Digital pathology. A new era of diagnostics and accompanying treatment of diseases

Over the past decades, significant progress has been made in the treatment of cancer. Today, it can be said that the disease is curable if it is detected in the initial stages — the rates of treatment and overcoming the five-year barrier after the diagnosis are much higher. The detection of malignant formations in the initial stages and making the correct diagnosis, monitoring the pathomorphosis of the disease are the basis of successful treatment. MEDplus editors asked pathologists how digital pathology can change the situation with the cancer establishment in Ukraine.

Gichka Sergey

pathologist

• Doctor of medical sciences
• Professor, Head of the Department of Pathological Anatomy, Bogomolets National Medical University
• President of the Association of Pathologists of Ukraine

Nikolaienko Sofia

pathologist

• geneticist
• Director of the Dialog Histological Laboratory

— How do you assess the state of the diagnosis of oncological diseases in Ukraine today?

— Several main stages can be distinguished in the diagnosis of oncological diseases: screening, clinical imaging and morphological verification.

The screening stage includes observations by a family doctor, regular (annual, five-yearly, etc.) preventive examinations (endoscopy, mammography, etc.), laboratory tests (PAP test, PSA, etc.) in accordance with international protocols for early diagnosis of oncology.

The clinical imaging stage is currently the most developed due to the number and modern equipment of health care institutions of various ownership, the presence of a sufficient number of specialists (radiologists, endoscopists, gynecologists) and the availability of examination methods.
However, the diagnosis of cancer requires morphological verification. The primary verification is carried out in health care institutions, which include a pathohistological laboratory, or in specialized centers.

The next steps include immunohistochemical and molecular genetic studies, which are required for immunophenotyping (a method for identifying and characterizing cells using their immunological properties) and molecular profiling of the tumor. The latest studies are carried out in a limited number of institutions, which negatively affects the effectiveness of cancer treatment in Ukraine. A significant number of patients are limited exclusively to histological examination, which makes it impossible to personalize the treatment. Thus, only the histological type of the tumor is disclosed and its biological features are neglected.

Another problem of the third stage is the insufficient number of specialist pathologists who work according to modern diagnostic standards. The use of digital pathology in the diagnosis of oncological diseases is generally in its infancy.

— What is digital pathology in oncology and what opportunities does this technology open up for hospitals?

— Digital pathology is a branch of pathology that focuses on data management based on information obtained from digitized histological preparations (slides). The technology is based on the use of special scanners, which are capable of recording high-resolution images of the histological preparation, with subsequent storage and transmission of information via telecommunications. Thanks to this, pathologists can consult cases remotely.

In 2017, the U.S. government agency responsible for the regulation and quality control of drug safety and efficacy (FDA) authorized the use of digital histological slides for screening (primary) histological diagnosis. Today, the methods of digital pathology are widely used for educational purposes in the countries of Europe, the USA, Great Britain and are being actively improved for use in the clinic. Due to the publication of slides in open access, domestic universities are also actively introducing this technology into the educational process.

In the USA, Israel, and other countries, digital slides play an important role in the initial diagnosis of oncology and subsequent referral to specialized centers.

How does the implementation of digital pathology benefit patients?

• Acceleration of screening diagnostics and more accurate results.
• Involvement of several specialists in the diagnosis, who have finished its quality.
• Saving digitized slides on the patient’s card.

— In your opinion, what steps should be taken at the state and hospital levels so that the technology works effectively?

— In order to spread the technologies of digital pathology, the state needs permission to use them in the screening diagnosis of diseases. Hospitals need to ensure the quality of production of histological preparations, have a scanner, and have trained staff.

To organize the process of implementation of digital pathology, quality monitoring, and analysis of the received data, it is necessary to create a reference center and involve regional health care institutions.

Digital scanners should be installed in reference centers in cities where the largest number of histological examinations are performed (Lviv, Odesa, Dnipro, etc.).