Technology paves the way forward in pathology

During the recent Digital Pathology Congress: Malaysia – National Policy on the Development and Use of Digital Pathology Technology, a panel of diverse speakers shared their experiences and insights on the rapidly developing field of digital Anatomic Pathology (AP), one of seven disciplines under the broad category of Laboratory Medicine.

The inaugural event was held at International Medical University (IMU) and was a collaboration with the MMU-UKM-IMU* Artificial Intelligence for Digital Pathology (AI4DP) consortium. The congress was held in conjunction with the IMU Digital Health Week in order to highlight the significance of digital pathology and its implications for society, provide an update on the development of digital pathology, and raise awareness of digital health, particularly digital pathology.

The definition of AP is “the science of the causes and effects of disease, particularly the branch of laboratory medicine concerned with the examination of tissue samples for diagnostic or forensic purposes.” As such, pathologists serve all medical disciplines and specialties. Despite this, Malaysia has only about 300 anatomic pathologists for a population of 32.7 million.

According to Professor Dr. Nor Hayati Othman, president of International Academy of Anatomic Pathology (Malaysian Division): “Anatomic pathologists are overburdened, and digital AP allows our specialty a way forward that is more efficient; enabling faster, more accurate diagnoses that will ultimately benefit patients while relieving our workload.”

Nor Hayati noted that currently all AP laboratories in Malaysia subscribe to digital AP services in the form of external quality assurance programmes (QAP) slides, but there is only one fully integrated digital AP laboratory in Malaysia, located at the Sarawak General Hospital, which facilitates communication between the central laboratory in Kuching and other peripheral laboratories in the state. However, its capabilities are currently underutilized as conventional microscopes are still utilized for routine diagnostic procedures.

She added that the objective is for more departments of AP to adopt digital AP in a more comprehensive and integrated manner. Using the COVID-19 pandemic as an example, the requirement for remote working compelled pathologists who were accustomed to working exclusively with glass slides to adapt and learn how to use digital slides in order to meet the high demand for their expertise while working from home.

While many are eager to build on this momentum, digital AP is still in its infancy, not only in Malaysia but in many other countries as well, and the path forward remains unclear in the absence of a national policy or implementation guidelines.

Such a policy would be essential for addressing the numerous factors and repercussions that digital AP would entail. This includes technical factors such as the type of equipment, software, image format, connectivity, and data storage, as well as extensive ethical concerns regarding data collection, privacy, and all applicable legal risks and repercussions.

“Policy is very important to set the direction for digital Anatomic Pathology, and we are fortunate that there is already a political will for healthcare transformation, with the Ministry of Health looking into this seriously,” said Professor Datuk Lokman Hakim Sulaiman, Pro Vice-Chancellor, Research; IMU. “A national policy is the first step towards creating confidence among practitioners.”

Lokman said the entire healthcare industry is already moving rapidly towards digitalization, and it was inevitable that [AP] would follow suit. “Our government already has the Malaysia Digital Economy Blueprint to support our transition to a technologically advanced nation, and digital Anatomic Pathology is just a small part of the bigger picture which is digital healthcare and digital governance. Educators, healthcare practitioners, entrepreneurs, policymakers … all sectors need to support this transition.”

In short, for this field to continue to advance, collaboration between industries is necessary, with education and training playing a crucial role in the development of future generations of stakeholders. “We are also fortunate to have case studies and best practices from other nations to serve as a starting point in developing our own national policy to govern the usage and standards for digital Anatomic Pathology, and I foresee rapid development in this area,” said Lokman.

Nor Hayati added: “I expect that, within the next decade, we will have many applications, equipment and analytics to choose from but it is such a new area that current opinions are mixed, with some appreciating the advantages it brings while others are more comfortable using their existing microscopes and glass slides. This means we have our work cut out for us, to create advocates and confidence among practitioners, starting with a national policy to govern its implementation.”

The conclusion of the IMU Digital Health Week and the inaugural Digital Pathology Congress left stakeholders optimistic and anticipating increased interest, confidence, and collaboration opportunities among students, healthcare professionals, entrepreneurs, the government and non-government organizations.

MMU: Multimedia University
UKM: Universiti Kebangsaan Malaysia