Amid growing demands by healthcare systems and the acute disruptions caused by the COVID-19 pandemic, many clinical labs in the Asia Pacific region are adopting digital pathology systems to improve workflows, serve patients better and ensure continuity of care even amid lockdowns, quarantines and other pandemic response measures.

To understand how labs can get started on the path to digital pathology implementation, we spoke with Dr Robert Y. Osamura, MD/PhD, Chief of the Diagnostic Pathology Department at Nippon Koukan Hospital in Japan and President Elect of the International Academy of Pathology (IAP). He offered three key takeaways about using digital pathology.

Be Open to New Approaches

Pathologists tend to be conservative and often prefer to keep using the equipment that’s familiar to them, but Dr Osamura believes there are good reasons to consider a digital approach.

“On the screen, we can see the entire image in a single glance, no matter how the pieces are scattered around on the slide,” he says, noting that it is possible to miss important areas when looking through a microscope. “We can go up to high magnification without any blurring, and come back to a particular fragment any time we want.”

When applying this new approach, Dr Osamura finds that concordance between digital images and slides is excellent. In comparison studies, he found a perfect match in 90% of cases. The few examples of differing results came not from major discrepancies in overall diagnosis (benign vs malignant) but from the degree of dysplasia detected. He also noted that Helicobacter pylori detection may be sometimes difficult on the image.

Due to regulations in Japan that require microscope confirmation for diagnoses made from most digital pathology platforms (unless approved by government), Dr Osamura and his team double-check all of their digital pathology calls with conventional techniques. He hopes the government will expand its approval to more digital pathology platforms, as this would allow pathologists to make diagnoses directly from digital images without additional follow-up.

Start with Targeted Use

As a starting point, Dr Osamura implemented digital pathology at Nippon Koukan Hospital, but only for certain types of specimens. This is a good way for a lab to evaluate digital pathology without having to make a large commitment, and it can make it easier for pathologists to get used to the hands-free approach.

Since small gastrointestinal biopsies make up about 60% of the pathology lab’s daily workload (depending on the institution), these are all reviewed with digital pathology first, followed by confirmation on slides as required by the government. Dr Osamura does not yet use this approach for surgical specimens, though he does plan to expand the digital pathology practice to those samples. “I hope we go more digital in the near future,” he says.

Learn from the COVID-19 Experience

For labs in regions that had shelter-in-place orders, the value of being able to make a diagnosis without being physically present in the lab became clear. While Dr Osamura’s lab was not subject to a lockdown, his colleagues in the U.S. and other countries were. “I heard of a good number of pathologists staying at home and using digital pathology to make diagnoses remotely,” he says.

Even though Dr Osamura was able to keep going to the hospital, the pandemic situation allowed him to see the challenges facing remote work for pathologists. For instance, a secure internet connection is essential for sharing private data between a hospital and someone’s home — but many places today lack such a connection.

“This is a big issue in Japan,” he says. Solving this, and expanding the use of digital pathology, will allow pathologists’ practices to be more resilient in the future.