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Digital Pathology Resource Guide

Table of Contents

Current and Emerging Applications of Digital Pathology

This section includes the following topics:

Digital Pathology is primarily used as a tool that pathologists can incorporate into their workflows. Reasons for adoption vary by practice setting.

Interviews with Digital Pathology and WSI experts identified several current/emerging application areas for this technology which can be seen in the table below.

Current Patient Care Application

Description

Frozen Section Interpretation

Remote interpretation of a frozen section slide(s) via digital pathology

Digital Image Analysis

Automated interpretation of IHC (e.g. HER2, ER/PR) or ISH assays, the automated algorithms that quantify intensity or percent positivity, rare events, etc.

Intra-practice

Consultation within a practice; e.g. sending slide to a sub specialty pathologists within the practice

Archiving

Fast and convenient slide retrieval; back-up documentation for legal purposes; comparison with previous biopsies; preservation of virtual slides in which tissue may be used for testing (e.g. molecular)

Diagnostic Pathology Report

WSI links in traditional pathology reports; incorporation of WSI into integrated reports; incorporation of WSI into hospital EMR

Consultation/ Expert Second Opinion

Expert 2nd opinion of challenging cases by national or international expert pathologists (between practices)

Quality Assurance

More conventional slide sharing and re-reads; allows for a robust QA system for auto-selection of random cases; tracking of slide review to ensure all areas of virtual slides are assessed

Clinical Conferences

Use of DP to present cases at tumor boards or pathology conferences

Emerging Patient Care Application

Description

International In-sourcing

Slides received digitally from an international source based upon a partnership whereby the US pathologist is viewing the slides for primary diagnosis and/or consultation


Future Patient Care Application

Description

Multiplex High-Medical Value Assays

Multiplex assays delivering prognostic or companion diagnostics information through analysis of multiple analytes simultaneously on a slide

Computer Aided Diagnosis

Automated interpretation of H&E stains (e.g. mitotic figures, rare event detection)

Primary Diagnosis

Primary histopathologic diagnosis rendered from digital rather than glass slide; May be limited to specific types of practice settings, such as a remote hospital or a clinic with insufficient volume to support an on-site pathologist or sub specialty practices that are at different locations (FDA has not yet approved WSI for primary diagnosis; see Section 8)

Source: CAP’s Module 4 Case for Change

Suggested Articles and Resources

  • A) Review of Advanced Imaging Techniques
    Chen Y, Liang C-P, Liu Y, Fischer AH, Parwani AV, Pantanowitz L. Review of advanced imaging techniques. J Pathol Inform. 2012; 3:22. doi: 10.4103/2153-3539.96751.
    Free full text available from PubMed
    PMID: 22754737
    NOTE: Also cited in Section 7.4
  • B) Increasing Specimen Coverage Using Digital Whole-Mount Breast Pathology: Implementation, Clinical Feasibility and Application
    in Research
    Clarke GM, Peressotti C, Constantinou P, Hosseinzadeh D, Martel A, Yaffe MJ. Increasing specimen coverage using digital whole-mount breast pathology: Implementation, clinical feasibility and application in research. Computerized Medical Imaging and Graphics. 2011;35(7-8):531-541. doi: 10.1016/j.compmedimag.2011.05.002.

    Full text available from Computerized Medical Imaging and Graphics (USD 31.50 for 24 hour access)
    PMID: 21652176
  • C) Digital Imaging in Pathology
    Park S, Pantanowitz L, Parwani AV. Digital Imaging in Pathology. Clin Lab Med. 2012; 32(4): 557-84. doi: 10.1016/j.cll.2012.07.006.

    Full text available from Clinics in Laboratory Medicine (USD 31.50)
    PMID: 23078660
    NOTE: Also cited in Section 7.4
  • D) Computer Aided Diagnostic Tools Aim to Empower Rather than Replace Pathologists: Lessons Learned from Computational Chess
    Hipp J, Flotte T, Monaco J, et al. Computer aided diagnostic tools aim to empower rather than replace pathologists: Lessons learned from computational chess. J Pathol Inform. 2011;2:25. doi: 10.4103/2153-3539.82050.

    Free full text available from PubMed
    PMID: 21773056
  • E) Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees
    Morrison AS, Gardner JM. Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees. Arch Pathol Lab Med. 2014;138(8):1002. doi: 10.5858/arpa.2013-0425-ED.
    No summary available.
    Free full text available from the CAP’s Archives
    PMID: 24199830
  • F) An Ultra-high Speed Whole Slide Image Viewing System
    Yagi Y, Yoshioka S, Kyusojin H, et al. An ultra-high speed Whole Slide Image viewing system. Anal Cell Pathol (Amst). 2012;35(1):65-73.
    Free full text available from PubMed
    PMID: 22925804
Table of Contents Table of Contents

Current and Emerging Applications of Digital Pathology

This section includes the following topics:

Digital Pathology is primarily used as a tool that pathologists can incorporate into their workflows. Reasons for adoption vary by practice setting.

