DIGITAL PATHOLOGY Hospital 1 Hospital 2 Hospital 3


Specimens are sent to central hub in network for preparation and scanning


Slides are diagnosed by central pathologist team at hub and results returned to referring hospitals


Central pathology “hub” (Major hospital or academic)


rare today, and once these algorithms have been in use for some time, results from clinical studies will hopefully provide indisputable, quantifiable evidence regarding the benefits of using AI within DP during screening programmes, supporting deployment in other public (or private) healthcare markets worldwide.


Hospital/Pharma out of network


Other hospitals may contract “hub” for scan and reading services (outsourcing)


Commercial laboratory


Central pathology “hub” may use third-party commercial laboratory for sub-specialty reading, out of hours or as “overspill” resource for periods of high demand


Fig1. The hub-and-spoke model of digital pathology adoption, which sees a central ‘hub’ coordinate scanning and analyses. This has been used across multiple geographical markets to off-set workforce shortages and facilitate remote working.


solutions whilst also indirectly supporting the requirement for investment in newer, more flexible, cloud-based LIS solutions. For DP departments, it was made clear that sometimes it’s better to move forward when innovating rather than wait for lengthy overhauls of existing infrastructure. The lessons didn’t stop there, however, as in DP implementations a hub-and-spoke model has quickly emerged, as illustrated in Figure 1. The National Pathology Imaging Co-operative (NPIC) is one such body coordinating these, recently helping to launch a network across the North of England. There, six NHS hospitals possessing 15 new scanners have launched a combined digital pathology service. The press release lauded the benefits of instantaneous image exchange where previously 10-day intervals existed, helping to prove one clear benefit to digitisation for new adopters currently sending slides via courier.


Looking to the future Whilst it’s estimated that more than 80% of NHS trusts currently have access to a scanner, most of these have been purchased recently and scanning volumes still represent a very low proportion of total slides analysed. DP in the UK today remains utilised mostly for specialist review, teaching, multidisciplinary tumour boards and research, with the first laboratory to go fully digital announced as recently as August 2021. As laboratories continue to


incrementally increase the volumes of slides processed, the UK market is


now turning its attention towards the challenges associated with storing these images.


Radiology has had a big influence on DP in the UK, most heavily felt in the topic of standardisation and image storage. Tenders here have started to mandate the use of the DICOM standard in DP. This facilitates both interoperability and metadata analysis in research, but also crucially supports images being stored in vendor neutral archives (VNAs). These already exist in most hospitals and are now being promoted to help DP image lifecycle management. Whilst use is still relatively low for DP today, there are considerable benefits to laboratories in exploiting these existing resources – particularly where costs are concerned. Moreover, with a growth in medical imaging VNA adoption of public cloud services, longer-term return on investment for consolidated image management is increasingly being proven. If VNAs shared between radiology and pathology departments experience success in the UK, rollout may help to support DP for primary diagnosis globally. The other trend being pursued in the UK that is worth paying attention to relates to the deployment of AI. There have been multiple examples of trusts beginning to trial algorithms in recent years, with vendors and peers alike keeping a close eye on implementations such as those in Wales, which are currently utilising AI on large numbers of patients. As the NSC’s recommendations take effect, the incidence of widespread AI use is likely to increase further. Examples of such large-scale AI deployments are


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n The Netherlands Multidisciplinary care at the forefront Another market which stood out during our market research into DP implementations was the Netherlands, which had reportedly managed to achieve some of the most sophisticated and multidisciplinary implementations of digital pathology worldwide. It’s a market known for prioritising


standardisation across digital healthcare reporting, including in a variety of ways for laboratories. For example, all genome diagnostic laboratories participated in a scheme to improve genomic variant interpretation by sharing data classifications to establish a centralised MOLGENIS database in 2019.3


This has


helped to support diagnostic accuracy in clinical practice. Within pathology laboratories, all in the Netherlands are affiliated with Pathological Anatomy National Automated Archive4


(PALGA), a


foundation dedicated to managing a computer network for data exchange with all laboratories, as well a national database containing all pathology results. The foundation uses its position to direct patient care, scientific research and education, and to support medical quality control and information exchanges in mass screening programmes. Because of schemes like these,


groups like the Computational Pathology Group at NKI-AVL are able to marry clinical, molecular diagnostic and digital pathology data in both research and diagnostic settings to improve patient diagnosis and care. The lesson to be learned here is clear: sophisticated DP implementations and multidisciplinary care must be underpinned by national initiatives which support DP standards across formats, protocols and reporting. Whilst the UK is helping to drive DICOM standardisation, the implementation of standardised workflows and terminology across the NHS is something that must be prioritised further in the future. NHSX/Digital has released a programme5


to implement


new standards for pathology test requests and results across the NHS in order to support this.


The Netherlands is one of the leading DP markets in Europe, with a major national telepathology project (Pathology


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