Issues to Consider When Implementing Digital Pathology for Primary Diagnosis

To the Editor.—The implementation of digital pathology for primary diagnosis is getting traction in the United States, where it has been delayed compared with other countries. The momentum was propelled by the US Food and Drug Administration approval that was initially obtained by Phillips for its IntelliSite Pathology Solution in 2017, followed by the Leica Aperio AT2 DX Digital Pathology System in 2019. Recently, the challenges of carrying out diagnostic pathology safely during coronavirus disease 2019 (COVID-19) has made the benefits of digital pathology more evident and appreciated.

The United States can follow in the tracks of others, such as Retamero et al¹  from the department of Anatomical Pathology at Granada University Hospitals, who recently published the article “Complete Digital Pathology for Routine Histopathology Diagnosis in a Multicenter Hospital Network,” describing the implementation of the Philips IntelliSite Pathology Solution. That organization was able to rapidly achieve full adoption of whole slide imaging (WSI) for most of their routine work. In Canada, we implemented digital pathology for primary diagnosis in specific subspecialty areas in 2011,²  and in Sweden the Department of Pathology at Linköping University Hospital (Linköping, Sweden) achieved full adoption several years ago.³ 

We recognize the challenges that must be overcome when moving a large group of pathologists to adopt this new technology in a short period of time. The ability to do so provided the basis for the accrual of financial benefits and a positive return on investment as described by the Granada group.¹  However, the planning for digital pathology as a platform for primary diagnosis is not only a tool for that specific use that can replace the microscope and allow remote diagnosis. It also should be recognized as the foundation for ongoing innovation and improvements in pathology.

Those seeking to implement digital pathology must be aware of the differences between “open” and “closed” systems. As pathologists move into the reality of digital pathology, the selection of a system requires detailed understanding of the pros and cons of purchasing an “off-the-shelf” closed system that is “plug-and-play” but does not allow for the addition of alternate scanners, and limits choices and availability of image analysis algorithms and novel artificial intelligence applications.

Moreover, a challenge of some digital pathology implementations has been the difficulty of working in 2 systems, using the image management system (IMS) for viewing the WSI and the laboratory information system (LIS) for reviewing gross descriptions, ordering additional stains, and reporting. The ideal system must allow complete LIS-IMS integration to ensure the success of the move to digital pathology.^2,3 

Digital pathology is an opportunity to improve the outcomes of pathology by allowing access to the right pathologist for the right patient at the right time,²  but it also must be implemented in a way that allows quick and accurate morphometry⁴  and the development of algorithms that will assist pathologists in carrying out their responsibilities faster and with significantly lower risk of error.⁵  These additional benefits of digital pathology will enhance both the diagnostic acumen and the clinical value of anatomic pathology.