Interviews with Digital Pathology and WSI experts identified several current/emerging application areas for this technology which can be seen in the table below.

Current Patient Care Application

Description

Frozen Section Interpretation

Remote interpretation of a frozen section slide(s) via digital pathology

Digital Image Analysis

Automated interpretation of IHC (e.g. HER2, ER/PR) or ISH assays, the automated algorithms that quantify intensity or percent positivity, rare events, etc.

Intra-practice

Consultation within a practice; e.g. sending slide to a sub specialty pathologists within the practice

Archiving

Fast and convenient slide retrieval; back-up documentation for legal purposes; comparison with previous biopsies; preservation of virtual slides in which tissue may be used for testing (e.g. molecular)

Diagnostic Pathology Report

WSI links in traditional pathology reports; incorporation of WSI into integrated reports; incorporation of WSI into hospital EMR

Consultation/ Expert Second Opinion

Expert 2nd opinion of challenging cases by national or international expert pathologists (between practices)

Quality Assurance

More conventional slide sharing and re-reads; allows for a robust QA system for auto-selection of random cases; tracking of slide review to ensure all areas of virtual slides are assessed

Clinical Conferences

Use of DP to present cases at tumor boards or pathology conferences

Emerging Patient Care Application

Description

International In-sourcing

Slides received digitally from an international source based upon a partnership whereby the US pathologist is viewing the slides for primary diagnosis and/or consultation


Future Patient Care Application

Description

Multiplex High-Medical Value Assays

Multiplex assays delivering prognostic or companion diagnostics information through analysis of multiple analytes simultaneously on a slide

Computer Aided Diagnosis

Automated interpretation of H&E stains (e.g. mitotic figures, rare event detection)

Primary Diagnosis

Primary histopathologic diagnosis rendered from digital rather than glass slide; May be limited to specific types of practice settings, such as a remote hospital or a clinic with insufficient volume to support an on-site pathologist or sub specialty practices that are at different locations (FDA has not yet approved WSI for primary diagnosis; see Section 8)

Source: CAP’s Module 4 Case for Change

Suggested Articles and Resources

  • A) Review of Advanced Imaging Techniques
    Chen Y, Liang C-P, Liu Y, Fischer AH, Parwani AV, Pantanowitz L. Review of advanced imaging techniques. J Pathol Inform. 2012; 3:22. doi: 10.4103/2153-3539.96751.
    Free full text available from PubMed
    PMID: 22754737
    NOTE: Also cited in Section 7.4
  • B) Increasing Specimen Coverage Using Digital Whole-Mount Breast Pathology: Implementation, Clinical Feasibility and Application
    in Research
    Clarke GM, Peressotti C, Constantinou P, Hosseinzadeh D, Martel A, Yaffe MJ. Increasing specimen coverage using digital whole-mount breast pathology: Implementation, clinical feasibility and application in research. Computerized Medical Imaging and Graphics. 2011;35(7-8):531-541. doi: 10.1016/j.compmedimag.2011.05.002.

    Full text available from Computerized Medical Imaging and Graphics (USD 31.50 for 24 hour access)
    PMID: 21652176
  • C) Digital Imaging in Pathology
    Park S, Pantanowitz L, Parwani AV. Digital Imaging in Pathology. Clin Lab Med. 2012; 32(4): 557-84. doi: 10.1016/j.cll.2012.07.006.

    Full text available from Clinics in Laboratory Medicine (USD 31.50)
    PMID: 23078660
    NOTE: Also cited in Section 7.4
  • D) Computer Aided Diagnostic Tools Aim to Empower Rather than Replace Pathologists: Lessons Learned from Computational Chess
    Hipp J, Flotte T, Monaco J, et al. Computer aided diagnostic tools aim to empower rather than replace pathologists: Lessons learned from computational chess. J Pathol Inform. 2011;2:25. doi: 10.4103/2153-3539.82050.

    Free full text available from PubMed
    PMID: 21773056
  • E) Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees
    Morrison AS, Gardner JM. Smart Phone Microscopic Photography: A Novel Tool for Physicians and Trainees. Arch Pathol Lab Med. 2014;138(8):1002. doi: 10.5858/arpa.2013-0425-ED.
    No summary available.
    Free full text available from the CAP’s Archives
    PMID: 24199830
  • F) An Ultra-high Speed Whole Slide Image Viewing System
    Yagi Y, Yoshioka S, Kyusojin H, et al. An ultra-high speed Whole Slide Image viewing system. Anal Cell Pathol (Amst). 2012;35(1):65-73.
    Free full text available from PubMed
    PMID: 22925804
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