Digital methods in pathology — the future is already here
Vera Timmermans Wielenga, Ben Vainer · Apmis · 2012
Steve Jobs has excellently demonstrated that even the most complicated technologies can become an everyday commodity. How will the digital revolution affect pathology in the next 10 years? Will the light microscope survive this revolution? Will we still use glass slides or will the process be replaced by an advanced form of scanning of tissue? Will pathologists download whole slide images from a server and navigate through the specimen on a touch screen? Will CT scans replace hands-on post-mortem examinations? Will a pathology report include thumbnail images of the morphology and of relevant staining? In short, how will the current analogue system adapt to this exploding digital development? Pathology departments generate a vast amount of information and knowledge when diagnosing a large spectrum of diseases on glass slides, after which the slides disappear into the archive, almost never to be retrieved. It seems such a waste. Digital archiving would give us the opportunity to use this knowledge again and again, not only for teaching purposes but also for comparison and validation in daily diagnostic practice. Digitalization may be used not only to create and view an image but also to open up the possibility of storing and retrieving additional information about the diagnostic process for quality assessment and education. We can readily imagine that digital pathology will be included in national and/or international guidelines stating that rare diseases should be assessed by panels of specialists around the world. We anticipate that patients will want their specimens to stand the test of these international expert groups. According to the reviews presented in this issue, this is a realistic possibility. As with all new technologies, digital imaging and analysis has stimulated our inquisitive minds. In scientific experiments, digital analysis has demonstrated a unique accuracy and has allowed quantification of tissue components not previously possible. Respecting standardization and reproducibility, it appears that specific digital image analysis solutions are especially well suited for assessment of several of the analyses currently performed on tissue sections, thus avoiding the bias of the human brain. Regardless of the number of pixels in a digital image, it will never be identical to the analogue image, which is probably why the pathology community still expresses concern regarding total replacement of the glass slide and light microscope with the scanner and screen. However, as is pointed out in this special issue of APMIS, it seems that modern slide scanners in combination with modern computer screens are able to produce images that are almost impossible to distinguish from those seen through the microscope. We are very grateful to our esteemed colleagues for taking their valuable time to enlighten our readers with their views on the past, present and future of these evolving technologies. Although digital imaging adds another step to an already complex process and still faces some serious quality issues when compared to conventional light microscopy, the advantages of digitalization of pathology specimens, both for diagnostic and scientific use, are overwhelming. In light of increasing demands for transparency in medical care, the introduction and implementation of digital pathology would appear mandatory.