Penetration of digital pathology in North America and Europe in research centers, laboratories, and universities is on rise in the recent years. Digital pathology is predicted to follow the successful path of radiology in near future in terms of acceptance. It has been possible due to obvious advantages over conventional microscopy. The possibility to scan and store the entire tissue slide in digital formats has opened many avenues. The sharing of digital image between pathologists for second opinion or consultation has become easier, faster, and safer. Improvement in communication bandwidth and storage facilities has made Telepathology possible for peer reviews. Overall, pathology workflow has become efficient because of the digitization process. Image processing technology in combination with machine learning and artificial intelligence has revolutionized digital pathology in both qualitative and quantitative assessments.

Challenges in digital pathology adoption:

However, with so many advantages, there is still some reluctancy in adopting digital pathology in both developed as well as emergent nations and there are several factors accounting for the same. The ratio of pathologists to population is already low in developed countries and is much lower in developing countries. Due to this huge gap, a pathologist is overloaded with slides that needs to be scrutinized. The mental fatigue affects the efficiency and accuracy of the pathologist. There are other issues apart from manpower deficiency, such as lack of infrastructure, economic constraints, poor quality control in slide preparation and handling, absence of support systems like LIS to manage the workflow, and a large population that hampers the overall quality of healthcare. There is an apparent increase in cases of non-communicable diseases, including cancer, diabetes, etc., in developing nations that require accurate pathologic diagnosis.

How digital pathology can overcome these challenges?

In rural areas, the absence of trained professionals necessitates expert diagnostic consultation from urban centers equipped with better infrastructure. Movement of physical slides, patients, or professionals for consultation is time consuming and an expensive proposition. This also increases the workload on few professionals in urban settings. Digital pathology can help bridge this gap. Digital Pathology Scanner that offer very competitive scan times and an affordable price tag are the need of the hour in emergent nations. The AI/ML-based quantifying solutions built with digital scanners will complement the pathologist in accurate quantitative analysis of slides. Innovative low-cost solutions like on-demand pathology systems, where the user pays per slide and not for the whole package, are being explored by some pioneers in this field. The IT revolution is already pacing in developing countries, with the advent of smart phones and tablets usage increasing with each generation in both the urban and rural areas. There is tremendous scope of growth for telepathology due to rapid advances in information and technology. Primary diagnosis and training in remote areas, secondary opinions, and referrals could be few of the applications that can be very well addressed by Telepathology effectively.

Role of digital pathology in education & research:

Digital pathology could also be helpful in developing countries in medical schools and universities. The system can improve the training process of technical staff and future pathologists. The digitized slide can be viewed multiple times by as many numbers of students at once. The difficulties like the deterioration of slide quality in terms of stain fading and efforts in maintenance of slides can be removed with easy adoption. The cloud-based systems, where the students and teachers can view the virtual slides will make learning and understanding easier as students and teachers will have access to specialized services like IHC, CISH and FISH, which are otherwise not commonly available in remote areas. With improvements in basic infrastructure like information technology, reliable electrical power, and investment in health care programs, digital pathology can bring myriad changes in improving the healthcare services in emergent nations. In my view, an expert pathologist located at a central clinical setup, receiving virtual slides taken across remote areas (probably through affordable scanners) for his review, would be an ideal healthcare model in developing countries.