Abstract
Digital pathology is on the verge of becoming a mainstream option for routine diagnostics. Faster whole slide image scanning has paved the way for this development, but implementation on a large scale is challenging on technical, logistical, and financial levels. Comparative studies have published reassuring data on safety and feasibility, but implementation experiences highlight the need for training and the knowledge of pitfalls. Up to half of the pathologists are reluctant to sign out reports on only digital slides and are concerned about reporting without the tool that has represented their profession since its beginning. Guidelines by international pathology organizations aim to safeguard histology in the digital realm, from image acquisition over the setup of work-stations to long-term image archiving, but must be considered a starting point only. Cost-efficiency analyses and occupational health issues need to be addressed comprehensively. Image analysis is blended into the traditional work-flow, and the approval of artificial intelligence for routine diagnostics starts to challenge human evaluation as the gold standard. Here we discuss experiences from past digital pathology implementations, future possibilities through the addition of artificial intelligence, technical and occupational health challenges, and possible changes to the pathologist’s profession.
Highlights
Histopathology is a diagnostic discipline founded on the visual interpretation of cellular biology captured in images
Up to half of the pathologists are reluctant to sign out reports on only digital slides and are concerned about reporting without the tool that has represented their profession since its beginning
Digital Pathology (DP) has shown exciting results for primary histopathological diagnoses, even more so with AI applications becoming embedded into the digital reporting work-flow
Summary
Histopathology is a diagnostic discipline founded on the visual interpretation of cellular biology captured in images. Digital images and video streams can be shared in real-time, bridging physical distance (telepathology) between local hospitals, colleges (second-opinion), teachers and students, and between home and workplace (home-office). They can be superimposed or linked beyond what physical glass slides would permit to facilitate spatial correlation across slides and stains. Remote viewing access requires sufficient data bandwidth (typically > 10 Mbit/s) and low latency for smooth operation. This can add up to considerable IT-capacity requirements in large pathology departments. The assessment of slides for polarization effects (e.g., amyloid, weddelit) cannot be performed on digital slide scans and necessitates evaluation from glass slides
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