because who wants to train at a center that has instruments they were using a century ago? Medical students don’t want to go into something that’s archaic; they want something sexy, modern, attractive. Trainees are looking for programs that are digital. They make sure they have looked at their program and checked off “Do they have digital capability? Will I be trained for the future?”

Do you have a fair number of senior or associate professors in pathology at Michigan who are doing remote sign-out?
Dr. Pantanowitz: We have a minority—about three people have signed out from home.