ALSO the slide becomes technologically advanced. The sample of a tumor traditionally analyzed under a microscope can in fact be transformed, within a few minutes, into a virtual file and can be shared in real time through a platform that connects all the laboratories to the network. This is a step forward of the so-called digital pathology towards an increasingly democratic diagnostics, because it can prevent patients from traveling hundreds of kilometers to physically carry their slide to the various centers to collect an additional opinion on the diagnosis and possible therapies.
Digitized laboratories, the example of Sicily and Piedmont
The introduction of scanners capable of transforming the ‘physical’ slide into files that can be consulted by computers has favored the spread of telepathology, that is, the transmission of images at a distance. The most advanced system in the world is located in Japan. In Europe the example of Holland is virtuous. But also in Italy there are some experiences of fully digitized pathological anatomy laboratories from the receipt of the tissue sample to the final diagnosis, as in Sicily and Piedmont.
The Italian Society of Pathological Anatomy and Diagnostic Cytopathology (SIAPeC-IAP) is focusing heavily on digital pathology and has drawn up a document together with the Istituto Superiore di Sanità (ISS) to establish the minimum requirements for a digital pathological anatomy laboratory. The text will be presented at the SIAPeC-IAP Congress, which will take place in virtual form from tomorrow to 27 November.
The slide is the starting point
The cells taken with the cytological examination and analyzed in the laboratory by the pathologist allow not only the diagnosis but also the study of gene alterations, essential for the selection of cancer patients who can be treated with targeted therapies. Slide analysis is therefore the starting point of precision oncology, which can improve survival rates in the metastatic phase of the disease, up to doubling them. “We are asked to define the nature of the lesions, expressing a diagnosis that is important for the patient’s journey”. explains Anna Sapino, President of SIAPeC-IAP: “It is, therefore, a job that requires high professionalism, the possibility of comparison and the use of new technologies, because not everything is always ‘white’ or ‘black’, and in these cases we must have support to minimize diagnostic doubt “.
Savings of millions of euros
This “third revolution” of the profession can in fact guarantee more precise and faster diagnoses. “The initial investment can lead to savings of millions of euros in a few years”, adds Filippo Fraggetta, President-elect of SIAPeC-IAP: “Not only that. The benefits for patients are very important. If they want counseling, they no longer have to travel to take the slide to different facilities, at the risk of it being lost or broken. The digital network cancels the distances between the center and the periphery. And the timing for reporting can be rationalized, even with positive effects in terms of less stress for patients waiting for the outcome. The ability to share digital slides with experts in real time, with maximum safety and reliability, even remotely, represents an additional weapon to guarantee the best standard of diagnosis and care. Pathological anatomies that go digital will be able to work in a more linear and simplified way, eliminating repetitive manual control actions. The versatility of digital pathology ranges from remote interpretation for primary diagnosis to the request for second opinions, academic use for training up to the evaluation of virtual preparations by multidisciplinary groups “.
But we need more pathologists
There is another aspect to consider: precision oncology has brought with it more workloads. Today in Italy there are about 1,100 pathologists, 5 years ago there were at least 1,500. “We need professionals – underlines Sapino – because the numbers of exams, especially for cancer, are on the rise and require specific skills. We still need our eyes and our head which translates an image into a diagnosis, no matter if seen under a microscope or on a screen ”.
The pathologist is involved in various moments of patient management within the diagnostic-therapeutic pathways (PDTA), from the screening phase to the diagnostic one up to controls. “We contribute to the development of PDTAs and SIAPeC-IAP participates in the drafting of guidelines and recommendations for the standardization of reports at national and international level”, explains Emanuela Bonoldi, National Secretary of the scientific society: “The final goal – cpnclude – is that, regardless of home, the patient always has access to the best assistance path “.