Digital Pathology Accelerates Research & Innovation, Improves Patient Care

Anil Parwani, MD, PHD, MBA: Anil Parwani, MD, PHD, MBA, views a digital pathology slide at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. This advanced technology helps to provide patients with faster and more accurate diagnoses.For the last year, hospitals and health care providers have been associated almost entirely with treating COVID-19 patients and fighting back against the pandemic. This shift in the national focus has led to a drastic decline in cancer screenings and treatments (Cancer 2020; https://doi.org/10.1002/cncr.33128). There's no evidence that the decline comes with any decrease in the rate of new cancer cases in the United States, however, so medical providers need to find a way to communicate to patients that the screenings and treatments they needed pre-pandemic are still necessary today. And when the screening reveals deeper investigation is needed, we need the most cutting-edge technology and the best processes in place to speed accurate diagnosis. In fact, at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), our diagnoses are faster and more precise than ever. Unfortunately, cancer doesn't slow down for COVID-19, so our team can't either. Since the onset of the pandemic, my colleagues and I have been able to utilize digital pathology workflows to continue our clinical reviews of cases, participate in tumor boards, as well as continue to participate in research programs—all due to the digital pathology program already in place at the OSUCCC - James. During the pandemic lockdowns, we were able to rapidly mobilize our digital pathology team so that we could continue providing the best care to our patients. Traditional pathology involves the processing of patient tissue in the lab, typically involving a glass slide containing tissue that pathologists view under a microscope. A diagnosis using this method is subjective and relies on the expertise and experience of the pathologist. It is also slow, often requiring the sharing of pathologic images to seek a second opinion. Digital pathology, on the other hand, improves in nearly every area. Also known as whole slide imaging, digital pathology replicates the information on the glass slide and pairs the virtual image with clinical information that gives pathologists all the critical details of the cancer they're working with. Pathologists can perform additional diagnostics like image analysis tests that are not possible with traditional glass slides. Images can be accessed, analyzed, and interpreted on a computer monitor remotely, with the ability to combine the pathologists' trained eye and predictive computer algorithms. I can look at an image and ask the computer to quantitate different types of features present in the sample. Historically, the manual version of this quantitative process with a microscope is more time-consuming, subjective, and prone to errors. We now have computer software programs that allow us to ask specific questions about the cancer. We can ask how many nuclei are in the field, how many show signs of cancer, the size and shape of the nucleus, and much more. This allows us to assess for prognostic and diagnostic markers more rapidly and accurately. These programs make the entire diagnostic process more objective and standardized, and could not be easily replicated by looking at a slide under a microscope. In addition to these benefits, digital pathology improves education and research. The process allows for images to be used in presentations at clinical conferences or in teaching residents, fellows, and other pathologists. We can create an archive of patient slides that is instantly available to anyone who can learn from it. Using this technology, we're making particularly exciting strides in colon cancer research. By digitizing the slides of our patient population, we're creating a large, annotated database of colon cancer images that are directly linked to patient information, treatment, outcomes, therapy, and genetic changes. It's a very powerful tool that allows for significant research opportunities. Without the digitization of our glass slides, this kind of database would require us to physically look back at each individual slide, a process that would be tedious and time-consuming. We also wouldn't be able to achieve standardization across institutions. Instead, we're creating an inter-institutional archive of images that can be easily shared, helping lead to unique colon cancer methodologies. Because of the ease of accessing this information, colon cancer research has accelerated rapidly. We now understand colon cancer's association with inflammation and can ask the computer to quantitate images of a patient's colon cancer relative to inflammation, allowing for a more objective review. The process has truly revolutionized how pathology is used to diagnose cancer and has even opened up new research opportunities. At the OSUCCC - James, we're honored to be at the forefront of implementing this technology for our patients. To date, the digital pathology team has scanned nearly 2 million slides—including 10 years of patients treated or followed by OSUCCC - James physicians and current patients starting in March 2018. Forty-one members of the pathology faculty are approved to use digital pathology for clinical diagnosis. We've been developing and implementing this process since 2017 and, coincidentally, many of its benefits are perfect for improving care and taking precautions amid the COVID-19 pandemic. No longer do pathologists need to gather around a microscope or transfer slides in person to assess a patient. Instead, this process can be completely digital, requiring less close contact with our colleagues. The ease and digitization of the process also allows for easier consultation with experts, which produces quicker results for our patients. It also can potentially reduce the number of days patients would spend in the hospital waiting for a diagnosis. At the OSUCCC - James, we hope the success of our digital pathology integration can serve as an example to other health systems. With an increased focus on making this transition, we can continue to accelerate research and innovation, improving outcomes for our patients and taking advantage of an increasingly digital world. ANIL PARWANI, MD, PHD, MBA, is Professor of Pathology at The Ohio State University, serving as the Vice Chair and Director of Anatomical Pathology. He is also the Director of Pathology Informatics and Director of the Digital Pathology Shared Resource at the OSUCCC - James. His research is focused on diagnostic and prognostic markers in bladder and prostate cancer, and molecular classification of renal cell carcinoma.