Head of Pathology Innovation and Business Development at Unilabs Switzerland

PD Dr Med Pierre Mainil-Varlet

Around 50 years ago, I discovered an Apple II computer under the Christmas tree. At the age of eight, I was surprised and excited. My father helped me set it up, explaining that he bought it so I could try automating his patients’ invoicing. It wasn't a gaming computer; instead, it became a tool for my programming endeavours. I completed my first programme two years later. Looking back, I realise that my father was a visionary, and that early experience transformed me into an early adopter of technology. From early on, I chose in my professional career to embrace the path of change.

The bulk of pathology laboratory work and diagnoses are done using techniques from the latter half of the nineteenth century, in the footsteps of the first pathologist, Rudolf Virchow. The hospital-based histology laboratory experienced several changes in the 1960s and 1970s when cryostats, enclosed tissue processors, plastic cassettes, and disposable knives were introduced. Other than the emergence of immunohistochemistry in the 1980s, few major changes happened. Of course, molecular pathology revolutionised our field, but it’s at the gene level.

The increased demand for pathology services, including growing biopsy numbers, desire for faster turnaround times, additional testing requirements, costs, and enhanced cancer case reporting have resulted in the introduction of disruptive new technologies. Digitalisation of histology and cytology and automation are compelling anatomical pathology labs to change their working environment and standards as the field becomes more interdisciplinary. These laboratories are on the brink of changes that will involve additional new duties for pathologists, histotechnologists, and even cytotechnologists.

Given the significant impact imaging has already had on radiology, it is anticipated that digital technology, including imaging, will inevitably boost the efficiency of anatomical pathology. Digital pathology is certainly gaining momentum as a proven and essential technology, and automation of sample preparation and analysis is crucial in achieving the standardisation and reduced variability that is required.

But let’s be realistic, convincing laboratories to implement a digital platform is harder than it seems. Economic circumstances haven’t helped the situation, either. Lab managers, already stressed by reduced budgets and staff shortages, struggle with the added cost and complexity of digital technologies. In digital transformation: “Where is the return on investment?” Tradition may argue that working with glass slides is faster and cheaper than their digital counterparts, but let's not overlook the immense potential of digital pathology. Pathologists, accustomed to microscopes, may find the shift to monitors unfamiliar, yet this transformation heralds a new era.

"Digitalisation of histology and cytology and automation are compelling anatomical pathology labs to change their working environment and standards as the field becomes more interdisciplinary."

The full potential of digital pathology should not be seen in seeing microscopy slides on screens! Digital pathology has several major advantages over traditional pathology.

1. Digital pathology allows the pathologist to improve their work-life balance, and this becomes more important when one-third of pathologists already report feeling burnout. Pathologists can work anywhere, and this flexible and often friendlier work environment leads to higher satisfaction.

2. Thanks to digital pathology, we are able to tap into a broader talent pool. With more talent at hand, the chances of finding a specialist are higher, and a specialist will improve the quality and the speed of the diagnosis because she/he will be savvier than a generalist.

3. Digital pathology unleashes the power of AI: the introduction of Artificial Intelligence in the practice of pathology also benefits the quality and speed of diagnostics. Those algorithms have seen a 50 percent reduction in time per case for the pathologist in some instances. Algorithms and artificial intelligence improve quality and processes and help with efficient case management, supervised, and validated by the specialist pathologist. AI also makes intelligent decisions about scanning and image parameters; first pass content detection identifying macro and micro elements of interest or identifying the most important slides for pathologists’ expert review. These advancements are only available once a slide has turned into a digital image. 

As Bill Gates said, “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.” To go fully digital, you need absolutely to simplify your workflow, all to reduce cost.

A successful digital transformation journey should also encompass the digital integration of the preanalytical work. Like all computational applications, AI-powered process automation solutions must be integrated into routine workflows to deliver their full value. Otherwise, you’ll spend most of the time that you just saved manually moving data from one application to another or toggling between screens. And that’s even more reason to centre your digital pathology practice around an open interoperable platform that allows you to easily introduce new AI applications – from process automation solutions to detection solutions – into your day-to-day operations. That transformation also allows you to improve your quality control with minimal effort.

Digital transformation and automation do not imply that fewer resources are needed. Instead, they suggest that tasks will change and be allocated differently. There is no need to fear the digital wave! It is important to accompany the change, and early adopters should support and guide their followers and late adopters. The fact is the patient and regulatory requirements will not impede the progress of the digital bullet train.

“To improve is to change, to be perfect is to change often” - Winston Churchill.