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Raymond D. Aller, MD & Hal Weiner

Digital pathology: from education to implementation

July 2019—Matthew Hanna, MD, is well aware that not all pathologists embrace the idea of using digital pathology for clinical applications. “I’m very confident it’s a familiarity issue,” says Dr. Hanna, clinical instructor in breast pathology and informatics at Memorial Sloan Kettering Cancer Center.

Once pathologists become accustomed to digital slide viewers and images, he contends, they’ll trust the technology’s accuracy. “The first step [for laboratories] is engaging pathology staff by giving access to digital pathology resources.” Fortunately, adds Dr. Hanna, who presented an overview of educational resources for digital pathology at the Healthcare Information and Management Systems Society’s annual meeting in February, recent improvements in digital pathology software interoperability and cloud computing have made it much easier to explore digital pathology content.

Dr. Hanna

Historically, Dr. Hanna explains, digital slide vendors have had proprietary file formats. But newer digital slide software can open files from all the major digital software vendors. And increased interoperability in digital pathology software has led to a corresponding increase in Web-based educational content.

Academic institutions and third-party software vendors have been developing open-access, Web-based whole slide image libraries, he says. These collections use Web interfaces that allow users to view digital pathology content without purchasing or installing digital slide software. “The beauty of having these [resources] available on the Web,” Dr. Hanna notes, “is there are no installations or plug-ins and no need to download any of the image files, which can take hundreds of megabytes to gigabytes of storage space.” (See “A killer app comes out of the crowd.”)

One place pathologists can search for these resources is the Digital Pathology Association website, which maintains a whole slide imaging repository and digital education offerings. The repository, which features static and whole slide image libraries from academia, industry, and independent sources, includes descriptive summaries of the libraries and indicates whether collections are free or subscription based.

As an instructor, Dr. Hanna often references the DPA’s digital slide repository, which contains whole slide images from a variety of sources. “It’s far easier to find images of specific pathologies by performing a text search for a diagnosis [on these sites] than to look for a static image in a textbook,” he says.

Other resources in the DPA’s repository, such as Pathobin, In Slice, and PathPresenter, allow users to create digital pathology content. PathPresenter, for example, is a Web-based platform for organizing digital pathology assets and creating presentations that pathologists can use for conferences and tumor boards, says Dr. Hanna, who is a member of PathPresenter’s medical advisory board. The platform’s library, which is searchable by diagnosis and pathology subdiscipline, contains more than 14,000 images crowdsourced from its user base of pathologists worldwide.

PathPresenter also provides educational modules that can be used to practice reading digital slides. The dermatopathology module, for example, gives a comprehensive summary of each of the critical diagnoses in skin pathology and whole slide images for each, Dr. Hanna explains. Users can follow hyperlinks to zoom in on specific regions of interest within each slide that correspond with diagnostic criteria.

Pathology departments should engage staff with digital pathology educational content on a regular schedule and not on an ad hoc basis, Dr. Hanna says. Among the resources that promote regular education is the CAP’s “Case of the Month,” which includes a digital slide image for a case, clinical history, and quiz questions. The DPA and National Society for Histotechnology also offer a Web-based digital pathology certificate program designed to provide both a broad overview of digital pathology and a deep dive into the details.

First, pathology departments need to identify what resources are available to them, Dr. Hanna explains. Then they need to leverage technologies that fit their workflow. Laboratories without established digital pathology teams may want to bring in an expert from another institution to advise on initial educational steps or send a staff member to visit a pathology lab that’s already worked through the challenges of implementing digital pathology on a large scale, he says.

Take Memorial Sloan Kettering, for instance, says Dr. Hanna, who helped expand the cancer center’s digital pathology operations more than a decade ago. An interface between the center’s digital pathology system and Cerner lab information system pulls slide images into patient records, allowing pathologists to use digital slide images for retrospective and archived cases. As a result, he explains, Memorial Sloan Kettering has significantly reduced the number of glass slide retrieval requests.