Digitization of Pathology Specimens Allows for Improved Workflow and Incorporation of Advanced Techniques

MedicalResearch.com Interview with:|
Dr. Wendy L. Frankel, MD. Kurtz Chair and Distinguished Professor and
Dr. Anil Parwani, MD, PhD, MBA, Associate Professor
Wexner Medical Center
The Ohio State University

MedicalResearch.com: What is the background for this work? How does digital pathology differ from traditional H/E specimens?  Is there is different processing method?  Difference in prep time or costs?

Response: Traditional pathology involves patient tissue coming to the lab and being processed. The end result is a glass slide with a stained tissue that pathologists use under a microscope. The process in digital pathology is the same, up until the point right after when the glass slide is made. In digital pathology, we put the glass slide under a scanner instead of under a microscope. The scanner creates a large file image that can be reviewed remotely by pathologists around the world.

The advantage of digital pathology, and the reason we are doing this at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), is because when the slide is digitized, the image can be rapidly shared with an expert for review, or another institute that the patient may be going to. In addition, I can look at the image and ask the computer to quantitate different types of features that are present in the sample. While this has historically been done manually with a microscope, it’s been a more subjective process that is open to human error.

On top of that, we now have computer programs that allow us to ask very specific questions about the sample. For example, we can ask how many nuclei are in the field, how many of the nuclei show signs of cancer, and the size and color of the nucleus. These programs make the whole diagnostic process more objective and standardized. This is something we just can’t do by looking at a glass slide under a microscope.

Finally, you can also use these images for presentations at clinical conferences or for teaching residents, fellows or other pathologists. You now have the means to create an archive of patient slides and have it instantaneously available.

MedicalResearch.com: How are you using digital pathology in colon cancer diagnosis and research?  Does digital pathology allow for better access to special stains or immunotesting? 

Response: For colon cancer research there are several things going on in the world of colon cancer. First, we are digitizing the slides for this patient population. In other words, we are creating a large, annotated database of colon cancer images, which are directly linked to patient information, treatment, outcomes, therapy and genetic changes. That information, along with the digital images, makes this a very powerful tool.

If we didn’t digitize, we would have a database that would require us to physically look at each individual slide, which can be very tedious. We also wouldn’t be able to achieve standardization across institutes. We are creating an inter-institutional archive of images that can be easily shared, allowing for unique colon cancer methodologies.

Because you can now download the information, colon cancer research has accelerated rapidly. For example, one of the things we can now understand about colon cancer is its association with inflammation. We can ask the computer to quantitate pictures in a patient’s colon cancer in relation to inflammation, allowing for the sample to be much more objectively reviewed. On a glass slide, this would be very challenging to do because you wouldn’t be able to share the slides due to there only being one copy. When it’s digitized, you have multiple copies so you can share them and assess them easier.

This technology allows us to compare a patient’s biopsies side-by-side, which is something you cannot do easily on a glass slide. 

MedicalResearch.com: What should readers take away from your report? 

Response: This is a powerful tool that allows researchers to share images quickly and easily, advancing medicine and providing important diagnostic decisions for patients. The end result is a very objective and accurate estimate and understanding of the extent of the cancer, and a standardization across different institutions. This will help get patients, researchers, oncologists and pathologists on the same page, and allow them to collaborate and use the technology to improve patient care and research. 

MedicalResearch.com: What recommendations do you have for future research as a result of your work?

Response: We hope to increase the number of patients we have scanned so that we have a large database to apply artificial intelligence on so we can have the computer easily recognize traits and better spot colon cancer or prostate cancer.

We want to keep learning from these features so when we encounter a new and rare tumor, we can feed this into the computer and ask for measurements to be done accurately and effectively. In order to better understand how tumors progress, we need a large number of patients scanned and recognized so we can build very powerful, accurate research. 

MedicalResearch.com: Is there anything else you would like to add?

Response: In summary, digital Pathology including whole slide imaging (WSI) has the potential to make the pathology workflow and reporting a more robust and dynamic process with many advanced features including incorporation of image analysis and computer-aided diagnosis using artificial intelligence.  The process of “digitization” should be viewed as an opportunity to truly advance a pathology practice leading to an improvement in the pathology reporting process as well as improving patient care.

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