The Future of Anatomic Pathology – 2 Possible Outcomes and More

Keith J. Kaplan, MD
February 8, 2017
Keith J. Kaplan, MD

allthingspath.com had a recent interesting post on 2 possible outcomes for anatomic pathology at some point in the future of anatomic pathology. One scenario is related to whole slide imaging and the other one is related to in vivo microscopy. We are asked – Which one of these prevails? In my opinion, both. There will be fewer “normal” biopsies with improved in-vivo microscopy with fewer pathology accessions but those that biopsies that are obtained because of equivocal in-vivo imaging will be further screened and eliminated from additional pathology review using whole slide imaging and improved analytics than we have today. This will leave only a fraction of the work we see today end up on microscope stages on pathologist’s desks.

And then there is a third outcome — liquid biopsy. And tissue based biopsies requiring clinicians, radiologists and pathologists will be eliminated. We will have to learn to interpret morphologic data from surrogate markers obtained in-vivo for diagnosis, treatment selection and prognosis. We will not be “surgical” pathologists, we will be “liquid” pathologists competing to interpret this information.

From allthingspath.com: 2 possible futures for pathology

Here is one possible future: Some day, whole slide imagers will be ubiquitous in pathology labs throughout the U.S. They will scan our slides quickly and in multiple contiguous focal planes, thus retaining all the morphologic data that exists in “analog” form. The quality of the whole slide imaging will be so good that pathologists will have no need to review the original slides. Our workflow will be entirely digital and physical proximity of the histology lab and the pathologist will no longer matter. Artificial intelligence algorithms will interpret the scanned slides and will flag the urgent diagnoses. At first computer assisted diagnosis will make pathologists’ jobs easier and we will be able to do more work faster and extract more information from morphology than we could before. However, eventually pathologists will have less to do as the computers become smarter and faster. At some point slide interpretation will no longer be done by human beings, since AI can do everything they do faster and are less prone to error. Furthermore, they will learn to identify complexnexi patterns with diagnostic and prognostic relevance which are beyond human perception. Patterns such as chromatin distribution, reconstructed 3D tissue architecture, and quantification of nuclear contour irregularity.

Here is another possible future: In vivo microscopy will improve to the point where it matches the resolution of histology, thus precluding the need for ex vivo microscopic interpretation. In conjunction with improvements in metabolic imaging and exosomal DNA analysis, histology will have nothing to contribute beyond the information which can be obtained in vivo. Whole slide imaging will become a redundant concept since there will no longer be slides to scan. Pathologists, radiologists, and clinicians who do endoscopy will compete for the professional right to interpret these in vivo images which will render most biopsies unnecessary.

Will one of these scenarios prevail? Or will the future be different?